Coping and the decision to hospitalize in emergency psychiatry

This study was done to clarify whether and in what way a patient's coping repertoire can be linked to the disposition decision in a psychiatric emergency service. For 1 year, all consultations (N = 1439) of a psychiatric emergency service were documented in a detailed questionnaire covering sociodemographic and diagnostic data as well as information about the disposition decision. Depending on disposition, three groups were identified: outpatients (N = 530), inpatients (N = 481), and a nonintervention group (N = 428). In addition, over a 5-month period, patients were requested to fill in the "Bernese Coping Modes" questionnaire. Thus, a sample of 28 patients undergoing outpatient crisis intervention and 28 patients referred to inpatient treatment was obtained. Statistical analysis included Chi square-test, t-test, Mann-Whitney U-test, and logistic regression analysis. Assessment of coping repertoire contributed more than the diagnosis to the decision to hospitalize. Outpatients have a larger coping repertoire (t = 3.48, p = 0.001) than inpatients and show higher values in "acceptance-stoicism," "dissimulation," "tackling," "giving meaning," "altruism," "optimism," and "relativizing." Logistic regression revealed relativizing, altruism, and optimism as being most important. Self-referral to emergency psychiatry was also correlated with outpatient treatment. Other criteria such as being without work, living alone, history of previous hospitalization, and the diagnosis of a psychotic or mood disorder were significantly correlated with referral to inpatient treatment. More attention should be paid to patients' coping repertoires in emergency services when deciding about the need for inpatient treatment.