Comparison of adolescent referred involuntarily or voluntarily to psychiatric hospitalization

Abstract

Purpose of the study

To study in an adolescent clinical inpatient population how clinical, background and psychological factors differ between adolescents referred voluntarily or involuntarily.

Methods

In this prospective cohort study, we compared adolescents (age 13–17 years, n = 206) who had been referred to psychiatric hospitalization for the first time in their life either voluntarily (n = 144) or involuntarily (n = 62). We gathered from clinical records data on the source, mode and reason for referral as well as on whether after referral the subjects were admitted to the hospital voluntarily or not, and whether they were committed to involuntary hospitalization after the observation period. Diagnostics was based on Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version (K-SADS-PL) interview, supplemented by information from clinical records. Structured self-reports provided information on family background, depressive symptoms, substance use, defense styles, self-image and perceived social support.

Results

The majority of referrals due to psychotic symptoms were involuntary, whereas self-harm was the primary reason for involuntary and voluntary referrals in comparable extent. After diagnostic evaluation, no significant difference in psychotic disorders was observed between the two groups, but anxiety disorders were more prevalent among inpatients referred voluntarily than involuntarily. Among adolescents referred involuntary, parents were more often unemployed and had mental health problems. In self-assessments, mature defense style and more positive self-image were associated with adolescents referred involuntarily compared with those referred voluntarily.

Conclusions

Not only psychiatric but also psychological and social factors were associated with involuntary referral for psychiatric hospitalization in adolescents.

Keywords:

• Adolescent
• involuntary psychiatric hospitalization
• psychotic symptoms
• self-harm

Acknowledgements

The authors are thankful to Dr Kirsi Kettunen for participating in designing and conducting the original KAIFUS study and for participating in supervision of diagnostics. The authors warmly thank all the personnel at the Kellokoski adolescent psychiatric ward who took care of the patients and were involved in gathering data for this study.

Ethics approval and consent to participate and for publication

The Ethics Committee of the Helsinki University Hospital approved the study protocol (June, 20, 2006, decision reference Dnro HUS 228/E7/06), and the institutional authority at the Hyvinkää Hospital Area gave permission to conduct the study. The study has been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

All participants and their legal guardians gave written informed consent to participate and for publication of study results after having received verbal and written information about the study.

Author contributions

HH, NL and MM (together with Dr. Kirsi Kettunen) designed and conducted the original clinical KAIFUS study. HH and M.R-M have gathered and managed the original data. EMS and MM designed the current study. EMS conducted the analyses, interpreted the results and prepared the manuscript. All authors have participated in the preparation of the manuscript and have approved the final version of the manuscript. All authors have had full access to all the data in the study. EMS takes responsibility for the integrity of the data and the accuracy of the data analysis.

Disclosure statement

No potential conflict of interest was reported by the authors.

Data availability statement

The datasets used and analysed during the current study are available from the corresponding author on reasonable request.

Additional information

Funding

The study was funded by the Helsinki University Hospital (HUH) Research funding. The original KAIFUS study was funded also by Hyvinkää Hospital District of HUS. The funding institution was not involved in any stage of the study i.e. not in the study design, the collection, analysis and interpretation of data, in the writing of the report nor in the decision to submit an article for publication.

Notes on contributors

Emma M. Savilahti

E.M.S. got her education as MD, PhD and adolescent psychiatrist at the University of Helsinki, where she is also currently finishing studies in cognitive psychotherapy. Her scientific research so far has been mainly in pediatric immunology. She currently works as a clinician in an adolescent psychiatric outpatient clinic.

Henna Haravuori

N.C.L. works as a professor at the University of Helsinki, and as a chief psychiatrist at the Helsinki University Hospital, Department of Forensic Psychiatry. She is also a family therapist.

Minna Rytilä-Manninen

M.M. works as a professor emeritus at the University of Helsinki. He contributes to research in adolescent psychiatry and psychotherapy. He is a psychotherapist.

Nina Lindberg

M.R-M, PhD, is nurse manager at the Helsinki University Hospital, adolescent psychiatric ward.

Mauri Marttunen

H.H. got her education as MD, PhD and adolescent psychiatrist at the University of Helsinki. Her scientific research is focused on adolescent mental health. She currently works in an adolescent psychiatric outpatient clinic and private practise.