Kallert Thomas W, Glöckner Matthias, Schützwohl Matthias
Department of Psychiatry and Psychotherapy, University Hospital, Dresden University of Technology, Dresden, Germany.
Eur Arch Psychiatry Clin Neurosci. 2008 Jun;258(4):195-209. doi: 10.1007/s00406-007-0777-4.
This article systematically reviews the literature on the outcome of acute hospitalization for adult general psychiatric patients admitted involuntarily as compared to patients admitted voluntarily. Inclusion and exclusion criteria qualified 41 out of 3,227 references found in Medline and PSYNDEXplus literature searches for this review. The authors independently rated these articles on six pre-defined indicators of research quality, carried out statistical comparisons ex-post facto where not reported, and computed for each adequate result the effect size index d for the comparison of means, and the Phi- or contingency coefficient for cross-tabulated data. Methodological quality of the studies, coming mostly from North American and European countries, showed significant variation and was higher concerning service-related than clinical or subjective outcomes. Main deficits appeared in sample size estimation, lack of clear follow-up time-points, and the absence of standardized instruments used to assess clinical outcomes. Length of stay, readmission risk, and risk of involuntary readmission were at least equal or greater for involuntary patients. Involuntary patients showed no increased mortality, but did have higher suicide rates than voluntary patients. Further, involuntary patients demonstrated lower levels of social functioning, and equal levels of general psychopathology and treatment compliance; they were more dissatisfied with treatment and more frequently felt that hospitalization was not justified. Future methodologically-sound studies exploring this topic should focus on patient populations not represented here. Further research should also clarify if the legal admission status is sufficiently valid for differentiating the outcome of acute hospitalization.
本文系统回顾了关于成年普通精神科患者非自愿入院与自愿入院相比的急性住院治疗结果的文献。在Medline和PSYNDEXplus文献检索中找到的3227篇参考文献中，纳入和排除标准筛选出41篇用于本综述。作者根据六个预先定义的研究质量指标对这些文章进行独立评分，在未报告的情况下进行事后统计比较，并为每个充分的结果计算均值比较的效应大小指数d，以及交叉列表数据的Phi系数或列联系数。这些研究大多来自北美和欧洲国家，其方法学质量存在显著差异，与服务相关的结果方面的质量高于临床或主观结果方面。主要缺陷在于样本量估计、缺乏明确的随访时间点以及缺乏用于评估临床结果的标准化工具。非自愿患者的住院时间、再入院风险和非自愿再入院风险至少与自愿患者相当或更高。非自愿患者的死亡率没有增加，但自杀率高于自愿患者。此外，非自愿患者的社会功能水平较低，一般精神病理学水平和治疗依从性水平相当；他们对治疗更不满意，更频繁地认为住院不合理。未来对该主题进行方法学上合理的研究应关注此处未涉及的患者群体。进一步的研究还应阐明法律入院状态是否足以有效区分急性住院治疗的结果。
