背景:与非自愿住院精神病治疗相关的因素存在不确定性。了解这些因素将有助于减少精神病学中的胁迫。
目的:在最大的非自愿入院数据库中探索与非自愿护理相关的变量。
方法:我们在新南威尔士州确定了超过5年的166102所公共精神健康医院的住院病人,澳大利亚。人口统计,在一项探索性研究中检查了临床和护理事件变量,多变量逻辑回归。
结果:总共54%的符合条件的入院包括非自愿护理。与非自愿护理的最强关联是法律系统的转诊(比值比4.98,95%CI4.61-5.38),和精神病(比值比4.48,95%CI4.31-4.64)或器质性精神障碍(比值比4.40,95%CI3.85-5.03)。非自愿治疗与物质使用障碍(比值比2.68,95%CI2.56-2.81)或情感障碍(比值比2.06,95%CI1.99-2.14)之间存在中等强度的关联;合并症大麻和苯丙胺使用障碍(比值比1.65,95%CI1.57-1.74);未婚状态(比值比1.62,95%CI1.49-1.76)和亚洲出生(1.42%CI比非洲或中东(赔率比1.32,95%CI1.24-1.40)。非自愿护理对于年龄>75岁的人不太可能(比值比0.68,95%CI0.62-0.74),合并人格障碍(比值比0.90,95%CI0.87-0.94)或私人健康保险(比值比0.89,95%CI0.86-0.93)。
结论:这项研究加强了与诊断相关的证据,非自愿治疗的社会经济和文化因素。需要有针对性的干预措施来减少弱势群体的非自愿入院。
BACKGROUND: There is uncertainty about factors associated with involuntary in-patient psychiatric care. Understanding these factors would help in reducing coercion in psychiatry.
OBJECTIVE: To explore variables associated with involuntary care in the largest database of involuntary admissions published.
METHODS: We identified 166 102 public mental health hospital admissions over 5 years in New South Wales, Australia. Demographic, clinical and episode-of-care variables were examined in an exploratory, multivariable logistic regression.
RESULTS: A total of 54% of eligible admissions included involuntary care. The strongest associations with involuntary care were referral from the legal system (odds ratio 4.98, 95% CI 4.61-5.38), and psychosis (odds ratio 4.48, 95% CI 4.31-4.64) or organic mental disorder (odds ratio 4.40, 95% CI 3.85-5.03). There were moderately strong associations between involuntary treatment and substance use disorder (odds ratio 2.68, 95% CI 2.56-2.81) or affective disorder (odds ratio 2.06, 95% CI 1.99-2.14); comorbid cannabis and amphetamine use disorders (odds ratio 1.65, 95% CI 1.57-1.74); unmarried status (odds ratio 1.62, 95% CI 1.49-1.76) and being born in Asia (odds ratio 1.42, 95% CI 1.35-1.50), Africa or the Middle East (odds ratio 1.32, 95% CI 1.24-1.40). Involuntary care was less likely for people aged >75 years (odds ratio 0.68, 95% CI 0.62-0.74), with comorbid personality disorder (odds ratio 0.90, 95% CI 0.87-0.94) or with private health insurance (odds ratio 0.89, 95% CI 0.86-0.93).
CONCLUSIONS: This research strengthens the evidence linking diagnostic, socioeconomic and cultural factors to involuntary treatment. Targeted interventions are needed to reduce involuntary admissions in disadvantaged groups.