Department of Psychiatry, Tri-Service General Hospital, Taipei, Taiwan.
Department of Pharmacy Practice, Tri-Service General Hospital, Taipei, Taiwan; School of Pharmacy, National Defense Medical Center, Taipei, Taiwan; Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan; School of Public Health, National Defense Medical Center, Taipei, Taiwan.
Schizophr Res. 2023 Apr;254:68-75. doi: 10.1016/j.schres.2023.02.002. Epub 2023 Feb 15.
This study aimed to identify risk factors for involuntary referral by police to emergency room (ER) psychiatric services for community-based patients with a mental illness via a generalized estimating equation (GEE) analysis. The analysis was based on data from the Management Information System of Psychiatric Care (MISPC) system for patients with a severe mental illness in Taipei, Taiwan and registered referral records of the police. Data on 6378 patients aged ≥20 years were used in this study, including 164 patients who were involuntarily referred to the ER by the police and 6214 patients who were not during the period of January 1, 2018 to December 31, 2020. GEEs were utilized to explore possible risk factors of repeated involuntary referral to ER psychiatric services for patients with a severe mental illness. The logistic regressions indicated that patients defined as "severe" according to the Mental Health Act of Taiwan (crude odds ratio (OR): 3.840, 95 % confidence interval (CI): 2.407-6.126), with a disability (crude OR: 3.567, 95 % CI: 1.339-9.501), with two or more family members with a psychiatric disorder (crude OR: 1.598, 95 % CI: 1.002-2.548), with a history of a suicide attempt (crude OR: 25.582, 95 % CI: 17.608-37.167), and with a history of domestic violence (crude OR: 16.141, 95 % CI: 11.539-22.579) were positively associated with involuntary referral to ER psychiatric services. However, age (crude OR: 0.971, 95 % CI: 0.960-0.983) and the MISPC score (crude OR: 0.834, 95 % CI: 0.800-0.869) were inversely associated with involuntary referral to ER psychiatric services. After adjusting for demographics and potential confounders, we found that patients defined as "severe" (Exp (β): 3.236), with a disability (Exp (β): 3.715), with a history of a suicide attempt (Exp (β): 8.706), and with a history of domestic violence (Exp (β): 8.826), as well as age (Exp (β): 0.986) and the MISPC score (Exp (β): 0.902) remained significantly associated with repeated involuntary referral to ER psychiatric services. In conclusion, community-based mentally ill patients with a history of a suicide attempt, with a history of domestic violence, with a severe illness, and with a profound level of disability were highly associated with involuntary referral to ER psychiatric services. We suggest that community mental health case managers identify significant factors associated with involuntary referral to ER psychiatric services to accordingly arrange case management plans.
本研究旨在通过广义估计方程（GEE）分析，确定社区精神疾病患者因非自愿被警察转介至急诊室（ER）精神科服务的风险因素。该分析基于台湾台北市严重精神疾病患者的精神保健管理信息系统（MISPC）系统和警察登记的转介记录中的数据。本研究使用了 6378 名年龄≥20 岁的患者数据，其中包括 164 名因警察非自愿转介至 ER 的患者和 6214 名未转介的患者。GEE 用于探索严重精神疾病患者重复非自愿转介至 ER 精神科服务的可能风险因素。逻辑回归表明，根据《台湾精神卫生法》定义为“严重”的患者（粗比值比（OR）：3.840，95%置信区间（CI）：2.407-6.126）、有残疾（粗 OR：3.567，95% CI：1.339-9.501）、有两个或更多有精神疾病家族成员（粗 OR：1.598，95% CI：1.002-2.548）、有自杀企图史（粗 OR：25.582，95% CI：17.608-37.167）和有家庭暴力史（粗 OR：16.141，95% CI：11.539-22.579）与非自愿转介至 ER 精神科服务呈正相关。然而，年龄（粗 OR：0.971，95% CI：0.960-0.983）和 MISPC 评分（粗 OR：0.834，95% CI：0.800-0.869）与非自愿转介至 ER 精神科服务呈负相关。在调整人口统计学和潜在混杂因素后，我们发现被定义为“严重”的患者（Exp（β）：3.236）、有残疾（Exp（β）：3.715）、有自杀企图史（Exp（β）：8.706）和有家庭暴力史（Exp（β）：8.826），以及年龄（Exp（β）：0.986）和 MISPC 评分（Exp（β）：0.902）与重复非自愿转介至 ER 精神科服务仍显著相关。总之，有自杀企图史、有家庭暴力史、病情严重、残疾程度深的社区精神疾病患者与非自愿转介至 ER 精神科服务高度相关。我们建议社区精神卫生个案管理者识别与非自愿转介至 ER 精神科服务相关的重要因素，以相应地安排个案管理计划。
