Socio-Demographic and Clinical Characteristics of Adults With Psychotic Symptomatology Under Involuntary Admission and Readmission for Compulsory Treatment in a Referral Psychiatric Hospital in Cyprus.

Katerina Kaikoushi,Evanthia Bella,Nicos Middleton,Maria Karanikola,Giorgos Alevizopoulos,Andeas Chatzittofis

doi:10.3389/fpsyt.2021.602274

Abstract

Socio-demographic and clinical characteristics of adults under compulsory psychiatric treatment, have not been reported adequately in Southern European countries. We investigated the socio-demographic and clinical characteristics of adults with psychotic symptomatology who were involuntarily treated in the acute Mental Health Services in Cyprus. A descriptive cross-sectional study was applied. Data collection (December 2016 to February 2018) achieved via a structured questionnaire including demographic and clinical variables. Census sampling was applied in Cyprus referral center for compulsory psychiatric treatment. The sample included 406 individuals (262 males, 144 females). Approximately 86.2% were single, 77.6% were unemployed, and 24.9% held a bachelor's degree. The most frequent clinical diagnosis was schizophrenia or a relevant psychotic disorder (86.4%). The most frequent admission cause was non-adherence to pharmacotherapy along with disorganized behavior (agitation and/or self-care deficit, and/or aggressive behavior, and/or suicidal behavior) (53.6%). Moreover, 70.7% of the sample reported a positive personal history of mental health problems, while 42.1% reported a positive family history of mental health disorders. Half of the participants (52%) were previously involuntarily admitted for compulsory treatment. Adjusted associations of readmission status were reported with Cypriot ethnicity (OR: 4.40, 95%CI: 2.58–7.50), primary education only (OR: 3.70, 95%CI: 1.64–8.37), readmission due to disorganized behavior along with non-adherence to pharmacotherapy (OR: 10.84, 95%CI: 2.69–43.72), as well as along with substance use (OR: 6.39, 95%CI: 1.52–26.82). Readmission was almost five times more likely to occur due to suicidal behavior (OR: 5.01, 95%CI: 1.09–22.99) compared to disorganized behavior not otherwise specified. Additionally, those with a diagnosis of schizophrenia were more than 12 times more frequently readmitted for compulsory treatment compared to other diagnoses (OR 12.15, 95%CI: 1.04–142). Moreover, the participants with higher secondary education had 54.6% less odds to be involuntarily re-admitted compared to Bachelor degree holders (OR 0.442, 95%CI: 0.24–0.79). A high percentage of involuntary treatment was noted due to non-adherence to pharmacotherapy and substance use. Re-evaluation of the effectiveness of relevant community interventions is suggested, as well as implementation of structured educational programs on therapy adherence during psychiatric hospitalization.

Highlights

There is longstanding evidence showing that the incidence of mental disorders in the general population is increasing globally [1], data on the factors associated with severe mental health disturbances leading to compulsory treatment have not been addressed adequately in Southern European and Mediterranean countries [2, 3]
It appeared that single and unemployed males of lower secondary education are more frequently involuntarily hospitalized for compulsory treatment to Athalassa Psychiatric Hospital (APH) compared to the general population
This study presents, for the first time, the socio-demographic and clinical characteristics of those involuntarily hospitalized for compulsory treatment in Cyprus, with special focus on the factors associated with readmission

Summary

Introduction

There is longstanding evidence showing that the incidence of mental disorders in the general population is increasing globally [1], data on the factors associated with severe mental health disturbances leading to compulsory treatment have not been addressed adequately in Southern European and Mediterranean countries [2, 3]. A significant proportion of people facing mental health problems, are reluctant to reach formal mental health services for help due to mental health social stigma [9]. As a result, their first contact with mental health services is more likely to happen under compulsory hospitalization due to severe deterioration of their mental health status [10]. Identification of the clinical and demographic profile of those receiving formal mental health services for the first time, via involuntary hospitalization, may be relevant in formulating awareness interventions in the general population [11]. The socio-demographic and clinical characteristics of individuals under compulsory psychiatric treatment in Southern European countries, including Cyprus, have been understudied [12,13,14]

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