1. Differences between the groups Results: Adult Characteristics
Influence of adults, clinicians, and environments upon type of psychiatric hospitalization
Christine R. Wydeen, Ph.D.
Introduction
Method (cont’d)
Differences between the groups
Conclusion
The costs associated with the psychiatric hospitalization of adults are immense (Geppert, 2003; Murray & Lopez, 1996)
Personal losses from mental illness to the adult and the current system of care are being calculated (Stein et al., 2005)
PA goals are that no adult should be involuntarily hospitalized >2/year
Predictor variables have been identified leading to an adult’s first and subsequent psychiatric hospitalization (Arfken et al., 2002)
The role of ED utilization by this population, and description of unmet needs within the literature (Gibbons et al., 2005; Hackman et al., 2006; Stanton, 2007)
The variables within the adult, the assessing clinician, and the environment speak to the complexity of the process leading to hospitalization (Walsh et al., 2005)
To inform clinicians and policy makers, the study describes the differences between the 2 groups; identifies which variables are most important in predicting probability of involuntary hospitalization
Dependent Variable: Hospitalization Type (Voluntary/Involuntary)
Analyses: Chi-square to investigate the differences between the groups (voluntary vs. involuntary): see Table 2.
Multiple logistic regression analyses of those variables with significant beta weights (age group, symptom manifestation, and diagnosis) conducted to predict the probability of involuntary hospitalization
Table 2.
Better understanding of the factors associated with depression in the young adult, the potential life and earning potential lost due to mental illness is needed (Geppert, 2003)
The regression model that included age group, symptom manifestation, and diagnostic categories correctly classified 80% of the cases into the involuntary group: noting significant change in the likelihood for those age and 65+
Future research is needed to better understand the complexity of the clinical assessment process as an opportunity to divert hospitalization once an adult presents to an ED
Efforts must be made to ensure that behavioral health services are well integrated into the community, and that decreasing in-patient utilization is offset by the increased 24-hour community based services responsive to those they serve (Stein et al., 2005)
Variable n OR p-value
Age (yrs) <.001
18 –
45 –
Symptom Manifestation <.001
Intrinsic
Extrinsic
Both
Diagnosis <.001
Depressive Disorder
Bipolar Disorder
Schizophrenia
Dementia
Results: Adult Characteristics
Table 1.
Variable n___
Total
Gender
Female
Male
Age (yrs)
County A B C
Other
Symptom Manifestation
Extrinsic
Intrinsic
Both
Diagnosis
Depressive Disorder 937
Bipolar Disorder
Schizophrenia
Psychotic Disorders 129
Anxiety Disorders
Dementia
Hx. of Prior Hospitalization No
Yes
Voluntary Admissions
Involuntary Admissions
_________________________________________
Those 65+ were involuntarily hospitalized 49% of the time, all other age categories had a much greater percentage within the voluntary category
Adults classified as presenting intrinsic symptom manifestation had 84% voluntary admissions
Dementia led to involuntary hospitalization over 94% of the time
49% male, 51% female
43% between the ages of 18 – 34; 5% were 60+
82% presented with intrinsic symptom manifestation (behaviors directed toward self harm)
54% diagnosed with Depressive Disorder
75% of the admissions occurred thru one agency
72% occurred from ED’s after normal agency business hours: 77% voluntary, 23% involuntary
78% were voluntary admissions; 22% involuntary
47% had a history of prior hospitalization
Clinician Sample (43): 9 accounted for 70% of the admissions – 5/9 were BA; 58% had Masters and completed 30% of the assessments; 40% BA’s did 58%. Of the total, 42% had 11+ yrs. experience
References
Arfken, C.J., Zeman, L.L., Yeager, L., Mischel, E. & Amirsadri, A. (2002). Frequent visitors to psychiatric emergency services: staff attitudes and temporal patterns. Journal of Behavioral Health Services & Research 29:
Geppert, C.M.A. (2003). Lost years. Psychiatric Times 20:26-28.
Gibbons,C., Bedard, M., & Mack, G. (2005). A comparison of client and mental health worker assessment of needs and unmet needs. Journal of Behavioral Health Services & Research 32:
Hackman, A.L., Goldberg, R.W., Brown, C.H., Fang, L.J., Dickerson, F.B., Wohlheiter, K., Medoff, D.R., Kreyenbuhl, J.A., & Dixon, L. (2006). Use of emergency department services for somatic reasons by people with serious mental illness. Psychiatric Services 57:
Murray, C.J.L. & Lopez, A.D. (1996). The global burden of disease. Cambridge, Mass.: Harvard School of Public Health.
Stanton, K. (2007). Communicating with ED patients who have chronic mental illnesses. American Journal of Nursing 107:61-65.
Stein, C.H., Dworsky, D.O., Phillips, R.E., & Hunt, M.G. (2005). Measuring personal loss among adults coping with serious mental illness. Community Mental Health Journal 41:
Walsh, J., Green, R., Matthews, J., & Bonucelli-Puerto, B. (2005). Social Workers’ views of the etiology of mental disorders: results of a national study. Social Work 50:43-53.
Method
Sample and data source:
Using administrative data from a 3-County MH/MR Administrative Unit, identified 1724 adults hospitalized within a 12-month period in PA
At the time of the study, all admissions passed through this county authorizing unit
Sample of 43/59 (73%) clinicians that completed the clinical assessments that led to the hospitalization approval by the attending physician was also included
Variables of interest:
Within the adult: see Table 1.
Clinician variables included educational background/area of concentration, experience, and proportion of admissions within the 12-month period
Environmental variables included setting, date, and time
Disclosure of Interest: Dr. Wydeen is affiliated with Community Care Behavioral Health Organization (570) ;