Compulsory and voluntary admissions in comparison: A 9-year long observational study
Open accessAbstract
Background: Few studies, so far, have been specifically designed to highlight the features related to Compulsory Admissions (CA) and Voluntary Admissions (VA) in Italian psychiatric emergency wards. Aims: The main purpose of this observational study was to compare the sociodemographic and clinical characteristics of VA and CA and to explore possible predictors of re-admissions. Methods: During a 6-month Index Period (February, the 1st–July, the 31st 2008) all psychiatric admissions were documented and then followed-up through all available informatic systems for the next 9 years. Results: Out of 390 hospitalizations, 101 (25.9%) were compulsory (CA rate was 2.79 per 10,000 inhabitants per year, mean duration of hospitalizations of 7.33 ± 7.84 days). Diagnoses were recorded for the 325 patients who had been hospitalized during index period: schizophrenic psychoses ([ p = .042], in particular schizophrenia [ p = .027]), manic episode ( p = .044), and delusional disorders ( p = .009) were associated with CA; conversely, the diagnosis of unipolar major depression ( p = .005) and personality disorders ( p = .048) were significantly more frequent in VA. The 325 admitted patients were followed up for 1,801 person-years. No significant differences were found in terms of drop-outs, transferring, and discharge rates, and mortality rates due to both natural causes and suicides. Factors associated with at least one compulsory readmission were younger age and having had a previous CA ( p = .011); conversely having been engaged with psychiatric services for over 1 year prior to index hospitalization was protective for a subsequent CA ( p = .013). Conclusions: After a 40-year old political reform, the current study shows that, in a context of integrated outpatient and inpatient services, engagement with outpatient care may be protective for compulsory rehospitalization.
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There was an association with involuntary readmission.
“By contrast, two studies found that overall readmission was not higher following involuntary admission (69,70) although there was an association with involuntary readmission, possibly indicating less therapeutic engagement (71–75).”
From The benefits and harms of inpatient involuntary psychiatric treatment: a scoping review (2025) · cites this paper as [72]
The association with involuntary readmission possibly indicates less therapeutic engagement.
“By contrast, two studies found that overall readmission was not higher following involuntary admission (69,70) although there was an association with involuntary readmission, possibly indicating less therapeutic engagement (71–75).”
From The benefits and harms of inpatient involuntary psychiatric treatment: a scoping review (2025) · cites this paper as [72]
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- Authors
- Draghetti, S., Alberti, S., Borgiani, G., Panariello, F., De Ronchi, D., & Atti, A. R.
- Affiliations
- University of Bologna (IT)
- Servizio Psichiatrico di Diagnosi e Cura “P. Ottonello” - Azienda Sanitaria Locale di Bologna, Italy
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy
- Corresponding author
- Draghetti, Stefano
- Venue
- International Journal of Social Psychiatry
- Publisher
- SAGE Publications
- Published
- 2021-12-19
- Volume
- 68
- Issue
- 8
- Pages
- 1716-1726
- ISSN
- 0020-7640 (ISSN-L)
- 1741-2854
- OpenAlex
- W4200329090
- Cited by
- 10
- References
- 62
- Citations by year
- 2026: 3 · 2025: 2 · 2024: 2 · 2023: 2 · 2022: 1
- FWCI
- 0.85
- Type
- journal article
- Language
- en
- Open access
- green
- hdl.handle.net
- Licence
- Locations
- International Journal of Social Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Archivio istituzionale della ricerca (Alma Mater Studiorum Università di Bologna) (submittedVersion, cc-by-nc-nd)
- RePEc: Research Papers in Economics (submittedVersion)
- Funders
- Università di Bologna
- Topics
- Social Sciences › Psychology › Clinical Psychology › Healthcare Decision-Making and Restraints
- Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
- Social Sciences › Psychology › Clinical Psychology › Historical Psychiatry and Medical Practices
- Keywords
- involuntary admission, voluntary admission, psychiatric hospitalization, hospital readmission, schizophrenia, manic episodes, unipolar major depression, personality disorders, delusional disorder
- MeSH terms
- Adult, Mental Disorders, Commitment of Persons with Psychiatric Disorders, Commitment of Mentally Ill, Hospitalization, Humans, Inpatients, Patient Admission, Suicide
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