Risk factors for involuntary admission in a Romanian patient sample

Involuntary admission is widely used in psychiatry, usually requiring that the patient present an imminent danger to himself or others. Previous studies have established several predictors for involuntary admission, but they have been almost exclusively conducted in Western European or North American countries. By contrast, data on this topic from Eastern European countries is virtually absent. Historically, involuntary admission has been often used as a tool for political repression in Romania before the fall of the communist regime. While there have been significant changes in the legal framework in the last 30 years, there is still no real-world data to build upon.

We analyzed a sample of 177 patients admitted to the "Alexandru Obregia" psychiatric hospital in Bucharest between November 2022 and January 2023, of which 49.7% (88) were involuntary hospitalizations. We collected socio-demographic and clinical data by both by direct interview, and by consulting patient records, attending physicians and relatives.

Socio-demographic factors predictive for involuntary admission were unemployment, lower income, and urban living. Of the clinical variables analyzed, diagnosis of psychosis or mania on admission carried increased risk of involuntary hospitalization, as did nonadherence to treatment, higher disease severity and aggression. Hospital presentation by police or ambulance carried significant additional risk compared to self-referral.

Certain categories of patients are considerably more likely to be involuntarily hospitalized and there appears to be considerable interrelatedness between the identified risk factors.