Department of Psychiatry, LWL-University Hospital Bochum, Alexandrinenstr. 1, 44791, Bochum, Germany.
Eur Child Adolesc Psychiatry. 2014 Mar;23(3):151-61. doi: 10.1007/s00787-013-0440-8. Epub 2013 Jun 21.
Involuntary psychiatric admission is a central issue in mental health care, especially in the treatment of children and adolescents. Its legal regulations do not only differ between European countries, but also on a federal level. Only few studies so far dealt with rates of involuntary admission (RIA), mainly focusing on adults, rather than children and adolescents. None of the studies analyzed this topic in a large cohort. The aim of this regional cross-sectional study was to compare voluntary and involuntary admissions in child and adolescent psychiatry (CAP) regarding personal and admission characteristics. Furthermore, risk factors and predictors of involuntary admission should be identified. A retrospective analysis of hospital admission registers from three major German CAP hospitals over a period of 6 years (2004-2009) was conducted (N = 10,547 inpatients). Group comparisons between involuntarily and voluntarily treated minors and a logistic regression to determine predictors of legal status were performed. Information on harm to self or others prior to the admission, medication and clinical outcome was not available due to data structure. 70.8 % of patients were voluntarily and 29.2 % involuntarily admitted. Both subsamples comprised more males. The RIA decreased consistently over the years, ranging from 25.7 to 32.4 %. The strongest predictor of being admitted involuntarily was suffering from mental retardation (OR = 15.74). Adolescence, substance abuse, psychotic disorders and admission on duty time were also strongly associated (OR > 3). In this first large cohort study on involuntary treatment of children and adolescents in Germany, about every fourth patient was treated involuntarily. Certain personal and disease-related factors increased the risk. Commitment laws and other legal instruments for regulating involuntary placements are inconsistent and a standardized description or systematic analysis is needed. The influence of demographic, institutional variables and care and health services aspects should also be investigated.
非自愿住院治疗是精神卫生保健的核心问题，尤其是在儿童和青少年的治疗中。其法律规定不仅在欧洲国家之间存在差异，而且在联邦层面上也存在差异。到目前为止，只有少数研究涉及非自愿住院率（RIA），主要集中在成年人，而不是儿童和青少年。没有一项研究在大样本中分析过这个问题。本区域横断面研究的目的是比较儿童和青少年精神病学（CAP）中自愿和非自愿住院治疗的个人和入院特征。此外，还应确定非自愿住院的风险因素和预测因素。对三家德国主要 CAP 医院的住院登记处进行了为期 6 年（2004-2009 年）的回顾性分析（共 10547 名住院患者）。对非自愿和自愿接受治疗的未成年人进行组间比较，并进行逻辑回归以确定法律地位的预测因素。由于数据结构的原因，入院前自我伤害或伤害他人、用药和临床结果的信息不可用。70.8%的患者为自愿住院，29.2%为非自愿住院。两个亚组都有更多的男性。RIA 逐年持续下降，范围从 25.7%到 32.4%。非自愿入院的最强预测因素是智力迟钝（OR=15.74）。青春期、物质滥用、精神病性障碍和值班入院也与（OR>3）密切相关。这是德国第一份关于儿童和青少年非自愿治疗的大型队列研究，约四分之一的患者接受了非自愿治疗。某些个人和与疾病相关的因素增加了风险。管理非自愿安置的承诺法和其他法律文书不一致，需要进行标准化描述或系统分析。还应调查人口统计学、机构变量以及护理和卫生服务方面的影响。
