Impact of compulsory admission on treatment and outcome: A propensity score matched analysis

Hofmann, Andreas B.; Schmid, H; Machetanz, Lena; Noboa, Vanessa; Seifritz, Erich; Vetter, Stefan; Egger, Stephan

doi:10.1192/j.eurpsy.2022.4

Cited by 7 publications

(8 citation statements)

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“…Greater severity of symptoms at admission was usually related to better outcomes [39][40][41]. Compulsory admission, mood and anxiety disorders, absence of personality disorders and substance use disorders, but also single stays were all associated with more favourable clinical evolutions [39,[41][42][43][44]. Controlling for baseline HONOS-secure/HONOS scores, our findings show that higher HCR-20 scores, longer LoS and number of previous hospitalizations were positively associated with HONOS-secure/HONOS score changes indicating that patients with more severe risk for violence, familiar with psychiatric care prior to incarceration are more susceptible to benefit from longer stays in acute care forensic units.…”

Section: Discussionmentioning

confidence: 99%

Determinants of clinical outcome and length of stay in acute care forensic psychiatry units

et al. 2023

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Criminological and sociodemographic variables, such as previous criminal convictions, increased risk of violence, early onset of mental disorder, antisocial personality, psychosis and low social support, have all been related to longer length of stay (LoS) and poorer outcome in long stay forensic services. The factors impacting on LoS and clinical response in acute care specialized units are poorly documented. To address this issue, we examined the psychiatric records of all cases admitted between January 1st and December 31th 2020 in the sole acute ward for detained persons located in the central prison of the Geneva County, Switzerland. Information on judicial status included pre-trial versus sentence execution, previous incarcerations, and age of the first incarceration. Sociodemographic data included age, gender, marital status, and education attainment. Previous inpatient stays prior to incarceration were recorded. All of the ICD-10 clinical diagnoses were made by two independent, board-certified psychiatrists blind to the scope of the study. The standardized assessment was based on the HoNOS (Health of Nation Outcome Scales) at admission and discharge, HONOS-secure at admission, HCR-20 (Historical Clinical Risk 20) version 2, PCL-R (Psychopathy Checklist Revised), and SAPROF (Structured Assessment of Protective Factors). Stepwise forward multiple linear regression models predicting the LoS and delta HONOS respectively were built with the above mentioned parameters. The selected variables were then used in univariate and multivariable regression models. Higher HCR-scores (mainly on clinical items), and longer LoS were related to higher delta HONOS scores. In contrast, cases in pre-trial detention showed a worst clinical outcome. In multivariable models, all three variables remained independent predictors of the clinical outcome and explained 30.7% of its variance. Only education and diagnosis of borderline personality were related to the LoS and explained 12.6% of its variance in multivariable models. Our results suggest that the use of acute wards specialized in forensic psychiatry are mainly useful for patients with prior inpatient care experience, and higher violence risk during sentence execution. In contrast, they seem to be less performant for persons in pre-trial detention that could benefit from less restrictive clinical settings.

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Section: Discussionmentioning

confidence: 99%

Determinants of clinical outcome and length of stay in acute care forensic psychiatry units

et al. 2023

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“…Beyond patient characteristics, as diagnosis and clinical profile, these results can be explained by differences in legislation and mental health service availability. We could interpret these admissions as in-hospital crisis interventions due to the lack of alternatives on the weekend ( 38 , 39 , 49 ).…”

Section: Discussionmentioning

confidence: 99%

“…First, in psychiatric crises and emergencies, death, loss of physical integrity, or disability are usually not expected outcomes ( 50 ). Second, the admission process in psychiatry is an intervention on its own, capable of changing the course of the disease and influencing outcomes ( 49 ). However, it remains unclear if admission to outpatient treatment, either compulsory or voluntary, outside daytime hours is sufficient to relieve an acute crisis or emergency or lead to an admission to inpatient treatment ( 51 , 52 ).…”

