Academic Journal
Determinants of clinical outcome and length of stay in acute care forensic psychiatry units
| Title: | Determinants of clinical outcome and length of stay in acute care forensic psychiatry units |
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| Authors: | D'Orta, Isabella, Weber, Kerstin Maud, Herrmann, François, Giannakopoulos, Panteleimon |
| Source: | BMC Psychiatry BMC Psychiatry, Vol 23, Iss 1, Pp 1-9 (2023) |
| Publisher Information: | Springer Science and Business Media LLC, 2023. |
| Publication Year: | 2023 |
| Subject Terms: | Psychiatry, Research, Mental Disorders, Prison, Acute psychiatric care, RC435-571, Forensic Psychiatry / methods, Length of Stay, Forensic Psychiatry, 16. Peace & justice, Clinical evolution, Mental Disorders / psychology, Patient Discharge, 3. Good health, Detained persons, Hospitalization, 618.97, Psychotic Disorders, 616.89, Humans |
| Description: | Criminological and sociodemographic variables, such as previous criminal convictions, increased risk of violence, early onset of mental disorder, antisocial personality, psychosis and low social support, have all been related to longer length of stay (LoS) and poorer outcome in long stay forensic services. The factors impacting on LoS and clinical response in acute care specialized units are poorly documented. To address this issue, we examined the psychiatric records of all cases admitted between January 1st and December 31th 2020 in the sole acute ward for detained persons located in the central prison of the Geneva County, Switzerland. Information on judicial status included pre-trial versus sentence execution, previous incarcerations, and age of the first incarceration. Sociodemographic data included age, gender, marital status, and education attainment. Previous inpatient stays prior to incarceration were recorded. All of the ICD-10 clinical diagnoses were made by two independent, board-certified psychiatrists blind to the scope of the study. The standardized assessment was based on the HoNOS (Health of Nation Outcome Scales) at admission and discharge, HONOS-secure at admission, HCR-20 (Historical Clinical Risk 20) version 2, PCL-R (Psychopathy Checklist Revised), and SAPROF (Structured Assessment of Protective Factors). Stepwise forward multiple linear regression models predicting the LoS and delta HONOS respectively were built with the above mentioned parameters. The selected variables were then used in univariate and multivariable regression models. Higher HCR-scores (mainly on clinical items), and longer LoS were related to higher delta HONOS scores. In contrast, cases in pre-trial detention showed a worst clinical outcome. In multivariable models, all three variables remained independent predictors of the clinical outcome and explained 30.7% of its variance. Only education and diagnosis of borderline personality were related to the LoS and explained 12.6% of its variance in multivariable models. Our results suggest that the use of acute wards specialized in forensic psychiatry are mainly useful for patients with prior inpatient care experience, and higher violence risk during sentence execution. In contrast, they seem to be less performant for persons in pre-trial detention that could benefit from less restrictive clinical settings. |
| Document Type: | Article Other literature type |
| File Description: | application/pdf |
| Language: | English |
| ISSN: | 1471-244X |
| DOI: | 10.1186/s12888-023-04748-2 |
| Access URL: | https://pubmed.ncbi.nlm.nih.gov/37072743 https://doaj.org/article/1e62b523fff34c048a28a6d4c036739d https://archive-ouverte.unige.ch/unige:174716 https://doi.org/10.1186/s12888-023-04748-2 |
| Rights: | CC BY URL: http://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (http://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (http://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data. |
| Accession Number: | edsair.doi.dedup.....cedf50c3f57383e1c8e6537c0fa00d6d |
| Database: | OpenAIRE |
| ISSN: | 1471244X |
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| DOI: | 10.1186/s12888-023-04748-2 |