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Higgins O, Chalup SK, Wilson RL. Machine Learning Model Reveals Determinators for Admission to Acute Mental Health Wards From Emergency Department Presentations. Int J Ment Health Nurs 2024. [PMID: 39209760 DOI: 10.1111/inm.13402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2024] [Revised: 05/31/2024] [Accepted: 07/27/2024] [Indexed: 09/04/2024]
Abstract
This research addresses the critical issue of identifying factors contributing to admissions to acute mental health (MH) wards for individuals presenting to the emergency department (ED) with MH concerns as their primary issue, notably suicidality. This study aims to leverage machine learning (ML) models to assess the likelihood of admission to acute MH wards for this vulnerable population. Data collection for this study used existing ED data from 1 January 2016 to 31 December 2021. Data selection was based on specific criteria related to the presenting problem. Analysis was conducted using Python and the Interpretable Machine Learning (InterpretML) machine learning library. InterpretML calculates overall importance based on the mean absolute score, which was used to measure the impact of each feature on admission. A person's 'Age' and 'Triage category' are ranked significantly higher than 'Facility identifier', 'Presenting problem' and 'Active Client'. The contribution of other presentation features on admission shows a minimal effect. Aligning the models closely with service delivery will help services understand their service users and provide insight into financial and clinical variations. Suicidal ideation negatively correlates to admission yet represents the largest number of presentations. The nurse's role at triage is a critical factor in assessing the needs of the presenting individual. The gap that emerges in this context is significant; MH triage requires a complex understanding of MH and presents a significant challenge in the ED. Further research is required to explore the role that ML can provide in assisting clinicians in assessment.
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Affiliation(s)
- Oliver Higgins
- RMIT University, Melbourne, Victoria, Australia
- Central Coast Research Institute, Gosford, Australia
- Central Coast Local Health District, Gosford, New South Wales, Australia
| | - Stephan K Chalup
- Data Science, School of Information and Physical Sciences (Computer Science and Software Engineering), University of Newcastle, Callaghan, New South Wales, Australia
| | - Rhonda L Wilson
- RMIT University, Melbourne, Victoria, Australia
- Central Coast Research Institute, Gosford, Australia
- Central Coast Local Health District, Gosford, New South Wales, Australia
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2
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Lundahl A. Suicide-preventive compulsory admission is not a proportionate measure - time for clinicians to recognise the associated risks. Monash Bioeth Rev 2024:10.1007/s40592-024-00190-6. [PMID: 38615159 DOI: 10.1007/s40592-024-00190-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2024] [Indexed: 04/15/2024]
Abstract
Suicide is considered a global public health issue and compulsory admission is a commonly used measure to prevent suicide. However, the practice has been criticised since several studies indicate that the measure lacks empirical support and may even increase suicide risk. This paper investigates whether the practice has enough empirical support to be considered proportionate. To that end, arguments supporting compulsory admission as a suicide-preventive measure for most suicidal patients are scrutinized. The ethical point of departure is that the expected benefits of compulsory admission should outweigh the potential harms of the measure to be proportionate and defensible. It is concluded that, for most suicidal patients, suicide-preventive compulsory admission cannot be presumed to be a proportionate measure. To be so, the expected medical benefits of the measure should be greater than the potential increase in suicide risk and other harms that compulsory admission could entail. Instead of using compulsory admission as a suicide-preventive measure, extra safety measures may be needed during and after compulsory admission to prevent the risk of hospitalisation-induced suicide.
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Affiliation(s)
- Antoinette Lundahl
- Stockholm Centre for Healthcare Ethics, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden.
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Bakola M, Peritogiannis V, Stuckler D, Kitsou KS, Gourzis P, Hyphantis T, Jelastopulu E. Who is coercively admitted to psychiatric wards? Epidemiological analysis of inpatient records of involuntary psychiatric admissions to a University General Hospital in Greece for the years 2008-2017. Int J Soc Psychiatry 2023; 69:267-276. [PMID: 35232289 DOI: 10.1177/00207640221081793] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Involuntary psychiatric admissions are a widely used practice despite ethical concerns about coercion. There are particular concerns that vulnerable groups, such as single, unemployed or racial minorities, may be more subjected to such practices. AIM We aimed to investigate the social patterns of involuntary psychiatric admissions from 2008 to 2017 at University General Hospital in Ioannina, Greece. METHOD We retrospectively assessed inpatient records from 2008 to 2017 of patients admitted to the Department of Psychiatry of the Ioannina University General Hospital, Northwestern Greece. Alternative patients of alternative years were selected for inclusion; this yielded 332 patients involuntarily admitted, corresponding to 28.5% of total involuntary psychiatric admissions. RESULTS Over the 10-year period, the overall numbers of annual involuntary psychiatric admissions remained relatively stable, as did the length of hospital stay (mean = 23.8 days). The most common disorder upon admission was schizophrenia spectrum disorders, accounting for approximately two-thirds of all admissions, followed by mood disorders (about 20%). There was evidence that people who lacked social support or experienced financial hardship were more greatly represented among those admitted: 70.2% of admitted patients were single and 64.8% were unemployed. Most patients had been admitted to the psychiatric ward in the past (64.2%). CONCLUSION Our study indicates potentially worrisome evidence that patients who are in vulnerable positions are at elevated likelihood of being involuntarily admitted to psychiatric wards. Future research is needed to evaluate the socio-demographic patterning of involuntary admissions in other European countries.