Section: Discussionmentioning

confidence: 99%

Relationship Between Time of Admission, Help-Seeking Behavior, and Psychiatric Outcomes: “From Dusk Till Dawn”

et al. 2022

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IntroductionDay and time of admission influence treatment outcomes and prognosis in several medical specialties; this seems related to resources' ability. It is largely unknown whether this also applies to mental health services. We investigate the relationship between time of admission, patients' demographic and clinical profile, and treatment outcomes.MethodsDemographic and clinical profiles of admitted and discharged patients to a general psychiatric ward between January 1st, 2013 and December 31st, 2020, were analyzed. In addition, we used the last year (i.e., 2020) to monitor rehospitalization. Time of admission was defined as weekdays (working day, weekend) and dayshifts (daytime, dusk, and dawn).ResultsDuring the study period, 12,449 patient admissions occurred. The mean age of the sample was 48.05 ± 20.90 years, with 49.32% (n = 6,140) females. Most admissions (n = 10,542, 84%) occurred on working days. Two-fifths of admissions (39.7%, n = 4,950) were compulsory, with a higher rate outside daytime hours. Patients had slight differences in the clinical profile, resulting from evaluating the different items of the Health of Nation Outcome Scale (HoNOS). Patients admitted on night shifts, weekends, and holidays showed a shorter length of stay; patients compulsorily admitted during daytime (disregarding the day of the week) had a longer length of stay. All patient groups achieved a robust clinical improvement (i.e., an HoNOS score reduction of around 50%), with similar readmission rates.DiscussionThe main finding of our study is the relationship between “daytime hours” and fewer compulsory admissions, a result of the interplay between demographics, clinical characteristics, and out-of-clinic service availability (such as ambulatory psychiatric- psychological praxis; day-clinic; home-treatment). The differing clinical profile, in turn, determines differences in treatment selection, with patients admitted after office hours experiencing a higher rate of coercive measures. The shorter length of stay for out-of-office admissions might result from the hospitalization as an intervention. These results should encourage the implementation of outpatient crisis-intervention services, available from dusk till dawn.

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“…Compulsory hospital admissions, whether or not associated with other coercive measures, are important causes of trauma and negative treatment outcomes among people with mental disorders. Several studies show that these episodes of deprivation of liberty constitute a very negative experience (Nyttingnes et al ., 2016 ; Sibitz et al ., 2011 ), affecting quality of life (Swanson et al ., 2003 ), with little evidence of effectiveness in terms of health status, social functioning and use of services (Hofmann et al ., 2022 ). The overall cost of compulsory hospitalizations has scarcely been studied (Venturini et al ., 2017 ).…”

Section: Introductionmentioning

confidence: 99%

Psychiatric advance directives facilitated by peer workers among people with mental illness: economic evaluation of a randomized controlled trial (DAiP study)

Loubière

Loundou

Auquier

et al. 2023

Epidemiol Psychiatr Sci

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Aims We aimed to assess the cost-effectiveness of psychiatric advance directives (PAD) facilitated by peer workers (PW-PAD) in the management of patients with mental disorders in France. Methods In a prospective multicentre randomized controlled trial, we randomly assigned adults with a Diagnostic and Statistical Manual of Mental Disorders, fifth edition diagnosis of schizophrenia, bipolar I disorder or schizoaffective disorders, who were compulsorily hospitalized in the past 12 months, to either fill out a PAD form and meet a peer worker for facilitation or receive usual care. We assessed differences in societal costs in euros (€) and quality-adjusted life-years (QALYs) over a year-long follow-up to estimate the incremental cost-effectiveness ratio of the PW-PAD strategy. We conducted multiple sensitivity analyses to assess the robustness of our results. Results Among the 394 randomized participants, 196 were assigned to the PW-PAD group and 198 to the control group. Psychiatric inpatient costs were lower in the PW-PAD group than the control group (relative risk, −0.22; 95% confidence interval, [−0.33 to −0.11]; P < 0.001), and 1-year cumulative savings were obtained for the PW-PAD group (mean difference, −€4,286 [−4,711 to −4,020]). Twelve months after PW-PAD implementation, we observed improved health utilities (difference, 0.040 [0.003–0.077]; P = 0.032). Three deaths occurred. QALYs were higher in the PW-PAD group (difference, 0.045 [0.040–0.046]). In all sensitivity analyses, taking into account sampling uncertainty and unit variable variation, PW-PAD was likely to remain a cost-effective use of resources. Conclusion PW-PAD was strictly dominant, that is, less expensive and more effective compared with usual care for people living with mental illness.

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Impact of compulsory admission on treatment and outcome: A propensity score matched analysis

Cited by 7 publications

References 63 publications

Determinants of clinical outcome and length of stay in acute care forensic psychiatry units

Determinants of clinical outcome and length of stay in acute care forensic psychiatry units

Relationship Between Time of Admission, Help-Seeking Behavior, and Psychiatric Outcomes: “From Dusk Till Dawn”

Psychiatric advance directives facilitated by peer workers among people with mental illness: economic evaluation of a randomized controlled trial (DAiP study)

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