Patient Preference and Adherence (Dec 2023)
Involuntary Hospitalizations in an Italian Acute Psychiatric Ward: A 6-Year Retrospective Analysis
Abstract
Rosaria Di Lorenzo,1 Matteo Reami,2 Diego Dragone,1 Martina Morgante,1 Giulia Panini,1 Sergio Rovesti,3 Tommaso Filippini,3,4 Silvia Ferrari,3,5 Paola Ferri3 1Mental Health Department and Drug Abuse, AUSL-Modena, Modena, Italy; 2School of Medicine & Surgery, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy; 3Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy; 4School of Public Health, University of California Berkeley, Berkeley, CA, USA; 5Mental Health Department and Drug Abuse, AUSL-IRCCS Reggio Emilia, Reggio Emilia, ItalyCorrespondence: Rosaria Di Lorenzo, Mental Health Department and Drug Abuse, SPDC in OCSAE, via P. Giardini, 1355, Baggiovara, Modena, 41126, Italy, Tel +393355410018, Email [email protected]; [email protected]: We evaluated the differences between demographic (age, sex, nationality, employment, housing, schooling, support administrator), clinical (hospitalization reason, aggressive behaviour, length of hospitalization, psychiatric diagnosis and comorbidities, psychiatric medications, discharge destination, “revolving door” hospitalizations) and environmental (pre-and pandemic period) variables in voluntary (VHs) and involuntary hospitalizations (IHs) in an acute psychiatric ward during a 6-year period.Patients and Methods: We retrospectively collected the selected variables concerning the hospitalizations of subjects over 18 years of age in the Service for Psychiatric Diagnosis and Care of Mental Health and Drug Abuse Department in Modena from 01/01/2017 to 31/12/2022.Results: We observed a progressive and sharp reduction in the number of VHs (n = 1800; 61.41%) during the pandemic and a stability of IHs (n = 1131; 38.59%), which in 2022 became prevalent. We highlighted the following differences between VHs and IHs: an increase in hospitalization length in IHs (14.25 mean days ± 15.89 SD) in comparison with VHs (8.78 mean days ± 13.88 SD), which increased more during the pandemic; an increase in aggressive behavior in IHs, especially during the pandemic (Pearson Chi2 = 90.80; p = 0.000); a prevalence of schizophrenia and bipolar disorders (Pearson Chi2 = 283.63; p = 0.000) and more frequent maladaptive social conditions among subjects in IHs.Conclusion: During the 6-year observation period, we underscored a trend of increasingly reduced recourse to VHs, whereas IHs increased even in the pandemic. Our results suggest that IHs in Psychiatry represented an extreme measure for treating the most severe psychopathological situations such as schizophrenia and bipolar disorders, characterized by aggressive behaviour and precarious social conditions, which needed longer stay than VHs, especially during the pandemic.Keywords: nonadherence to treatment, involuntary psychiatric hospitalizations, pandemic, revolving door
