Viinamäki H, Tienari P, Niskanen L, Niskanen M, Leppävuori A, Hiltunen P, Rahikkala H, Herzog T, Malt U F, Lobo A, Huyse F J
Department of Psychiatry, Kuopio University Hospital, Finland.
Acta Psychiatr Scand. 1998 Jan;97(1):47-54. doi: 10.1111/j.1600-0447.1998.tb09962.x.
The aim of this paper was to explore the factors necessitating psychiatric hospital care in a Finnish multi-centre study of general hospital in-patients referred for psychiatric consultation. The study group consisted of 1251 patients referred to psychiatric hospital (n = 181) and a comparison group (n = 1070) consisting of subjects who were not referred. Differences between groups were studied by univariate analysis. Logistic regression analysis was used both to assess the factors contributing to referral to psychiatric hospital and to create predictive models. The validity of the models was analysed by means of receiver operating characteristic (ROC) curves in an independent sample. Psychiatric hospital care during the previous 5 years was associated with a 3.7-fold (odds ratio) increased risk of hospitalization. A diagnosis of psychosis was associated with a 2.9-fold increased risk, and attempted suicide as a reason for consultation was associated with a 2.1-fold increased risk. Not being married doubled the risk, and the odds ratio was also high in cases of poor psychosocial functioning (as assessed by Global Assessment of Functioning (GAF) score). The predictive model differentiated reasonably well between those patients who were hospitalized and the other patients. In conclusion, this multi-centre study of factors predictive of referral to psychiatric hospital among general hospital patients revealed that the most important determinants were previous psychiatric care, diagnosis of psychosis or severe depression, attempted suicide, being unmarried, and poor psychosocial functioning as assessed by GAF score.
本文旨在通过一项针对芬兰多中心综合医院住院患者进行精神科会诊的研究，探索需要精神科住院治疗的因素。研究组包括1251名被转诊至精神科医院的患者（n = 181），以及一个由未被转诊的受试者组成的对照组（n = 1070）。通过单因素分析研究组间差异。采用逻辑回归分析来评估促成转诊至精神科医院的因素，并建立预测模型。通过独立样本中的受试者工作特征（ROC）曲线分析模型的有效性。过去5年中接受过精神科住院治疗会使住院风险增加3.7倍（优势比）。精神病诊断会使风险增加2.9倍，因自杀未遂前来会诊会使风险增加2.1倍。未婚会使风险加倍，心理社会功能差（通过功能总体评定量表（GAF）评分评估）的情况优势比也很高。该预测模型能够较好地区分住院患者和其他患者。总之，这项针对综合医院患者转诊至精神科医院预测因素的多中心研究表明，最重要的决定因素是既往精神科治疗、精神病或重度抑郁症诊断、自杀未遂、未婚以及通过GAF评分评估的心理社会功能差。