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Affiliation(s)
- Maria Bakola
- Postgraduate Program of Public Health, Medical School, University of Patras, Greece
| | - Vaios Peritogiannis
- Mobile Mental Health Unit of the Prefectures of Ioannina and Thesprotia, Society for the Promotion of Mental Health in Epirus, Ioannina, Greece
| | - David Stuckler
- Department of Social and Political Sciences, University of Bocconi, Milan, Italy
| | | | - Philippos Gourzis
- Department of Psychiatry, Medical School, University of Patras, Greece
| | - Thomas Hyphantis
- Department of Psychiatry, Division of Medicine, School of Health Sciences, University of Ioannina, Greece
| | - Eleni Jelastopulu
- Department of Public Health, Medical School, University of Patras, Greece
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Schneider M, Back M, Krückl JS, Moeller J, Lang UE, Huber CG. Compulsory psychiatric admissions in the canton of Basel-Stadt between September 2013 and April 2022: Analysis of the cantonal database of the Health Department of Basel-Stadt. Int J Soc Psychiatry 2022:207640221141020. [PMID: 36453089 DOI: 10.1177/00207640221141020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
BACKGROUND According to federal and cantonal law, persons with an acute mental illness can be admitted to a psychiatric hospital or another suitable institution against their will, when other therapeutic options are not available or have been exhausted. In the canton of Basel-Stadt, this is the responsibility of public health officers employed by the division of Social Medicine of the cantonal Health Department. AIMS This study aims to elucidate which factors influence the decision-making of public health officers regarding compulsory admissions over the period from September 2013 to April 2022 in the canton of Basel-Stadt. METHOD Leveraging comprehensive clinical data from the health department of the canton Basel-Stadt (N = 5,'550), we estimated a mixed effects logistic regression model to identify factors contributing to the decision of public-health officers to compulsorily admit patients, while controlling for potential clustering effects among public health officers. RESULTS The risk for compulsory admissions was most strongly predicted by the presence of potential self-harm. In comparison, while being a strong predictor, potential harm to others played a considerably lesser role. Furthermore, psychiatric syndrome, previous compulsory admissions, and the specific context of evaluation were significant predictors. Finally, we found no meaningful personal bias among public health officers. CONCLUSION The results suggest that public health officers' decision-making regarding compulsory admissions focuses on preventing self-harm and, to a lesser degree, harm to others. This indicates that such measures are only used as a measure of last resort, which is in line with current evidence regarding the detrimental effects of compulsory measures on treatment outcomes in psychiatry. Our findings suggest that all relevant stakeholders, including the police, share this perspective. Decision-making regarding compulsory admissions was mostly free of personal biases, suggesting adherence to shared professional standards by public health officers.
