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Predicting length of stay in Italian Psychiatric Forensic Hospitals: a survival analysis

Published online by Cambridge University Press:  11 October 2011

Angelo Fioritti ,
Elisa Ferriani ,
Paola Rucci ,
Vittorio Melega ,
Cristina Venco ,
Anna Rosa Scaramelli  and
Fabio Santarini
Angelo Fioritti*
Affiliation:
Programma Salute Mentale e Dipendenze Patologiche, Azienda USL Rimini, Rimini
Elisa Ferriani
Affiliation:
Dipartimento di Salute Mentale, Azienda USL Città di Bologna, Bologna
Paola Rucci
Affiliation:
Dipartimento di Psichiatria, Neurobiologia, Farmacologia e Biotecnologie, Università di Pisa, Pisa
Vittorio Melega
Affiliation:
Dipartimento di Salute Mentale, Azienda USL Città di Bologna, Bologna
Cristina Venco
Affiliation:
Dipartimento di Salute Mentale, Azienda Ospedaliera Carlo Poma, Mantova
Anna Rosa Scaramelli
Affiliation:
Dipartimento di Salute Mentale, Azienda USL Città di Bologna, Bologna
*
Indirizzo per la corrispondenza: Dr. A. Fioritti, Direttore Programma Salute Mentale e Dipendenze Patologiche, Azienda USL Rimini, via Coriano 38 47900 Rimini. Fax: +39-051-707.079 E-mail: afioritti@auslrn.net
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Summary

Admission to an Italian Forensic Hospital (OPG) results in formal exit from psychiatric care provided by NHS community based psychiatric services. The length of stay in such facilities is often perceived as a factor negatively affecting the opportunity for reintegration in the community. Method – Factors predicting length of stay in OPG were investigated by means of a survival analysis carried out on a cohort of 118 inmates of three OPGs (Castiglione delle Stiviere, Reggio Emilia and Montelupo Fiorentino), who represent the whole forensic population from 3 different geographical areas at 30.06.97; all discharges occurred in the following 18 months were examined. Results – In survival analyses conducted on individual predictors, five variables predicted a longer stay: type of offence (homicide: 706.6 weeks vs. 307.1 for minor offences and 194.7 for grievous bodily harm, log-rank =31.8, p >0.001), type of admission (RR=0.98, CI 95% 0.97-0.99, p>0.001), the diagnosis of schizophrenia (621.9 weeks vs. 398.9 weeks or less for other diagnoses; log rank=9.08, df=3, p=0.028), BPRS thought disturbance score (RR=0.89, CI 98% 0.81-0.98, p>0.01), hospital of stay (314.6 weeks in Montelupo Fiorentino vs. 706.6 for Reggio Emilia and 621.9 for Castiglione delle Stiviere; log-rank = 9.64, df=2, p>0.001). In a Cox linear regression model three significant factors were selected: type of offence, type of admission, diagnosis of schizophrenia. Conclusions – Judicial factors are relevant in determining the length of stay in OPG. The diagnosis of schizophrenia seems to play an independent role in predicting a longer stay.

Riassunto

L'internamento in Ospedale Psichiatrico Giudiziario (OPG) costituisce un allontanamento dai circuiti assistenziali psichiatrici del Servizio Sanitario Nazionale e la sua durata può influire negativamente sulle possibilità di reinserimento nel territorio di provenienza. Metodo – I fattori predittivi della durata di degenza in OPG sono stati indagati mediante una analisi di sopravvivenza condotta su una coorte di 118 pazienti degenti nei tre OPG del Centro-Nord al 30.06.97, provenienti da tre Regioni (Emilia Romagna, Toscana, Friuli Venezia Giulia), prendendo in esame le dimissioni effettuate nei 18 mesi successivi. Risultati – Da analisi di sopravvivenza condotte sui singoli fattori sono emersi, come predittori di durata di internamento, il reato commesso (omicidio: tempo mediano di permanenza 706.6 settimane, rispetto alle 307.1 e 194.7 dei reati minori e delle lesioni; log-rank =31.8, p<0.001), la durata preventivata della misura di sicurezza (RR=0.98, CI 95% 0.97-0.99, p<0.001); la diagnosi di schizofrenia (621.9 settimane rispetto alle 389.9 settimane o meno delle altre diagnosi; log-rank = 5.83, p<0.01); i disturbi del pensiero alia BPRS (RR=0.89, CI 98% 0.81-0.98, p<0.01); OPG di internamento (314.6 settimane a Montelupo Fiorentino rispetto alle 706.6 di Reggio Emilia e alle 621.9 di Castiglione delle Stiviere; log-rank = 9.64, df=2, p<0.001). In un modello di regressione di Cox a più covariate solo il tipo di reato, la durata della misura di sicurezza e la diagnosi sono risultati significativi. Conclusioni – I fattori inerenti il sistema giudiziario sono determinanti nel predire la durata della degenza. La diagnosi di schizofrenia sembra aver un ruolo indipendente nel predire una degenza più lunga

Keywords

pazienti psichiatrici reiospedali psichiatrici giudiziaridurata di degenzaanalisi di sopravvivenzamentally ill offendersforensic hospitalslength of staysurvival analysis
Type
Articles
Information
Epidemiology and Psychiatric Sciences , Volume 10 , Issue 2 , June 2001 , pp. 125 - 134
Copyright
Copyright © Cambridge University Press 2001

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