Barakat Ansam, Blankers Matthijs, Cornelis Jurgen E, van der Post Louk, Lommerse Nick M, Beekman Aartjan T F, Dekker Jack J M
Department of Research, Arkin Institute for Mental Health Care, Amsterdam, Netherlands.
Department of Psychiatry, Amsterdam University Medical Centres (UMC), Location VUmc, Amsterdam Public Health Research Institute Amsterdam UMC, Amsterdam, Netherlands.
Front Psychiatry. 2021 Feb 5;12:602912. doi: 10.3389/fpsyt.2021.602912. eCollection 2021.
This study aims to determine factors associated with psychiatric hospitalisation of patients treated for an acute psychiatric crisis who had access to intensive home treatment (IHT). This study was performed using data from a randomised controlled trial. Interviews, digital health records and eight internationally validated questionnaires were used to collect data from patients on the verge of an acute psychiatric crisis enrolled from two mental health organisations. Thirty-eight factors were assigned to seven risk domains. The seven domains are "sociodemographic", "social engagement", "diagnosis and psychopathology", "aggression", "substance use", "mental health services" and "quality of life". Multiple logistic regression analysis (MLRA) was conducted to assess how much pseudo variance in hospitalisation these seven domains explained. Forward MLRA was used to identify individual risk factors associated with hospitalisation. Risks were expressed in terms of relative risk (RR) and absolute risk difference (ARD). Data from 183 participants were used. The mean age of the participants was 40.03 (SD 12.71), 57.4% was female, 78.9% was born in the Netherlands and 51.4% was employed. The range of explained variance for the domains related to "psychopathology and care" was between 0.34 and 0.08. The "aggression" domain explained the highest proportion ( = 0.34) of the variance in hospitalisation. "Quality of life" had the lowest explained proportion of variance ( = 0.05). The forward MLRA identified four predictive factors for hospitalisation: previous contact with the police or judiciary (OR = 7.55, 95% CI = 1.10-51.63; ARD = 0.24; RR = 1.47), agitation (OR = 2.80, 95% CI = 1.02-7.72; ARD = 0.22; RR = 1.36), schizophrenia spectrum and other psychotic disorders (OR = 22.22, 95% CI = 1.74-284.54; ARD = 0.31; RR = 1.50) and employment status (OR = 0.10, 95% CI = 0.01-0.63; ARD = -0.28; RR = 0.66). IHT teams should be aware of patients who have histories of encounters with the police/judiciary or were agitated at outset of treatment. As those patients benefit less from IHT due to the higher risk of hospitalisation. Moreover, type of diagnoses and employment status play an important role in predicting hospitalisation.
本研究旨在确定在可获得强化居家治疗（IHT）的情况下，因急性精神危机接受治疗的患者入住精神病院的相关因素。本研究使用了一项随机对照试验的数据。通过访谈、数字健康记录以及八份国际验证问卷，从两个心理健康组织招募的处于急性精神危机边缘的患者中收集数据。38个因素被归入7个风险领域。这7个领域分别是“社会人口统计学”“社会参与”“诊断与精神病理学”“攻击行为”“物质使用”“心理健康服务”和“生活质量”。进行多因素逻辑回归分析（MLRA）以评估这7个领域对住院治疗中伪方差的解释程度。采用向前MLRA来识别与住院相关的个体风险因素。风险以相对风险（RR）和绝对风险差异（ARD）表示。使用了183名参与者的数据。参与者的平均年龄为40.03岁（标准差12.71），57.4%为女性，78.9%出生于荷兰，51.4%有工作。与“精神病理学与护理”相关领域的解释方差范围在0.34至0.08之间。“攻击行为”领域对住院治疗中方差的解释比例最高（=0.34）。“生活质量”的解释方差比例最低（=0.05）。向前MLRA确定了四个住院治疗的预测因素：既往与警方或司法部门有过接触（比值比=7.55，95%置信区间=1.10 - 51.63；ARD = 0.24；RR = 1.47）、激动（比值比=2.80，95%置信区间=1.02 - 7.72；ARD = 0.22；RR = 1.36）、精神分裂症谱系及其他精神病性障碍（比值比=22.22，95%置信区间=1.74 - 284.54；ARD = 0.31；RR = 1.50）以及就业状况（比值比=0.10，95%置信区间=0.01 - 0.63；ARD = -0.28；RR = 0.66）。IHT团队应留意那些有与警方/司法部门接触史或在治疗开始时就激动的患者。因为这些患者因住院风险较高而从IHT中获益较少。此外，诊断类型和就业状况在预测住院方面起着重要作用。