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Affiliation(s)
- Michael Schneider
- University Psychiatric Clinics Basel, University of Basel, Basel, Switzerland
| | - Moritz Back
- Health Department of Basel-Stadt, Cantonal Medical Service, Social Medicine, Basel, Switzerland
| | - Jana S Krückl
- University Psychiatric Clinics Basel, University of Basel, Basel, Switzerland.,Division of Clinical Psychology and Epidemiology, Department of Psychology, University of Basel, Basel, Switzerland
| | - Julian Moeller
- University Psychiatric Clinics Basel, University of Basel, Basel, Switzerland.,Division of Clinical Psychology and Epidemiology, Department of Psychology, University of Basel, Basel, Switzerland
| | - Undine E Lang
- University Psychiatric Clinics Basel, University of Basel, Basel, Switzerland
| | - Christian G Huber
- University Psychiatric Clinics Basel, University of Basel, Basel, Switzerland
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Mac Donald B, Bulik CM, Petersen LV, Clausen L. Influence of eating disorder psychopathology and general psychopathology on the risk of involuntary treatment in anorexia nervosa. Eat Weight Disord 2022; 27:3157-3172. [PMID: 35864298 PMCID: PMC9805523 DOI: 10.1007/s40519-022-01446-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 07/03/2022] [Indexed: 01/04/2023] Open
Abstract
PURPOSE We explored associations between clinical factors, including eating disorder psychopathology and more general psychopathology, and involuntary treatment in patients with anorexia nervosa. Our intention was to inform identification of patients at risk of involuntary treatment. METHODS This was a retrospective cohort study combining clinical data from a specialized eating disorder hospital unit in Denmark with nationwide Danish register-based data. A sequential methodology yielding two samples (212 and 278 patients, respectively) was adopted. Descriptive statistics and regression analyses were used to explore associations between involuntary treatment and clinical factors including previous involuntary treatment, patient cooperation, and symptom-level psychopathology (Eating Disorder Inventory-2 (EDI-2) and Symptom Checklist-90-Revised (SCL-90-R)). RESULTS Somatization (SCL-90-R) (OR = 2.60, 95% CI 1.16-5.81) and phobic anxiety (SCL-90-R) (OR = 0.43, 95% CI 0.19-0.97) were positively and negatively, respectively, associated with the likelihood of involuntary treatment. Furthermore, somatization (HR = 1.77, 95% CI 1.05-2.99), previous involuntary treatment (HR = 5.0, 95% CI 2.68-9.32), and neutral (HR = 2.92, 95% CI 1.20-7.13) or poor (HR = 3.97, 95% CI 1.49-10.59) patient cooperation were associated with decreased time to involuntary treatment. Eating disorder psychopathology measured by the EDI-2 was not significantly associated with involuntary treatment. CONCLUSIONS Clinical questionnaires of psychopathology appear to capture specific domains relevant to involuntary treatment. Poor patient cooperation and previous involuntary treatment being associated with shorter time to involuntary treatment raise important clinical issues requiring attention. Novel approaches to acute anorexia nervosa care along with unbiased evaluation upon readmission could mitigate the cycle of repeat admissions with involuntary treatment. LEVEL OF EVIDENCE Level III, cohort study.
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Affiliation(s)
- Benjamin Mac Donald
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Aarhus, Denmark.
| | - Cynthia M Bulik
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Liselotte V Petersen
- The National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark
- Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Aarhus University, Aarhus, Denmark
- Centre for Integrated Register-Based Research (CIRRAU), Aarhus University, Aarhus, Denmark
| | - Loa Clausen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Aarhus, Denmark
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What renders living alone a risk factor for involuntary psychiatric admission? CURRENT PSYCHOLOGY 2022. [DOI: 10.1007/s12144-022-03592-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Durmaz O, Büyükçapar A, Arinci B, Inceman C, Akkişi Kumsar N. Investigating differences of medications in hospitalized schizophrenia and schizoaffective disorder patients: impact of substance use. JOURNAL OF SUBSTANCE USE 2022. [DOI: 10.1080/14659891.2022.2077249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Onur Durmaz
- Department of Psychiatry, Erenkoy Mental Health and Neurology Training & Research Hospital, Istanbul, Turkey
| | - Aslı Büyükçapar
- Department of Psychiatry, Erenkoy Mental Health and Neurology Training & Research Hospital, Istanbul, Turkey
| | - Berçem Arinci
- Department of Psychiatry, Erenkoy Mental Health and Neurology Training & Research Hospital, Istanbul, Turkey
| | - Can Inceman
- Department of Psychiatry, Erenkoy Mental Health and Neurology Training & Research Hospital, Istanbul, Turkey
| | - Neslihan Akkişi Kumsar
- Department of Psychiatry, Erenkoy Mental Health and Neurology Training & Research Hospital, Istanbul, Turkey
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Drakonakis N, Stylianidis S, Peppou LE, Douzenis A, Nikolaidi S, Tzavara C, Baladima CE, Iatropoulou GO, Psarra V, Tsopanaki E, Barbato A. Outcome of Voluntary vs Involuntary Admissions in Greece over 2 years after Discharge: A Cohort Study in the Psychiatric Hospital of Attica "Dafni". Community Ment Health J 2022; 58:633-644. [PMID: 34370149 DOI: 10.1007/s10597-021-00865-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 06/20/2021] [Indexed: 10/20/2022]
Abstract
The increasing rates of involuntary hospitalization constitute a major ethical issue in psychiatric practice. The present cohort study endeavours to investigate the relationship between patients' legal status (involuntary vs voluntary) and the outcome of their hospitalization, over 2 years after discharge. All individuals admitted in the 3rd Psychiatric Department of the Psychiatric Hospital of Attica during February 2015-February 2017 took part in the study. 64.7% of patients were compulsory admitted. Findings indicate a statistically significant improvement in global functioning and symptomatology levels from admission to discharge for all treated patients, independently of their legal status. However, readmission rates over 2 years after discharge were high (34.8% vs. 21.9% in voluntary and involuntary patients, respectively). In conclusion, psychiatric admission, irrespectively of legal status leads to clinical improvement.
