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      Risk factors for readmission in schizophrenia patients following involuntary admission

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      1 , 1 , 2 , 3 , 4 , *
      PLoS ONE
      Public Library of Science

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          Abstract

          Background

          Individuals with schizophrenia who are involuntarily admitted may have poorer prognosis, including higher readmission rates, than those voluntarily admitted. However, little is known about the risk factors for readmission in those schizophrenia patients who are involuntarily admitted.

          Aims

          We aim to explore the risk factors for readmission in this population.

          Method

          We enrolled 138 schizophrenia patients with involuntary admission from July 2008 to June 2013 and followed those patients for readmission outcomes at 3 months and at 1 year.

          Results

          The one-year and 3-months readmission rates were 33.3% and 15.2%, respectively. Unmarried status (adjusted odds ratio (aOR) = 6.28, 95% CI: 1.48–26.62), previous history of involuntary admission (aOR = 4.08, 95% CI: 1.19–14.02), longer involuntary admission days (aOR = 1.04, 95% CI: 1.01–1.07) and shorter total admission days (aOR = 1.03, 95% CI: 1.01–1.05) were associated with increased risk for 1-year readmission. Younger age (aOR = 1.10, 95% CI 1.02–1.18) was associated with increased risk for 3-months readmission.

          Conclusions

          Unmarried status, prior history of involuntary admission, longer involuntary admission days and shorter total admission days were associated with increased risk for 1-year readmission. Healthcare providers may need to focus on patients with these risk factors to reduce subsequent readmissions.

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          Most cited references35

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          Patients' views and readmissions 1 year after involuntary hospitalisation.

          Little is known about the long-term outcome of involuntary admissions to psychiatric hospitals. To assess involuntary readmissions and patients' retrospective views of the justification of the admission as 1-year outcomes and to identify factors associated with these outcomes. Socio-demographic data and readmissions were collected for 1570 involuntarily admitted patients. Within the first week after admission 50% were interviewed, and of these 51% were re-interviewed after 1 year. At 1 year, 15% of patients had been readmitted involuntarily, and 40% considered their original admission justified. Lower initial treatment satisfaction, being on benefits, living with others and being of African and/or Caribbean origin were associated with higher involuntary readmission rates. Higher initial treatment satisfaction, poorer initial global functioning and living alone were linked with more positive retrospective views of the admission. Patients' views of treatment within the first week are a relevant indicator for the long-term prognosis of involuntarily admitted patients.
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            Epidemiology of involuntary placement of mentally ill people across the European Union.

            Despite the tendency for harmonisation of strategies for mental health care delivery, rules and regulations for involuntary placement or treatment of mentally ill persons still differ remarkably internationally. Rapid European integration and other political developments require valid and reliable international overviews, sound studies and profound analyses of this controversial issue. To give an overview of compulsory admission data from official sources across the European Union (EU). Data on the legal frameworks for involuntary placement or treatment of people with mental illness and their outcomes were provided and assessed by experts from all EU member states. Total frequencies of admission and compulsory admission rates vary remarkably across the EU. Variation hints at the influence of differences in legal frameworks or procedures. Time series suggest an overall tendency towards more or less stable quotas in most member states. Further research is greatly needed in this field. Common international health reporting standards are essential to the compilation of basic data.
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              Outcomes of involuntary hospital admission--a review.

              This paper reviews studies on outcomes of involuntary hospital admissions in general adult psychiatry, and predictors of outcomes. Studies assessing observer-rated clinical change and self-rated outcomes were identified. Relevant databases were searched and authors were contacted. Studies were classified according to quality criteria. Eighteen studies fulfilled the inclusion criteria. Most involuntarily admitted patients show substantial clinical improvement over time. Retrospectively, between 33% and 81% of patients regard the admission as justified and/or the treatment as beneficial. Data on predictors of outcomes is limited and inconsistent. Patients with more marked clinical improvement tend to have more positive retrospective judgements. A substantial number of involuntary patients do retrospectively not feel that their admission was justified and beneficial. At least for this group, new approaches might have to be considered. Larger studies are required to identify predictors on which patients are likely to fall into this group.
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                Author and article information

                Contributors
                Role: Data curationRole: Formal analysisRole: ResourcesRole: Writing – original draft
                Role: ConceptualizationRole: Formal analysisRole: Project administrationRole: ResourcesRole: SupervisionRole: Writing – original draftRole: Writing – review & editing
                Role: ConceptualizationRole: MethodologyRole: Writing – original draftRole: Writing – review & editing
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                26 October 2017
                2017
                : 12
                : 10
                : e0186768
                Affiliations
                [1 ] Taoyuan Psychiatric Center, Ministry of Health and Welfare, Taoyuan, Taiwan
                [2 ] Department of Psychiatry, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan
                [3 ] Department of Psychiatry, Far Eastern Memorial Hospital, New Taipei City, Taiwan
                [4 ] School of Medicine, National Yang-Ming University, Taipei, Taiwan
                Maastricht University, NETHERLANDS
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                ‡ These authors are first authors on this work.

                Author information
                http://orcid.org/0000-0002-4265-0736
                Article
                PONE-D-17-24173
                10.1371/journal.pone.0186768
                5658080
                29073180
                d84fa773-c42e-4768-a45a-9bdd6fd0ed68
                © 2017 Hung et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 4 August 2017
                : 7 October 2017
                Page count
                Figures: 0, Tables: 4, Pages: 11
                Funding
                Funded by: Taoyuan Psychiatric Center, Ministry of Health and Welfare of Taiwan
                Award ID: TYPC-2015-01
                Award Recipient :
                This study was supported by a grant from the Taoyuan Psychiatric Center, Ministry of Health and Welfare of Taiwan (TYPC-2015-01) to Dr. YY Hung, ( http://www.typc.mohw.gov.tw/english/). The funding body had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
                Research Article
                Medicine and Health Sciences
                Mental Health and Psychiatry
                Schizophrenia
                Medicine and Health Sciences
                Mental Health and Psychiatry
                Substance-Related Disorders
                Substance Abuse
                Medicine and Health Sciences
                Public and Occupational Health
                Substance-Related Disorders
                Substance Abuse
                Medicine and Health Sciences
                Diagnostic Medicine
                Prognosis
                Social Sciences
                Economics
                Health Economics
                Health Insurance
                Medicine and Health Sciences
                Health Care
                Health Economics
                Health Insurance
                Research and Analysis Methods
                Mathematical and Statistical Techniques
                Statistical Methods
                Statistical Hypothesis Testing
                Chi Square Tests
                Physical Sciences
                Mathematics
                Statistics (Mathematics)
                Statistical Methods
                Statistical Hypothesis Testing
                Chi Square Tests
                Biology and Life Sciences
                Psychology
                Addiction
                Alcoholism
                Social Sciences
                Psychology
                Addiction
                Alcoholism
                Medicine and Health Sciences
                Mental Health and Psychiatry
                Substance-Related Disorders
                Alcoholism
                Medicine and Health Sciences
                Public and Occupational Health
                Substance-Related Disorders
                Alcoholism
                Medicine and Health Sciences
                Health Care
                Health Care Providers
                Medicine and Health Sciences
                Health Care
                Health Risk Analysis
                Custom metadata
                The ethics committee of the study hospital (Taoyuan Psychiatric Center, Ministry of Health and Welfare, Taiwan) has imposed restrictions on sharing a de-identified data set publicly because data of those with involuntary admission are regarded by the committee as potentially sensitive information. The contact information for the ethics committee is as follows: ethical@ 123456typc.mohw.gov.tw .

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