Factors affecting psychiatric inpatient hospitalization from a psychiatric emergency service

University of Maryland School of Social Work, Baltimore, MD 21201, USA.
General hospital psychiatry (Impact Factor: 2.61). 08/2011; 33(6):618-25. DOI: 10.1016/j.genhosppsych.2011.06.004
Source: PubMed


As a gateway to the mental health system, psychiatric emergency services (PES) are charged with assessing a heterogeneous array of short-term and long-term psychiatric crises. However, few studies have examined factors associated with inpatient psychiatric hospitalization following PES in a racially diverse sample. We examine the demographic, service use and clinical factors associated with inpatient hospitalization and differences in predisposing factors by race and ethnicity.
Three months of consecutive admissions to San Francisco's only 24-h PES (N = 1,305) were reviewed. Logistic regression was used to estimate the associations between demographic, service use, and clinical factors and inpatient psychiatric hospitalization. We then estimated separate models for Asians, Blacks, Latinos and Whites.
Clinical severity was a consistent predictor of hospitalization. However, age, gender, race/ethnicity, homelessness and employment status were all significant related to hospitalization. Alcohol and drug use were associated with lower probability of inpatient admission, however specific substances appear particularly salient for different racial/ethnic groups.
While clinical characteristics played an essential role in disposition decisions, these results point to the importance of factors external to PES. Individual and community factors that affect use of psychiatric emergency services merit additional focused attention.

