Abstract
BackgroundThe main objectives of the mobile Psychiatric Emergency Services (PES) in the Netherlands are to assess the presence of a mental disorder, to estimate risk to self or others, and to initiate continuity of care, including psychiatric hospital admission. The aim of this study was to assess the associations between the level of suicidality and risk of voluntary or involuntary admission in patients with and without a personality disorder who were presented to mobile PES.MethodsObservational data were obtained in three areas of the Netherlands from 2007 to 2016. In total, we included 71,707 contacts of patients aged 18 to 65 years. The outcome variable was voluntary or involuntary psychiatric admission. Suicide risk and personality disorder were assessed by PES-clinicians. Multivariable regression analysis was used to explore associations between suicide risk, personality disorder, and voluntary or involuntary admission.ResultsIndependently of the level of suicide risk, suicidal patients diagnosed with personality disorder were less likely to be admitted voluntarily than those without such a diagnosis (admission rate .37 versus .46 respectively). However, when the level of suicide risk was moderate or high, those with a personality disorder who were admitted involuntarily had the same probability of involuntary admission as those without such a disorder.ConclusionsWhile the probability of voluntary admission was lower in those diagnosed with a personality disorder, independent of the level of suicidality, the probability of involuntary admission was only lower in those whose risk of suicide was low. Future longitudinal studies should investigate the associations between (involuntary) admission and course of suicidality in personality disorder.
Highlights
The main objectives of the mobile Psychiatric Emergency Services (PES) in the Netherlands are to assess the presence of a mental disorder, to estimate risk to self or others, and to initiate continuity of care, including psychiatric hospital admission
Two studies found no association between suicide risk and hospital admission in the Netherlands [10, 11], others found that the probability of involuntary admission was increased by suicide risk in Israel [12], the USA [13, 14] and Germany [15]
This study shows that suicidal patients diagnosed with a personality disorder are less likely to be voluntarily admitted to a psychiatric hospital by PES, as compared to patients not diagnosed with a personality disorder when suicide risk is higher, the personality disorder diagnosis becomes irrelevant in the case of an involuntary admission
Summary
The main objectives of the mobile Psychiatric Emergency Services (PES) in the Netherlands are to assess the presence of a mental disorder, to estimate risk to self or others, and to initiate continuity of care, including psychiatric hospital admission. The aim of this study was to assess the associations between the level of suicidality and risk of voluntary or involuntary admission in patients with and without a personality disorder who were presented to mobile PES. Personality disorders and admission When the perceived risk of suicide is high, PES may initiate psychiatric hospital admission, either with or without the patient’s consent. It is a matter of professional debate whether or not suicidal patients should be admitted: some argue that protection should have the greatest priority [6], while others contend that restricting a patient’s autonomy may increase the risk of suicide during and after admission [7, 8]. Two studies found no association between suicide risk and hospital admission in the Netherlands [10, 11], others found that the probability of involuntary admission was increased by suicide risk in Israel [12], the USA [13, 14] and Germany [15]
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