Health Services Research & Development

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2006 HSR&D National Meeting Abstract


1046 — Adverse Impact of Involuntary Hospitalization on Perceptions of Psychiatric Care in Veterans

Author List:
Butterfield MI (Durham VAMC HSR&D/Duke Med Ctr)
Stechuchak KM (Durham VAMC HSR&D)
Olsen MK (Durham VAMC HSR&D/Duke Med Ctr)
Strauss JL (Durham VAMC HSR&D/Duke Med Ctr)
Zervakis JB (Durham VAMC HSR&D)
O'Loughlin SH (Durham VAMC)
Roland EJ (Durham VAMC/Duke Med Ctr/NCCU)
Swartz MS (Duke University)
Oddone EZ (Durham VAMC HSR&D/Duke Med Ctr)
Weinberger M (Durham VAMC HSR&D/Duke Medical Center)

Objectives:
The VA assesses satisfaction with inpatient psychiatric care as a performance monitor. Coercive interventions such as involuntary commitment may impact on patients’ perceptions of mental health treatment, yet no studies examined these issues in veterans. Thus, we examined the impact of involuntary commitment and perceived coercion on perceptions of care in veterans with SMI.

Methods:
Veterans (N=211) with SMI who were psychiatrically hospitalized between March 2004-August 2005 were enrolled. Perceptions of care were assessed using the Perception of Care (POC) survey (global evaluation domain) and involuntary commitment was assessed by record review. Perceived coercion was measured using the Admission Experience Survey. Bivariate relationships between perceptions of care and involuntary commitment, perceived coercion and lifetime treatment history variables were examined using t-tests. Variables significant at p<0.10 were retained for inclusion in a multiple linear regression model.

Results:
Eighty-eight percent of the sample were men, mean age was 50.26, and 34.1% were Caucasian. As to primary psychiatric diagnosis, 50.7% had PTSD, 31.8% had psychotic disorders, and 17.5% had mood disorders. Nearly seventeen percent (n=35) were involuntarily committed and 67.3% perceived some coercion at the current psychiatric hospital admission. Forty-five percent had a lifetime involuntary commitment history and 30.5% reported they were denied a needed medication during a hospitalization. The mean global POC score was 68.9 (SD=25.2). In the multiple linear regression model controlling for demographics, psychiatric diagnosis, substance abuse, and self-rated health, those who were involuntarily committed or perceived coercion had lower POC scores (b=-13.41; 95% CI=-22.37 to –4.44; p=0.004 and b= -6.58; 95% CI= -13.67 to 0.51; p=0.07 respectively). Subjects who felt they were denied a needed medication had lower POC scores (b=-13.67; 95% CI=-20.86 to -6.47; p= 0.0002).

Implications:
These results suggest that involuntary commitment status and having been denied a medication are significantly related to negative global perceptions of care among psychiatrically hospitalized veterans with SMI. Other variables were not significant in the adjusted model.

Impacts:
Because satisfaction with inpatient psychiatric care is assessed nationally by the VA and reported as a performance monitor, the influence of involuntary commitment on this monitor should be considered.