Admission Patterns Of Patients With Mental Disorder And Its Relevant Factors

Objective:To investigate the different admission patterns of patients with mental disorder and understand its relevant factors before the implementation of the Chinese Mental Health Law.Methods:Subjects admitted consectively to the psychiatric department of the second Xiangya Hospital, Central South University from July26th2012to September10th2012were recruited in the current study. A self-developed questionnaire was used to investigate all socio-demographic data and clinical information of the patients within48hours on admission by interviewing the patients and their family members. The patients whose duration of hospitalization was less than24hours were excluded in this study. The diagnoses meet the criteria of ICD-10(International Classification of Diseases, tenth version) made by the psychiatrists. The data of259patients were qualified for the statistic analysis in the current study.Results:1.259patients (male117, female142) participated in the present study. They were divided into two groups based on different ward,99patients (38.2%) were admitted to the open-door ward,160patients (61.8%) were admitted to the locked-door ward. 2. The mean age of the patients in open-door ward (38.20±17.23) was significantly higher than that in locked-door ward (29.96±11.87)(P <0.01). There were also significant differences in household average monthly income (P=0.040), residential place (P=0.013), marital status(P=0.03) and occupational categories (P<0.01) between the two groups, but no difference ststistically was found in gender, educational level and medical insurance (P>0.05).3. The total numbers of previous admission to the psychiatric facility of the patients in open-door ward (1.69±1.22) were significantly less than that in locked-door ward (2.21±1.79)(P=0.011), but no significant difference was found in duration of illness (P=0.253). The medication adherence prior to admission of the patients in the open-door ward was better than that in the locked-door ward (P<0.01). The total score of MOAS (3.06±5.59), SDSS (8.32±4.52) and BPRS (39.65±9.00) of the patients in open-door ward was significantly lower than that in locked-door ward (9.21±8.42;10.57±4.88;49.10±10.76) respectively (P <0.01). There was significant difference in diagnoses between two groups (P<0.01), the patients in open-door ward are diagnosed as less schizophrenics and bipolar disorder and more depression and neurosis than that in locked-door ward. The total score of SSICA (21.15±7.19) and ITAQ (13.79±5.50) of the patients in open-door ward was significantly higher than that in locked-door ward (8.65±9.25;5.70±6.15) respectively (P<0.01).4. Based on the Chinese Mental Health Law,176patients met the definition of severe psychoses. Of them,117patients (66.5%) met the criterion for involuntary admission. The rate of the involuntary admission in the open-door and locked-door ward was19.2%and61.2%respectively.5. Stepwise logistic regression analysis showed that diagnoses, medication adherence, total scores of MOAS, SDSS, BPRS and ITAQ were the major relevant factors of admission patterns in patients with mental disorder (χ2=153.049, P<0.01), but total scores of MOAS and ITAQ were the major factors of involuntary admission in patients with mental disorder (χ2=125.414, P<0.01).6. There was significant difference in total scores of SSICA and ITAQ among schizophrenics (respectively10.18±9.98,6.62±6.37), mood disorders (respectively15.64±10.7,10.27±7.23) and patients with neurosis (respectively20.50±6.74,14.10±6.14)(P<0.05), but no significant difference was found between depressed patients (respectively19.42±9.11,13.16±5.78) and patients with neurosis(P>0.5). There was also significant difference in total scores of SSICA and ITAQ between patients whose total score of BPRS greater than35(respectively12.37±10.36,8.23±6.94) and those less than or equal to35(respectively18.73±9.36,11.98±7.02)(P<0.01). Conclusions:1. The findings showed that the involuntary admission to general hospital was the major pattern of the patients with mental disorder in Hunan province before the implementation of Chinese Mental Health Law. Currently the involuntary admission rate is61.8%.2.38.8percent of the patients in locked-door ward did not meet the criterion for involuntary hospitalization before the implementation of Chinese Mental Health Law.3. Diagnoses, medication adherence, dangerousness, informed consent competence, insight to the illness, severity of mental symptoms and social disability were the major relevant factors of admission patterns in patients with mental disorder, but dangerousness and insight were the major factors of involuntary admission in patients with mental disorder.4. The competence of informed consent and insight into illness were different on the diagnostic categories and severity of illness.