Abstract
Objective: The aim of this study was to analyze factors associated with the legal status at psychiatric admission of individuals with psychosis or bipolar disorder in a Latin-American cultural setting.Methods: Prospective observational study was conducted in São Paulo, Brazil. We analyzed 169 individuals with bipolar or psychotic disorder in need of hospitalization. Sociodemographic data, data on the psychiatric disorder, information about the hospital stay, and data at time of discharge were collected. Their families were also contacted by telephone and interviews were conducted at 1, 2, 6, and 12 months post-discharge as a follow-up.Results: Eighty-eight patients (52%) had a voluntary admission and 81 (48%) had an involuntary admission (IA). The average length of admission was similar in both groups (17.4 vs. 17.3 days, p = 0.22). It was significantly more common for IA patients to be admitted because of other-directed aggressiveness (47.7 vs. 65.4%, p = 0.02). The percentage of individuals that needed physical restraint during hospital stay among IA patients was also significantly higher (11.4 vs. 25.9%, p = 0.01). Having any religious affiliations was significantly related to an IA status as well (OR = 4–6.48).Conclusion: Our results suggest that cultural factors related to religious affiliations might play an important role in determining psychiatric hospitalization legal status. Religion might possibly influence someone’s judgment and insight about his/her psychiatric disorder. This study restates the importance of dealing with the subject of religion with patients.
Highlights
An involuntary admission (IA) is sometimes found necessary in the course of the treatment of a patient with psychiatric disorders [1]
Our results suggest that cultural factors related to religious affiliations might play an important role in determining psychiatric hospitalization legal status
The majority of patients received a diagnosis of psychosis (F2x, according to ICD 10) (VA = 63.9%, IA = 68.5%)
Summary
An involuntary admission (IA) is sometimes found necessary in the course of the treatment of a patient with psychiatric disorders [1]. Despite the evidence supporting that IA is sometimes indispensable, hospitalizing someone against his/her will is still a controversial topic. It is often pointed out that an IA and coercive practices could be considered an infringement of individual freedom [1] and might have negative consequences in the treatment. It might create a feeling of exclusion from participation in the treatment process [3] and greater levels of dissatisfaction with it [4]. Coercive practices might create an aversion to the medical treatment [7] and reduce the probability of the patient seeking care. A review study [4] found that the outcome of an involuntary hospital admission, in terms of length of stay, readmission risk and risk of involuntary readmission, was at least equal, if not worse, to the outcome of a voluntary admission (VA)
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