Original Articles

Patterns of admission to acute psychiatric in-patient facilities: a national survey in Italy

A. Preti^a1, P. Rucci^a2a3, G. Santone^a4, A. Picardi^a5, R. Miglio^a6, R. Bracco^a7, B. Norcio^a7 and G. de Girolamo^a8 c1

for the PROGRES-Acute Group

†

^a1 Department of Psychology, University of Cagliari, Cagliari, Italy

^a2 Department of Psychiatry, Neurobiology, Pharmacology and Biotechnologies, University of Pisa, Pisa, Italy

^a3 Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA

^a4 Psychiatric Clinic, United Hospital of Ancona and Polytechnic University of Marche, Ancona, Italy

^a5 Mental Health Unit, Centre of Epidemiology, Health Surveillance and Promotion, Italian National Institute of Health, Rome, Italy

^a6 Faculty of Statistics, University of Bologna, Bologna, Italy

^a7 Department of Mental Health, ASL Triestina, Trieste, Italy

^a8 IRCCS Centro S. Giovanni di Dio-Fatebenefratelli, Brescia, Italy

Abstract

Background A proper understanding of patterns of care represents a crucial step in improving clinical decision making and enhancing service provision. Only a few studies, however, have explored global patterns of psychiatric admissions nationwide, and none have been undertaken in Italy.

Method Sociodemographic, clinical and treatment-related information was collected for 1577 patients admitted to 130 public and 36 private in-patient facilities in Italy during an index period in the year 2004. All patients were also rated using the 24-item Brief Psychiatric Rating Scale (BPRS) and the Personal and Social Performance (PSP) rating scales.

Results Non-affective psychoses (36%) were the most common diagnoses and accounted to a large extent for compulsory admissions. Private facilities were more likely to admit patients with organic mental disorders and substance abuse/dependence and less likely to admit patients with non-affective psychoses. Overall, 77.8% of patients had been receiving treatment by a mental health professional in the month prior to admission. In 54% of cases, the admission was solicited by patients' family members. The main factors preceding admission were impairment in work or social functioning, social withdrawal, and conflict with family members. Agitation, delusions and/or hallucinations, and the presence of multiple problems were associated with compulsory admissions, whereas depressive and anxiety symptoms were associated with voluntary admissions.

Conclusions In a mixed, public–private psychiatric care system, like the Italian one, public and private facilities admit patients with widely different clinical characteristics and needs. Family support represents an important resource for most patients, and interventions specifically addressed to relieving family burden are warranted.

(Received June 25 2007)

(Revised April 10 2008)

(Accepted April 15 2008)

(Online publication June 26 2008)

Key Words:

• Community-based mental health;
• General Hospital Psychiatric Unit;
• pathways to care;
• schizophrenia;
• voluntary/involuntary patients

Correspondence:

^c1 Address for correspondence: G. de Girolamo, M.D., IRCCS Centro S. Giovanni di Dio-Fatebenefratelli, Brescia, Italy. (Email: gdegirolamo@fatebenefratelli.it)

Footnotes

† For members of the PROGRES-Acute Group see the Appendix.