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    • "With regard to categorical diagnosis, our findings are consistent with previous studies that identified the diagnosis of psychotic or affective disorders as one of the main factors predicting admission [1–4,6–8,10]. Concerning psychopathological dimensions, some studies focused attention on specific symptoms, pointing to delusions, hallucinations, aggressive behaviors and agitation as predictors of hospitalization [2] [8] [10] [21]. If we consider these symptoms as the clinical expression of SVARAD dimensions such as reality distortion, anger/aggressiveness, activation and impulsivity, their predictive role is consistent with previous findings. "
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    ABSTRACT: Objective: To identify which patient factors predict psychiatric hospitalization in patients presenting to the emergency department and to examine the role of the dimensional approach to psychopathology in predicting hospitalization. Methods: We consecutively recruited 312 patients undergoing psychiatric evaluation in the emergency room of a hospital in Rome over a 6-month period. Patients were rated on the SVARAD (Scala per la Valutazione Rapida Dimensionale), a scale designed for the rapid assessment of the main psychopathological dimensions. Information about patient history, as well as sociodemographic and clinical variables, was also collected. Univariate analysis was performed to detect the variables associated with recommendation of psychiatric hospitalization. Multiple logistic regression analysis was used to identify independent predictors of hospitalization and compare their strength. A replication study was performed in another hospital on a random sample of 118 patients. Results: In both studies, patients who were recommended for psychiatric hospitalization showed significantly higher levels of anger/aggressiveness, apathy, impulsivity, reality distortion, thought disorganization and activation. Multivariate analysis identified psychopathological dimensions (reality distortion, impulsivity, apathy), diagnosis of psychotic or mood disorders and proposal for compulsory admission as independent predictors of psychiatric hospitalization. Hierarchical regression analysis revealed that the dimensional evaluation was the strongest predictor. Conclusions: Our findings suggest that, in emergency setting, a systematic dimensional assessment may usefully complement the categorical assessment. Future research should aim at developing an operational assessment model, including both categorical and dimensional approaches to psychopathology.
    No preview · Article · Sep 2015 · General hospital psychiatry
    • "Individual patient factors related to clinical need, such as risk of danger to others and/or self and psychiatric diagnoses, have consistently been associated with inpatient admission practices (Way et al. 1992; Lyons et al. 1995; George et al. 2002; Unick et al. 2011). Individual demographic characteristics, including ethnicity and age, have also been associated with inpatient admission practices, although with mixed results (Goldberg et al. 2007; Unick et al. 2011). Social variables associated with a greater likelihood of inpatient admission include the presence of family members in the emergency department and poor community functioning (Slagg 1993; Rabinowitz et al. 1995; Mattioni et al. 1999; Way & Banks 2001). "
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    ABSTRACT: Background Individuals with intellectual disabilities (ID) are disproportionately high users of psychiatric emergency services. Despite the demand for psychiatric assessments in the emergency department (ED), no clear guidelines have been established as to what factors should guide clinical decision-making processes. The current study aimed to explore individual, social and contextual factors related to psychiatric care outcomes among patients with ID in the emergency department.Method Emergency department charts were reviewed for 66 individuals with ID who visited the emergency department during a psychiatric crisis.ResultsStandardised crisis severity scores were significantly higher in patients seen by psychiatrists as compared with patients who did not receive psychiatric consultations in the emergency department. A significantly greater proportion of patients with moderate or severe levels of ID (vs. borderline/mild) received psychiatric consultations. Emergency department visits resulting in inpatient hospital admission did not differ from those that did not, with the exception of the level of ID: patients admitted to psychiatric inpatient care were more likely to have moderate or severe levels of ID.Conclusions The psychiatric care experiences of patients with ID in the emergency department appear highly variable. Further research focused on emergency department clinical decision-making practices concerning this population is warranted.
    No preview · Article · Jun 2015 · Journal of Intellectual Disability Research
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    • "These reasons include lack of treatment alternatives for older adults. Given that other studies have found similarly lower thresholds for admission of comorbid mental health and substance abuse patients and subsequently shorter stays and lower level discharges, we find this to be a plausible explanation (Stulz et al., 2014; Unick et al., 2011). A third explanation is that individuals admitted with depression only represent distinct depression subtypes in older adults, which have distinct clinical courses with resulting different lengths of stay. "
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    ABSTRACT: Objective: The prevalence of depression in older adults has been increasing over the last 20 years and is associated with economic costs in the form of treatment utilization and caregiving, including inpatient hospitalization. Comorbid alcohol diagnoses may serve as a complicating factor in inpatient admissions and may lead to overutilization of care and greater economic cost. This study sought to isolate the comorbidity effect of alcohol among older adult hospital admissions for depression. Methods: We analyzed a subsample (N = 8,480) of older adults (65+) from the 2010 Nationwide Inpatient Sample who were hospitalized with primary depression diagnoses, 7,741 of whom had depression only and 739 of whom also had a comorbid alcohol disorder. To address potential selection bias based on drinking and health status, propensity score matching was used to compare length of stay, total costs, and disposition between the two groups. Results: Bivariate analyses showed that older persons with depression and alcohol comorbidities were more often male (59.9% versus 34.0%, p < .001) and younger (70.9 versus 75.9 years, p < .001) than those with depression only. In terms of medical comorbidities, those with depression and alcohol disorders experienced more medical issues related to substance use (e.g., drug use diagnoses, liver disease, and suicidality; all p < .001), while those with depression only experienced more general medical problems (e.g., diabetes, renal failure, hypothyroid, and dementia; all p < .001). Propensity score matched models found that alcohol comorbidity was associated with shorter lengths of stay (on average 1.08 days, p < .02) and lower likelihood of post-hospitalization placement in a nursing home or other care facility (OR = 0.64, p < .001). No significant differences were found in overall costs or likelihood of discharge to a psychiatric hospital. Conclusions: In older adults, depression with alcohol comorbidity does not lead to increased costs or higher levels of care after discharge. Comorbidity may lead to inpatient hospitalization at lower levels of severity, and depression with alcohol comorbidity may be qualitatively different than non-comorbid depression. Additionally, increased costs and negative outcomes in this population may occur at other levels of care such as outpatient services or emergency department visits. (Journal of Dual Diagnosis, 11:83–92, 2015)
    Full-text · Article · Feb 2015 · Journal of Dual Diagnosis
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