Factors predictive of referral to psychiatric hospital among general hospital psychiatric consultations

Abstract

The aim of this paper was to explore the factors necessitating psychiatric hospital care in a Finnish multi-centre study of general hospital in-patients referred for psychiatric consultation. The study group consisted of 1251 patients referred to psychiatric hospital (n = 181) and a comparison group (n = 1070) consisting of subjects who were not referred. Differences between groups were studied by univariate analysis. Logistic regression analysis was used both to assess the factors contributing to referral to psychiatric hospital and to create predictive models. The validity of the models was analysed by means of receiver operating characteristic (ROC) curves in an independent sample. Psychiatric hospital care during the previous 5 years was associated with a 3.7-fold (odds ratio) increased risk of hospitalization. A diagnosis of psychosis was associated with a 2.9-fold increased risk, and attempted suicide as a reason for consultation was associated with a 2.1-fold increased risk. Not being married doubled the risk, and the odds ratio was also high in cases of poor psychosocial functioning (as assessed by Global Assessment of Functioning (GAF) score). The predictive model differentiated reasonably well between those patients who were hospitalized and the other patients. In conclusion, this multi-centre study of factors predictive of referral to psychiatric hospital among general hospital patients revealed that the most important determinants were previous psychiatric care, diagnosis of psychosis or severe depression, attempted suicide, being unmarried, and poor psychosocial functioning as assessed by GAF score.

A multicenter investigation of consultation-liaison psychiatry in Italy

“…Over 50% had had previous emotional disorders needing psychiatric attention. These results are in line with most recent European reports [18,19] and seem to indicate that C-L services are frequently offered to the most vulnerable segments of the general population; the elderly, those belonging to a socioeconomic low class, or patients with previous psychiatric disturbances.…”

“…Psychiatric diagnoses according to ICD-10 were comparable with those found in other studies [12,13,18]. Affective disorders were diagnosed in about one-third of the patients, confirming the high prevalence of these disturbances in the general hospital [19] and the need for close attention to an accurate diagnosis and adequate treatment of depression in physically ill patients [20,21]. In line with other reports, adjustment disorders were also frequently diagnosed among referred patients (14% prevalence in our sample) [22,23].…”

“…The study was conducted on a nationwide level, involving 12 provinces (6 in the north of Italy, 3 in central Italy, and 3 in southern Italy), for a total of 17 hospitals (19,804 beds in all) and 17 corresponding psychiatric consultation services. 1 All of the patients admitted to the hospitals and referred to psychiatry during a period of 12 consecutive months, between 1993 and 1994, were assessed using an abridged version of the Patient Registration Form (PRF-SF) [7,8], with the necessary alterations according to the Italian cultural context and health service.…”

The Revolving Door Phenomenon Revisited: Time to Readmission in 17’415 Patients with 37’697 Hospitalisations at a German Psychiatric Hospital

“…Lower rehospitalisation rates for F3, F4 and F5 diagnosis as compared to F2 or F6 reflect the tendency towards a chronic course for schizophrenia and personality disorders as compared to other mental disorders [34] [35] [12]. It seems noteworthy that early onset in our sample was not related to course of illness and/or rehospitalisation risk.…”

Asistencia psiquiátrica sectorizada en las tres últimas décadas: Efectos sobre los ingresos del área Uribe Costa en Vizcaya

“…b) Derivación «informal» desde el CSM a las urgencias hospitalarias ante la imposibilidad de conseguir una cama en el momento de plantearse un ingreso, o como mejor forma de manejar la negativa del paciente al mismo. c) Tendencia, desde las urgencias hospitalarias y de forma independiente de otras variables clínicas o sociodemográficas (17), al ingreso preventivo o por otras presiones asociadas, de pacientes desconocidos para ellas, asociado asimismo al desconocimiento o inexistencia de recursos disponibles en caso de enviarlos a su domicilio en un estado precario. En cualquier caso, son posibilidades que necesitan estudios específicos ulteriores para acercarnos a su respuesta.…”