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Affiliation(s)
- Nektarios Drakonakis
- Psychiatric Hospital of Attica "Dafni", Athens, Greece. .,Department of Social Sciences, Faculty of Psychology, Panteion University of Social and Political Sciences, Athens, Greece.
| | - Stelios Stylianidis
- Association for Regional Development and Mental Health (EPAPSY), Athens, Greece.,Department of Social Sciences, Faculty of Psychology, Panteion University of Social and Political Sciences, Athens, Greece
| | - Lily Evangelia Peppou
- Department of Social Sciences, Faculty of Psychology, Panteion University of Social and Political Sciences, Athens, Greece.,University Mental Health, Neurosciences and Precision Medicine Research Institute "Costas Stefanis", Athens, Greece
| | - Athanasios Douzenis
- 2nd Department of Psychiatry, University of Athens, Attikon Hospital, Athens, Greece
| | - Sofia Nikolaidi
- Association for Regional Development and Mental Health (EPAPSY), Athens, Greece
| | - Chara Tzavara
- Department of Hygiene, Epidemiology and Medical Statistics, Centre for Health Services Research, National and Kapodistrian University of Athens, Athens, Greece
| | - Charikleia Eirini Baladima
- Department of Social Sciences, Faculty of Psychology, Panteion University of Social and Political Sciences, Athens, Greece
| | - Georgia Olga Iatropoulou
- Department of Social Sciences, Faculty of Psychology, Panteion University of Social and Political Sciences, Athens, Greece
| | | | | | - Angelo Barbato
- Laboratory of Epidemiology and Social Psychiatry, IRCCS Istituto Di Ricerche Farmacologiche 'Mario Negri', Milan, Italy.,IRIS Postgraduate Psychotherapy School, Milan, Italy
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Hofmann AB, Schmid HM, Hofmann LA, Noboa V, Seifritz E, Vetter S, Egger ST. Impact of Compulsory Admission on Treatment and Outcome: A Propensity Score Matched Analysis. Eur Psychiatry 2022; 65:e6. [PMID: 35040426 PMCID: PMC8853855 DOI: 10.1192/j.eurpsy.2022.4] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background Despite multiple ethical issues and little evidence of their efficacy, compulsory admission and treatment are still common psychiatric practice. Therefore, we aimed to assess potential differences in treatment and outcome between voluntarily and compulsorily admitted patients. Methods We extracted clinical data from inpatients treated in an academic hospital in Zurich, Switzerland between January 1, 2013 and December 31, 2019. Observation time started upon the first admission and ended after a one-year follow-up after the last discharge. Several sociodemographic and clinical characteristics, including Health of the Nation Outcome Scales (HoNOS) scores, were retrospectively obtained. We then identified risk factors of compulsory admission using logistic regression in order to perform a widely balanced propensity score matching. Altogether, we compared 4,570 compulsorily and 4,570 voluntarily admitted propensity score-matched patients. Multiple differences between these groups concerning received treatment, coercive measures, clinical parameters, and service use outcomes were detected. Results Upon discharge, compulsorily admitted patients reached a similar HoNOS sum score in a significantly shorter duration of treatment. They were more often admitted for crisis interventions, were prescribed less pharmacologic treatment, and received fewer therapies. During the follow-up, voluntarily admitted patients were readmitted more often, while the time to readmission did not differ. Conclusions Under narrowly set circumstances, compulsory admissions might be helpful to avert and relieve exacerbations of severe psychiatric disorders.
