Castelpietra Giulio, Guadagno Silvia, Pischiutta Livia, Tossut Davide, Maso Elisa, Albert Umberto, Balestrieri Matteo
Outpatient and Inpatient Care Service, Central Health Directorate, Friuli Venezia Giulia Region, Trieste.
Udine Nord Community Mental Health Centre, Mental Health Department, Friuli Centrale Healthcare Agency, Udine.
J Public Health Res. 2021 Aug 5;11(1):2382. doi: 10.4081/jphr.2021.2382.
To compare the characteristics of compulsory admissions (CAs) and voluntary admissions (VAs) in a General Hospital Psychiatric Unit (GHPU), and to assess whether CA and VA patients' outcomes improved during hospitalisation and follow-up in mental health services (MHS) based on community continuity of care.
Observational longitudinal study comparing 19 CAs and 83 VAs consecutively admitted to GHPU of Udine, Italy, and followed up for six months by MHS. Five psychometric scales assessed psychosocial and clinical characteristics for each patient at admission (T0), discharge (T1) and follow-up (T2). Statistical analyses were performed using: multivariate logistic regression for comparing CA and VA; Friedman χ2 and Mann-Whitney tests for outcomes' improvement.
Being hospitalised for a psychotic crisis was the most significant predictor of CA (OR = 5.07). An outcomes' improvement was observed from T0 to T1 in almost all psychometric tests, while from T1 to T2 only for PSP-A (useful social activities), CGI-S (severity of illness) and CGI-EI (drug's efficacy related to side effects). CA was associated to lower performances in all scales at T0, in GAF and CGI-S at T1, while no difference with VA was observed at T2.
CA and VA patients improved to a same extent during hospitalisation and follow-up, particularly in relation to social functioning. This fosters the hypothesis that community-based MHS using a longitudinal continuity of care model might achieve recovery in a long-term perspective. Future research may benefit by considering patients' subjective experiences and assessing long-term improvement in those who received person-centred interventions.
比较综合医院精神科病房（GHPU）中强制入院（CA）和自愿入院（VA）的特征，并基于社区连续性护理评估CA和VA患者在住院期间及精神卫生服务（MHS）随访中的结局是否有所改善。
观察性纵向研究，比较意大利乌迪内GHPU连续收治的19例CA患者和83例VA患者，并由MHS进行为期6个月的随访。使用五个心理测量量表评估每位患者入院时（T0）、出院时（T1）和随访时（T2）的心理社会和临床特征。采用以下方法进行统计分析：多因素逻辑回归比较CA和VA；Friedman χ2检验和Mann-Whitney检验评估结局改善情况。
因精神病性危机住院是CA最显著的预测因素（OR = 5.07）。几乎所有心理测量测试中，从T0到T1观察到结局有所改善，而从T1到T2仅在PSP-A（有用的社会活动）、CGI-S（疾病严重程度）和CGI-EI（药物疗效与副作用相关）方面有所改善。CA在T0时所有量表的表现较低，在T1时GAF和CGI-S较低，而在T2时与VA无差异。
CA和VA患者在住院期间及随访中改善程度相同，尤其是在社会功能方面。这支持了这样一种假设，即采用纵向连续性护理模式的基于社区的MHS从长期来看可能实现康复。未来的研究可通过考虑患者的主观体验并评估接受以患者为中心干预的患者的长期改善情况而受益。
