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Patterns of admission to acute psychiatric in-patient facilities: a national survey in Italy

Published online by Cambridge University Press:  26 June 2008

A. Preti ,
P. Rucci ,
G. Santone ,
A. Picardi ,
R. Miglio ,
R. Bracco ,
B. Norcio  and
G. de Girolamo
A. Preti
Affiliation:
Department of Psychology, University of Cagliari, Cagliari, Italy
P. Rucci
Affiliation:
Department of Psychiatry, Neurobiology, Pharmacology and Biotechnologies, University of Pisa, Pisa, Italy Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
G. Santone
Affiliation:
Psychiatric Clinic, United Hospital of Ancona and Polytechnic University of Marche, Ancona, Italy
A. Picardi
Affiliation:
Mental Health Unit, Centre of Epidemiology, Health Surveillance and Promotion, Italian National Institute of Health, Rome, Italy
R. Miglio
Affiliation:
Faculty of Statistics, University of Bologna, Bologna, Italy
R. Bracco
Affiliation:
Department of Mental Health, ASL Triestina, Trieste, Italy
B. Norcio
Affiliation:
Department of Mental Health, ASL Triestina, Trieste, Italy
G. de Girolamo*
Affiliation:
IRCCS Centro S. Giovanni di Dio-Fatebenefratelli, Brescia, Italy
*
*Address for correspondence: G. de Girolamo, M.D., IRCCS Centro S. Giovanni di Dio-Fatebenefratelli, Brescia, Italy. (Email: [email protected])
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Abstract

Background

A proper understanding of patterns of care represents a crucial step in improving clinical decision making and enhancing service provision. Only a few studies, however, have explored global patterns of psychiatric admissions nationwide, and none have been undertaken in Italy.

Method

Sociodemographic, clinical and treatment-related information was collected for 1577 patients admitted to 130 public and 36 private in-patient facilities in Italy during an index period in the year 2004. All patients were also rated using the 24-item Brief Psychiatric Rating Scale (BPRS) and the Personal and Social Performance (PSP) rating scales.

Results

Non-affective psychoses (36%) were the most common diagnoses and accounted to a large extent for compulsory admissions. Private facilities were more likely to admit patients with organic mental disorders and substance abuse/dependence and less likely to admit patients with non-affective psychoses. Overall, 77.8% of patients had been receiving treatment by a mental health professional in the month prior to admission. In 54% of cases, the admission was solicited by patients' family members. The main factors preceding admission were impairment in work or social functioning, social withdrawal, and conflict with family members. Agitation, delusions and/or hallucinations, and the presence of multiple problems were associated with compulsory admissions, whereas depressive and anxiety symptoms were associated with voluntary admissions.

Conclusions

In a mixed, public–private psychiatric care system, like the Italian one, public and private facilities admit patients with widely different clinical characteristics and needs. Family support represents an important resource for most patients, and interventions specifically addressed to relieving family burden are warranted.

Keywords

Community-based mental healthGeneral Hospital Psychiatric Unitpathways to careschizophreniavoluntary/involuntary patients
Type
Original Articles
Information
Psychological Medicine , Volume 39 , Issue 3 , March 2009 , pp. 485 - 496
Copyright
Copyright © 2008 Cambridge University Press

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