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Affiliation(s)
- Andreas B Hofmann
- Faculty of Medicine, Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital, University of Zurich, Zurich, Switzerland
| | - Hanna M Schmid
- Faculty of Medicine, Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital, University of Zurich, Zurich, Switzerland
| | - Lena A Hofmann
- Faculty of Medicine, Department of Forensic Psychiatry, Psychiatric University Hospital, University of Zurich, Zurich, Switzerland
| | - Vanessa Noboa
- Faculty of Medicine, Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital, University of Zurich, Zurich, Switzerland.,Faculty of Medicine, San Francisco de Quito University, Quito, Ecuador
| | - Erich Seifritz
- Faculty of Medicine, Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital, University of Zurich, Zurich, Switzerland
| | - Stefan Vetter
- Faculty of Medicine, Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital, University of Zurich, Zurich, Switzerland
| | - Stephan T Egger
- Faculty of Medicine, Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital, University of Zurich, Zurich, Switzerland.,Faculty of Medicine, Department of Psychiatry, University of Oviedo, Oviedo, Spain
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Ziltener T, Möller J, Imfeld L, Lieb R, Lang UE, Huber CG. Time to readmission in psychiatric inpatients with a therapeutic leave. J Psychiatr Res 2021; 144:102-109. [PMID: 34610513 DOI: 10.1016/j.jpsychires.2021.09.050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 09/15/2021] [Accepted: 09/23/2021] [Indexed: 01/25/2023]
Abstract
AIMS Interventions to decrease readmissions in psychiatric patients are urgently needed. In Switzerland therapeutic leave (TL) composes a cornerstone of inpatient treatment. TL is a planned time-limited absence from the inpatient ward giving patients the opportunity to test their resilience in their usual environment. Evidence of its applicability as an intervention reducing readmissions is lacking. Therefore, our objective was to examine the association between TL and readmission risk. METHODS Using the Kaplan-Meier curve we compared the time to readmission of 3'302 inpatients at the UPK Basel with and without TL. Cox regression was applied, integrating other covariates associated with readmission. RESULTS The Kaplan-Meier curve indicated longer cumulative survival in patients with TL. The log-rank test implied statistical significance (χ2(1) = 18.8, p < .05). The Cox regression showed a reduced hazard for patients with TL (HR = 0.735, CI 95% = [0.639, 0.846], p < .001) and for involuntarily hospitalized patients (HR = 0.760, CI 95% = [0.618, 0.934], p < .01). A higher readmission risk was found for a history of psychiatric admissions (HR = 1.005, CI 95% = [1.004, 1.005], p < .001), higher severity of symptoms at admission (HR = 1.029, CI 95% = [1.018, 1.040], p < .001), comorbidity (HR = 1.178, CI 95% [1.024, 1.355], p = .022), and a diagnosis with schizophrenia-spectrum disorders (HR = 1.401, CI 95% [1.164, 1.687], p = .001). CONCLUSION Linking TL with readmission risk, our results imply an easy way to improve quality of care, with possible implications for practice, policies and quality interventions. TL might be suitable to enhance recovery, reduce readmissions and health care costs. RCTs are needed for validation.
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Affiliation(s)
- Tiziana Ziltener
- University Psychiatric Clinics Basel, University of Basel, Wilhelm Klein-Str. 27, CH, 4002, Basel, Switzerland; University of Basel, Faculty of Psychology, Department of Clinical Psychology and Epidemiology, Missionsstr. 60/62, CH, 4055, Basel, Switzerland.
| | - Julian Möller
- University Psychiatric Clinics Basel, University of Basel, Wilhelm Klein-Str. 27, CH, 4002, Basel, Switzerland; University of Basel, Faculty of Psychology, Department of Clinical Psychology and Epidemiology, Missionsstr. 60/62, CH, 4055, Basel, Switzerland
| | - Lukas Imfeld
- University Psychiatric Clinics Basel, University of Basel, Wilhelm Klein-Str. 27, CH, 4002, Basel, Switzerland
| | - Roselind Lieb
- University of Basel, Faculty of Psychology, Department of Clinical Psychology and Epidemiology, Missionsstr. 60/62, CH, 4055, Basel, Switzerland
| | - Undine E Lang
- University Psychiatric Clinics Basel, University of Basel, Wilhelm Klein-Str. 27, CH, 4002, Basel, Switzerland
| | - Christian G Huber
- University Psychiatric Clinics Basel, University of Basel, Wilhelm Klein-Str. 27, CH, 4002, Basel, Switzerland
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11
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Silva B, Gholam M, Golay P, Bonsack C, Morandi S. Predicting involuntary hospitalization in psychiatry: A machine learning investigation. Eur Psychiatry 2021; 64:e48. [PMID: 34233774 PMCID: PMC8316455 DOI: 10.1192/j.eurpsy.2021.2220] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background Coercion in psychiatry is a controversial issue. Identifying its predictors and their interaction using traditional statistical methods is difficult, given the large number of variables involved. The purpose of this study was to use machine-learning (ML) models to identify socio-demographic, clinical and procedural characteristics that predict the use of compulsory admission on a large sample of psychiatric patients. Methods We retrospectively analyzed the routinely collected data of all psychiatric admissions that occurred between 2013 and 2017 in the canton of Vaud, Switzerland (N = 25,584). The main predictors of involuntary hospitalization were identified using two ML algorithms: Classification and Regression Tree (CART) and Random Forests (RFs). Their predictive power was compared with that obtained through traditional logistic regression. Sensitivity analyses were also performed and missing data were imputed through multiple imputation using chain equations. Results The three models achieved similar predictive balanced accuracy, ranging between 68 and 72%. CART showed the lowest predictive power (68%) but the most parsimonious model, allowing to estimate the probability of being involuntarily admitted with only three checks: aggressive behaviors, who referred the patient to hospital and primary diagnosis. The results of CART and RFs on the imputed data were almost identical to those obtained on the original data, confirming the robustness of our models. Conclusions Identifying predictors of coercion is essential to efficiently target the development of professional training, preventive strategies and alternative interventions. ML methodologies could offer new effective tools to achieve this goal, providing accurate but simple models that could be used in clinical practice.
