Brieger P, Kling Lourenço P, Steinert T, Längle G, Lemke U, Herpertz S C, Croissant D, Becker T, Kilian R
Bezirkskrankenhaus Kempten, Akademisches Lehrkrankenhaus der Universität Ulm, Freudental 1, 87435, Kempten (Allgäu), Deutschland,
Nervenarzt. 2014 May;85(5):606-13. doi: 10.1007/s00115-013-3865-x.
There is considerable variance in involuntary psychiatric hospital admission rates both in Europe and Germany. In a prospective comparison between five hospitals in three German federal states we assessed and analyzed involuntary psychiatric hospital admissions, including the patient's perspective.
All involuntarily admitted patients were assessed by an independent researcher. Clinical data, patient and psychiatrist views were documented with different instruments including the McArthur admission experience survey.
In this study 104 out of 244 involuntarily admitted patients gave informed consent. We found considerable differences between study centres concerning involuntary admission quotas (3.2-25.8% of all hospital admissions) and involuntary admission rates (16.6-97.6 per year per 100,000 inhabitants). Hospitals in the state of Baden-Württemberg had the lowest involuntary admission rates while they were highest in Bavaria. In Baden-Württemberg involuntarily admitted patients were more likely to suffer from chronic schizophrenia, they were more severely ill and experienced the involuntary hospital admission as more strenuous. There were no differences between centres concerning frequency of dangerous behavior or self-harm.
We found a high variance across regions concerning the reasons for, frequencies and legal basis of involuntary hospital admissions. Regional differences of legal frameworks and service organization can explain this only to a limited amount. Transparency, legal certainty and reflection of stakeholder roles are a future necessity. Furthermore, there is a need for stringent compliance with legal regulations and coherent documentation.
在欧洲和德国，非自愿精神病院住院率存在相当大的差异。在德国三个联邦州的五家医院进行的一项前瞻性比较中，我们评估并分析了非自愿精神病院住院情况，包括患者的观点。
所有非自愿入院患者均由一名独立研究人员进行评估。临床数据、患者和精神科医生的观点通过不同工具记录，包括麦克阿瑟入院体验调查。
在本研究中，244名非自愿入院患者中有104名给予了知情同意。我们发现各研究中心在非自愿住院配额（占所有医院住院人数的3.2 - 25.8%）和非自愿住院率（每10万居民每年16.6 - 97.6例）方面存在显著差异。巴登 - 符腾堡州的医院非自愿住院率最低，而巴伐利亚州最高。在巴登 - 符腾堡州，非自愿入院患者更易患慢性精神分裂症，病情更严重，且认为非自愿住院更费力。各中心在危险行为或自我伤害频率方面无差异。
我们发现不同地区在非自愿住院的原因、频率和法律依据方面存在很大差异。法律框架和服务组织的地区差异只能部分解释这一现象。透明度、法律确定性和利益相关者角色的反思是未来的必要条件。此外，需要严格遵守法律法规并进行连贯记录。
