Predictors of clinical and social outcomes following involuntary hospital admission: a prospective observational study
- 647 Downloads
The Study aimed to assess clinical and social outcomes following involuntary admissions over 1 year and identify socio-demographic and clinical patient characteristics associated with more or less favourable outcomes. Seven hundred and seventy-eight involuntary patients admitted to one of 22 hospitals in England were assessed within the first week after admission and at 1 month, 3 month and 12 month follow-ups. Outcome criteria were symptom levels, global functioning, objective social outcomes, and subjective quality of life (SQOL). Baseline characteristics and patients’ initial experience were tested as predictors. Symptom levels and global functioning improved moderately. Objective social outcomes showed a small, but statistically significant deterioration, and SQOL a small, but significant improvement at 1 year. In multivariable analyses, admission due to risk to oneself and receiving benefits predicted poorer symptom outcomes. Female gender and higher perceived coercion were associated with better objective social outcomes, whilst higher initial satisfaction with treatment predicted more positive SQOL at follow-ups. Over a 1-year period following involuntary hospital admission, patients on average showed only limited health and social gains. Different types of outcomes are associated with different predictor variables. Patients’ initial experience of treatment, in the form of perceived coercion or satisfaction with treatment, has predictive value for up to a year following the admission.
KeywordsCommitment of mentally ill Coercion Patient admission Outcome assessment (health care) Inpatients
This study was funded by a grant from the Department of Health, United Kingdom (com. no. 0230072). This work was undertaken by the Unit for Social and Community Psychiatry, Barts’ and the London School of Medicine and Dentistry, Queen Mary University of London, and the views expressed in the publication are those of the authors and not necessarily those of the Department of Health. The funding source had no role in the study design and conduct of the study, data collection, management, data analysis, data interpretation, or writing of the report and preparation, review or approval of the manuscript. All authors report no conflicts of interest. The study was supported by the NIHR UK Mental Health Research Network. We are also grateful to all interviewed patients, the supporting staff in all participating organisations, and the research assistants who collected the data.
Conflict of interest
The authors declare that they have no conflict of interest.
- 1.American Psychiatric Association (1994) Diagnostic and statistical manual of mental disorders, 4th edn. American Psychiatric Press, Washington, DCGoogle Scholar
- 4.Fitzmaurice GM, Laird NM, Ware JH (2004) Applied longitudinal analysis. Wiley, New YorkGoogle Scholar
- 5.Galderisi S, Piegari G, Mucci A, Acerra A, Luciano L, Rabasca AF, Santucci F, Valente A, Volpe M, Mastantuono P, Maj M (2009) Social skills and neurocognitive individualized training in schizophrenia: comparison with structured leisure activities. Eur Arch Psychiatry Clin Neurosci 260:305–315PubMedCrossRefGoogle Scholar
- 7.Holscher F, Reissner V, Di Furia L, Room R, Schifano F, Stohler R, Yotsidi V, Scherbaum N (2008) Difference between men and women in the course of opiate dependence: is there a telescoping effect? Eur Arch Psychiatry Clin Neurosci 260:235–241Google Scholar
- 10.Kallert TW, Priebe S, McCabe R, Kiejna A, Rymaszewska J, Nawka P, Ocvar L, Raboch J, Starkova-Kalisova L, Koch R, Schutzwohl M (2007) Are day hospitals effective for acutely ill psychiatric patients? A European multicenter randomized controlled trial. J Clin Psychiatry 68:278–287PubMedCrossRefGoogle Scholar
- 11.Katsakou C, Bowers L, Amos T, Morriss R, Rose D, Wykes T, Priebe S Coercion and treatment satisfaction among involuntary patients. Psychiatr Serv 61:286–292Google Scholar
- 15.Kjellin L, Westrin C-G, Eriksson K, Alexsson-Ostman M (1993) Coercion in psychiatric care. Problems of medical ethics in a comprehensive empirical study. Behav Sci Law 11:323–334Google Scholar
- 17.Lukoff D, Nuechterlien K, Ventura J (1986) Manual for the expanded brief psychiatric rating scale. Schizophr Bull 13:261–276Google Scholar
- 21.Priebe S, Fakhoury W (2008) Quality of life. In: Mueser K, Jeste D (eds) The clinical handbook of schizophrenia. Guilford Press, New YorkGoogle Scholar
- 23.Priebe S, Gruyters T, Heinze M, Hoffmann C, Jakel A (1995) Subjective evaluation criteria in psychiatric care-methods of assessment for research and general practice. Psychitr Prax 22:140–144Google Scholar
- 27.Priebe S, Katsakou C, Gloeckner M, Dembinskas A, Fiorillo A, Karastergiou A, Kiejna A, Kjellin L, Nawka P, Onchev G, Raboch J, Schuetzwohl M, Solomon Z, Torres-González F, Wang D, Kallert T (2010) Patients’ views of involuntary hospital admission after one and three months: a prospective study in eleven European countries. Br J Psychiatry 196:179–185Google Scholar