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Affiliation(s)
- Benedetta Silva
- Community Psychiatry Service, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.,Department of Health and Social Action (DSAS), Cantonal Medical Office, General Directorate for Health of Canton of Vaud, Lausanne, Switzerland
| | - Mehdi Gholam
- Epidemiology and Psychopathology Research Unit, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.,Ecole Polytechnique Fédérale de Lausanne EPFL, School of Basic Sciences, Institute of Mathematics, Lausanne, Switzerland
| | - Philippe Golay
- Community Psychiatry Service, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.,General Psychiatry Service, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Charles Bonsack
- Community Psychiatry Service, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Stéphane Morandi
- Community Psychiatry Service, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.,Department of Health and Social Action (DSAS), Cantonal Medical Office, General Directorate for Health of Canton of Vaud, Lausanne, Switzerland
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12
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Maki S, Nagai K, Ando S, Tamakoshi K. Structure and predictors of in-hospital nursing care leading to reduction in early readmission among patients with schizophrenia in Japan: A cross-sectional study. PLoS One 2021; 16:e0250771. [PMID: 33930056 PMCID: PMC8087037 DOI: 10.1371/journal.pone.0250771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Accepted: 04/13/2021] [Indexed: 12/02/2022] Open
Abstract
Schizophrenia is a disorder characterized by psychotic relapses. Globally, about 15%-30% of patients with schizophrenia discharged from inpatient psychiatric admissions are readmitted within 90 days due to exacerbation of symptoms that leads to self-harm, harm to others, or self-neglect. The purpose of this study was to investigate the structure and predictors of in-hospital nursing care leading to reduction in early readmission among patients with schizophrenia. A new questionnaire was developed to assess the extent to which respondents delivered in-hospital nursing care leading to reduction in early readmission among patients with schizophrenia. This study adopted a cross-sectional research design. The survey was conducted with the new questionnaires. The participants were registered nurses working in psychiatric wards. Item analyses and exploratory factor analyses were performed using the new questionnaires to investigate the structure of in-hospital nursing care leading to reduction in early readmission. Stepwise regression analyses were conducted to examine the factors predicting in-hospital nursing care leading to reduction in early readmission. Data were collected from 724 registered nurses in Japan. In-hospital nursing care leading to reduction in early readmission was found to consist of five factors: promoting cognitive functioning and self-care, identifying reasons for readmission, establishing cooperative systems within the community, sharing goals about community life, and creating restful spaces. In-hospital nursing care leading to reduction in early readmission was predicted by the following variables: the score on the nursing excellence scale in clinical practice, the score on therapeutic hold, and the participation of community care providers in pre-discharge conferences. Japanese psychiatric nurses provide nursing care based on these five factors leading to reduction in early readmission. Such nursing care would be facilitated by not only nurses' excellence but also nurses' environmental factors, especially the therapeutic climate of the ward and the participation of community care providers in pre-discharge conferences.
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Affiliation(s)
- Shigeyoshi Maki
- Department of Nursing, School of Nursing, Sugiyama Jogakuen University, Nagoya, Aichi, Japan
| | - Kuniyoshi Nagai
- Department of Nursing, School of Nursing, Nagoya University of Arts and Sciences, Nagoya, Aichi, Japan
| | - Shoko Ando
- Department of Nursing, Nagoya University Graduate School of Medicine (Health Sciences), Nagoya, Aichi, Japan
| | - Koji Tamakoshi
- Department of Nursing, Nagoya University Graduate School of Medicine (Health Sciences), Nagoya, Aichi, Japan
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de Jong MH, Wierdsma AI, Zoeteman J, van Boeijen CA, Van Gool AR, Mulder CL. Risk factors for repeated emergency compulsory psychiatric admissions. BJPsych Open 2020; 7:e19. [PMID: 33349278 PMCID: PMC7791558 DOI: 10.1192/bjo.2020.153] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The characteristics of patients who have repeated compulsory psychiatric admissions are largely unknown. AIMS To investigate the frequency and risk factors for repeated emergency compulsory psychiatric admission (ECPA); and to identify targets for interventions to reduce repeated ECPA. METHOD Data were collected from a database of electronic patient files (EPFs) held by three psychiatric emergency services (PES) in the Netherlands. Analyses were based on the data for adult patients (aged 18-75 years) with a first PES contact in 2010-2015. Using descriptive statistics and regression analysis, we studied the associations between baseline patient factors and repeated ECPA and time to readmission, within a 2-year follow-up period. RESULTS We included 6059 patients: 15.6% had two or more ECPAs. In total, 66% of second ECPAs had occurred within 6 months of the first. About 30% of all ECPAs were repeated ECPAs. Two baseline factors were associated with a higher frequency of a second ECPA: history of receiving any mental healthcare treatment, whether in-patient or out-patient or both, and a lower level of self-care. Three were associated with a lower frequency: ethnicity (other than Dutch), older age and suicidality. Lower Global Assessment of Functioning (GAF) scores and housing problems were associated with a shorter time to compulsory readmission and persistent psychiatric problems with a longer time to compulsory readmission. CONCLUSIONS We found that 15.6% of patients had two or more ECPAs. Two-thirds of the second ECPAs had occurred within 6 months of the first. Like earlier studies, the risk factors we identified suggest that interventions to reduce the risk of repeated compulsory psychiatric admission should seek to improve self-care, general daily functioning and homelessness.
