Sex perspective on mandatory admission in acute psychotic patients

TL;DR

The study finds that young women with psychotic disorders are more likely to be involuntarily hospitalized, suggesting a need for gender-specific approaches in mental health care.

Contribution

The study identifies a significant interaction between sex and age in predicting involuntary admission rates among individuals with psychotic disorders.

Findings

Young women with psychotic disorders face a higher risk of involuntary admission.

A logistic regression model shows sex and the interaction between sex and age are significant predictors of involuntary admission.

No significant differences in age at admission were found between males and females.

Abstract

Psychotic disorders are strongly linked to a higher risk of mandatory hospitalization, often affecting men more, though some studies report the opposite. Recent investigations also show a higher rate of involuntary admissions in younger individuals. Knowledge in this area is still limited despite extensive research.

Analyze whether there is an association between sex and age with involuntary admissions of individuals with psychotic disorders.

Retrospectively, 254 people with psychotic disorders admitted between 2018-2023 to the adult psychiatric inpatient unit at Hospital Universitari Germans Trias i Pujol were selected, collecting their nature of admission, sex, age, and discharge diagnosis. Comparisons between voluntary and involuntary admissions, with respect to sex and age variables, were conducted using independent sample t-tests, Mann-Whitney U tests, Fisher’s exact test, and chi-square tests. A logistic regression model was used to identify variables significantly associated with mandatory admission.

In both the male and female groups, there were no statistically significant differences in terms of the mean age at admission (p = 0.162) or the nature of admission (p = 0.586) (
Table 1). When analyzing the voluntary nature of admission based on age and sex, statistically significant differences were only found in the female group (p = 0.01), resulting in a 9.18 year age difference among those admitted voluntarily (
Table 2). The model that best predicted the probability of involuntary admission in individuals with psychotic disorders included the sex variable (OR = 4.88) and the interaction between sex and age (OR = 0.97) (
Table 3).
Table 1:Differences between sex regarding voluntariness of patients with psychotic disorders.MaleFemale
p value
N (%)
122 (48%)132 (52%)Age, m (SD)
38.39 (16.64)44.15 (18.44)0.162Admissions, N (%)
Voluntary38 (31.1%)37 (28.0%)0.586Involuntary84 (68.9%)95 (72.0%)

Table 2:Analysis of voluntariness by sex and age.
Age, m (SD)
VoluntaryInvoluntary

p value

Male37.45 (16.38)38.81 (16.84)0.677Female50.76 (18.19)41.58 (17.98)0.01*Total44.01 (18.44)40.28 (17.46)0.127

Table 3:Predictors of involuntariness in psychotic patients: Logistic regression model (ENTER METHOD).
Predictor
-2log likelihood
Nagelkerke R2
x2 (df*)
OR* (95% CI*)
p value
301.220.0390.03 (1)Age1.01 (0.98; 1.03)0.674Sex4.88 (1.15; 20.72)0.032*Age x Sex Interaction0.97 (0.94; 0.99)0.046*

Differences between sex regarding voluntariness of patients with psychotic disorders.

Analysis of voluntariness by sex and age.

Predictors of involuntariness in psychotic patients: Logistic regression model (ENTER METHOD).

Young women with psychotic disorders face a higher risk of involuntary admissions, emphasizing the need for gender-specific strategies to improve care of these patients.

None Declared

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