Predicting aftercare in psychiatric emergencies

Aftercare dispositions in psychiatric emergencies have often been limited to the classic armamentarium of admission vs nonadmission. It is unknown to what extent there are differences in predicting follow-up after psychiatric emergency room (PER) visits when focusing on a broader scope of aftercare possibilities.

This observational study describes and predicts aftercare dispositions after a psychiatric emergency referral: admission, onsite short-term crisis-intervention program (CIP), refusal of any aftercare, and outpatient aftercare. From March 2000 until March 2002, PER patients (N=3,719) of the university hospital were monitored regarding sociodemographic and clinical characteristics, and use of health services.

Forty-four percent were admitted, 38% were referred to outpatient treatment, 9% refused any aftercare, and the remainder was referred to the CIP. Psychotic patients were most likely to be admitted [odds ratios (ORs) between 5.98 and 6.52], followed by patients with suicidal symptoms (OR=2.25) and those who reported outpatient service utilization (OR=1.43). Young patients (OR=3.36) or those with anxiety disorders (OR=2.03) were most likely to be referred for outpatient aftercare. Patients diagnosed with a personality disorder were at highest risk of refusing any aftercare (OR=1.81).

Despite the existence of a short-term onsite CIP, the majority of the patients were admitted after PER referral. We assume that the existence of this program decreased the number of patients who otherwise would refuse all aftercare. More research is needed in order to explain aftercare dispositions more appropriately.