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Affiliation(s)
| | - André I Wierdsma
- Epidemiological and Social Psychiatric Research Institute (ESPRi), Department of Psychiatry, Erasmus University Medical Centre, the Netherlands
| | | | | | | | - Cornelis L Mulder
- Epidemiological and Social Psychiatric Research Institute (ESPRi), Department of Psychiatry, Erasmus University Medical Centre, the Netherlands
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Brown P, Waite F, Lambe S, Rosebrock L, Freeman D. Virtual Reality Cognitive Therapy in Inpatient Psychiatric Wards: Protocol for a Qualitative Investigation of Staff and Patient Views Across Multiple National Health Service Sites. JMIR Res Protoc 2020; 9:e20300. [PMID: 32667897 PMCID: PMC7471884 DOI: 10.2196/20300] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 06/29/2020] [Accepted: 06/30/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Patients in psychiatric wards typically have very limited access to individual psychological therapy. Inpatients often have significant time available, and an important transition back to everyday life to prepare for-but historically, there have been few trained therapists available on wards for the delivery of evidence-based therapy. Automated virtual reality (VR) therapy may be one route to increase the provision of powerful psychological treatments in psychiatric hospitals. The gameChange automated VR cognitive therapy is targeted at helping patients overcome anxious avoidance and re-engage in everyday situations (such as walking down the street, taking a bus, or going to a shop). This treatment target may fit well for many patients preparing for discharge. However, little is known about how VR therapy may be viewed in this setting. OBJECTIVE The objectives of the study are to explore psychiatric hospital staff and patients' initial expectations of VR therapy, to gather patient and staff views of an automated VR cognitive therapy (gameChange) after briefly experiencing it, and to identify potential differences across National Health Service (NHS) mental health trusts for implementation. Guided by an implementation framework, the knowledge gained from this study will be used to assess the feasibility of VR treatment adoption into psychiatric hospitals. METHODS Focus groups will be conducted with NHS staff and patients in acute psychiatric wards at 5 NHS mental health trusts across England. Staff and patients will be interviewed in separate groups. Individual interviews will also be conducted when preferred by a participant. Within each of the 5 trusts, 1 to 2 wards will be visited. A total of 8-15 staff and patients per ward will be recruited, with a minimum total of 50 staff and patients recruited across all sites. Focus group questions have been derived from the nonadoption, abandonment, and challenges to the scale-up, spread, and sustainability (NASSS) framework. Focus groups will discuss expectations of VR therapy before participants are given the opportunity to briefly try the gameChange VR therapy. Questions will then focus on opinions about the therapy and investigate feasibility of adoption, with particular consideration given to site specific issues. A thematic analysis will be conducted. RESULTS As of May 15, 2020, 1 patient focus group has been conducted. CONCLUSIONS The study will provide unique insight from patients and staff into the potential for implementing automated VR therapy in psychiatric wards. Perspectives will be captured both on the use of immersive technology hardware and therapy-specific issues in such settings. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/20300.
