Prevalence and Clinical and Coercion Characteristics of Patients who Abscond during Inpatient Care from Psychiatric Hospital

Abstract

Background:Patients absconding from psychiatric hospitals pose a serious concern for the safety of patients and public alike. Absconding is associated with an increased risk of suicide, self-harm, homicide, and becoming “missing” from society. There are only scarce data on profile and outcome of the absconding patients in India.Aims:To study the prevalence and describe the clinical and coercion characteristics of patients who abscond during inpatient care from an open ward.Methodology:“Absconding” was defined as patients being absent from the hospital for a period of more than 24 h. This is an analysis of absconding patients out of the 200 admitted patients at a tertiary psychiatric hospital. Descriptive statistic was used to analyze the demographic, clinical, and perceived coercion profile and outcome.Results:The absconding rate was 4.5 incidents per 100 admissions. Most of these patients were males, from a nuclear family, admitted involuntarily, belonging to lower socio-economic status, diagnosed with schizophrenia or mood disorder with comorbid substance use disorder and had absent insight. The MacArthur Perceived Coercion Scale score was 4.58 (±1.44), and 80% of the absconded patients felt subjective coercive experiences in most domains at admission. Out of the 9 absconded patients, 2 patients had completed suicides and one continued to remain untraceable.Conclusion:The absconded patients were males; admitted involuntarily; diagnosed with schizophrenia, mood disorder, and comorbid substance use disorder; and had absent insight and high perceived coercion. Absconding patients had the tendency to harm themselves and wander away from home.

Absconding During Inpatient Care from a Tertiary Psychiatric Hospital: A Comparative Study

“…Further research should focus on this event with a longer period of observation and should include This finding is also supported by previous descriptive and case-control studies, which found psychotic illness to be a common factor predicting absconding events. 5,12,22,24,31,37 A few studies have also found increased rates of affective illness, substance use, and personality disorders. 10,38,39 A significantly higher proportion of patients who absconded had irritable affect both at the time of admission and around the time of absconding.…”

“…A recent study from a psychiatric hospital in India also found a higher prevalence of absconding among patients who had an absent insight. 24 About 10% of cases had a history of prior absconding from the hospital in the previous admissions. This proportion is less than what was found by Meehan et al, 40 who found that one-third of those who absconded had a similar history in their previous hospitalizations.…”

“…5,[34][35][36] Like other studies, most of the absconding cases in our study were male and from a younger age group. 15,22,24,30,33 Similarly, John et al 30 also found a smaller proportion of females than males and speculated that the low rate among the women might be due to the culturally inculcated restrictions among Indian women. On the contrary, Khisty et al 19 and Dickens and Campbell 4 did not find any significant difference between absconding cases in men and women.…”

“… 20 A few studies from India also have investigated this. 19 , 21 – 24 A literature review by Stewart and Bowers 3 has shown that a few studies had included control groups but very few among them had used matched controls to examine absconding events. Also, India has witnessed a significant shift in mental health care services over the last three decades.…”

“…Mental health care services took a more deinstitutionalized approach, and all restrictive approaches were abolished from psychiatric care settings. Among a few studies from India, only one by Gowda et al 24 recently examined the characteristics of the patient who abscond during inpatient care at a psychiatric hospital. Hence, the study was aimed to examine the sociodemographic and clinical profiles of adult inpatients who absconded in a specified period and to compare them with matched controls.…”