Determinants of compulsory admissions in a state psychiatric hospital-Case control study.

Abstract

Compulsory admissions are against the patient's will and are presumably due to diverse reasons. There has been a rise in compulsory admissions world over. The objective of the study was to determine the risk factors for compulsory admissions in a state psychiatric hospital. A case control study was conducted at the state psychiatric hospital, Trivandrum, Kerala. Cases were involuntary non-legal admissions while controls were voluntary admissions. Putative risk factors studied included social support, severity of psychopathology etc., in addition to the socio-demographic variables. Risk factors for compulsory admissions were higher age, 30-49 years, OR=1.98, 95% CI [1.03-3.81]; >50years, OR=2.2, 95% CI [1.03-4.72], being from an urban locale,OR=1.99, 95% CI [1.13-3.52], living in joint & extended families OR=2.12, 95% CI [1.3-3.4], homelessness OR=2.24, 95% CI [1.32-3.79] and poor social support, OR=4.45 [2.53-7.81]. The type of illness, its duration, diagnosis, or symptom severity were not significantly related to compulsory admissions, but past compulsory admissions OR=5.36, 95% CI [2.09-13.75], poor functioning OR=2.54, 95% CI [1.31-4.91] and poor compliance to medication OR=1.78, 95% CI [1.05-3.01] were associated with compulsory admission. Poor social support, past involuntary admissions and poor functional status retained their association after multivariate analysis. By addressing the modifiable factors like poor social support, poor functional status, and poor compliance to medication, compulsory admissions could be prevented. Since it is found that compulsory admissions are likely to repeat, such patients form a high risk group requiring specific interventions.