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Affiliation(s)
- Poppy Brown
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Felicity Waite
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
- Oxford Health NHS Foundation Trust, Oxford, United Kingdom
| | - Sinéad Lambe
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
- Oxford Health NHS Foundation Trust, Oxford, United Kingdom
| | - Laina Rosebrock
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
- Oxford Health NHS Foundation Trust, Oxford, United Kingdom
| | - Daniel Freeman
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
- Oxford Health NHS Foundation Trust, Oxford, United Kingdom
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Morán-Sánchez I, Bernal-López MA, Pérez-Cárceles MD. Compulsory admissions and preferences in decision-making in patients with psychotic and bipolar disorders. Soc Psychiatry Psychiatr Epidemiol 2020; 55:571-580. [PMID: 31728560 DOI: 10.1007/s00127-019-01809-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 11/09/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE Participation in medical decisions and taking into account patients' values and preferences are especially important for psychiatric patients who may be treated against their will. The increasing rates of coercive measures and the underlying clinical, ethical, and legal issues highlight the need to examine their use in psychiatry. Although limited congruence in decision-making preferences may be on the basis of these coercive practices, this issue has not been adequately addressed. We explore the relationship between compulsory admissions and congruence in decision-making preferences in mental health settings. METHODS Cross-sectional study among 107 outpatients with DSM diagnoses of schizophrenia of bipolar disorder using the Control Preference Scale to assess congruence in decision-making experienced and preferred style. History of compulsory admissions was obtained through review of available records. Descriptive statistics and multivariate analyses were used. RESULTS 70% of patients reported experiencing their preferred style of decision-making and 44% patients had history of compulsory admissions. These patients were more autonomous and preferred to take a more active role. The degree of congruence was lower in patients with previous compulsory admissions. The best predictors of compulsory admissions were not having a regular doctor and the unmatched participation preferences. CONCLUSIONS Patients who experienced a different level of participation in decision-making than desired more frequently had compulsory admissions. We propose to assess participation preferences each time a relevant treatment decision is about to be made and tailor care accordingly. We identified several factors leading to compulsory admissions that can be modified to prevent further coercive measures.
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Affiliation(s)
- Inés Morán-Sánchez
- Mental Health Centre, Health Service of Murcia, CSM Cartagena, Calle Real, 8, 30201, Murcia, Spain.
| | - María A Bernal-López
- Mental Health Centre, Health Service of Murcia, CSM Cartagena, Calle Real, 8, 30201, Murcia, Spain
| | - Maria D Pérez-Cárceles
- Department of Legal and Forensic Medicine, Faculty of Medicine, Biomedical Research Institute (IMIB), Regional Campus of International Excellence "Campus Mare Nostrum", University of Murcia, Murcia, Spain
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Morandi S, Silva B, Bonsack C, Golay P. Propensity to decide on involuntary hospitalisation in primary medical care: Dispositional or situational determinants? INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2020; 69:101552. [PMID: 32241456 DOI: 10.1016/j.ijlp.2020.101552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 03/11/2020] [Accepted: 03/11/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND The incidence of involuntary hospitalisations varies widely among and within countries. One factor that could account for these variations is the local profile of medical doctors deciding on involuntary admissions. The first goal of this study was to test whether to decide on an involuntary hospitalisation was an individual or a situational disposition. The second goal was to explore doctors' characteristics associated with the use of coercion in specific situations. METHOD Medical doctors of four French-speaking Swiss cantons with the competence, according to cantonal laws, to decide on an involuntary hospitalisation were invited to take part in an online survey. Respondents were asked whether they would decide on an involuntary hospitalisation or not in seven clinical vignettes. Propensity to decide on involuntary hospitalisation was estimated with a two-parameter logistic item response model and latent class analysis. Univariate logistic regression models were used to test whether individual factors were associated with the use of coercion in each situation. RESULTS 192 medical doctors completed the online questionnaire. There was near-zero correlation between vignettes: an involuntary hospitalisation decided on by a doctor in one situation was not related to the use of coercion in another. No subgroup was more prone to generally resort to coercion. However, some individual characteristics were related to the use of coercion in specific situations. CONCLUSIONS Medical doctors' propensity to use coercion for mental health problems was better accounted for by situational rather than dispositional factors. Thus, the use of coercion should be examined as a multidimensional concept.
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Affiliation(s)
- Stéphane Morandi
- Community Psychiatry Service, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Place Chauderon 18, 1003 Lausanne, Switzerland; Cantonal Medical Office, Public Health Service of Canton Vaud, Department of Health and Social Action (DSAS), Avenue des Casernes 2, 1014 Lausanne, Switzerland.
| | - Benedetta Silva
- Community Psychiatry Service, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Place Chauderon 18, 1003 Lausanne, Switzerland; Cantonal Medical Office, Public Health Service of Canton Vaud, Department of Health and Social Action (DSAS), Avenue des Casernes 2, 1014 Lausanne, Switzerland
| | - Charles Bonsack
- Community Psychiatry Service, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Place Chauderon 18, 1003 Lausanne, Switzerland
| | - Philippe Golay
- Community Psychiatry Service, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Place Chauderon 18, 1003 Lausanne, Switzerland
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