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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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References

BIBLIOGRAFIA

Buchanan, A., Reed, A., Wessely, S., Garety, P., Taylor, P., Grubin, D. & Dunn, G. (1993). Acting on delusions. II: the phenomenological correlates of acting on delusions. British Journal of Psychiatry 163, 77–81.CrossRefGoogle ScholarPubMed
Calcedo, Barba A.L. & Calcedo, Ordonez A. (1994). Violence and paranoid schizophrenia. International Journal of Law and Psychiatry 17, 253–263.CrossRefGoogle Scholar
Dell, S., Robertson, G. & Parker, E. (1987). Detention in Broadmoor. Factor in length of stay. British Journal of Psychiatry 150, 824–827.CrossRefGoogle ScholarPubMed
Fioritti, A. & Melega, V. (2000). Psichiatria forense in Italia: una storia ancora da scrivere. Epidemiologia e Psichiatria Sociale 9, 219–226.CrossRefGoogle Scholar
Fioritti, A., Melega, V., Scaramelli, A. R., Ferriani, E., Rucci, P., Santarini, F., Venco, C. & Oggioni, A. (1999) Violenza e malattia mentale: uno studio sulla popolazione di tre Ospedali Psichiatrici Giudiziari. Il reo e ilfolle 9–10, 137–148.Google Scholar
Fioritti, A., Melega, V., Ferriani, E., Santarini, F., Venco, C. & Rucci, P. (2001). Crime and mental illness: an investigation of three Italian forensic hospitals. Journal of Forensic Psychiatry, 12,1,36–51.CrossRefGoogle Scholar
Folstein, M.F.; Folstein, S.E. & Hugh, P.R. (1975). Mini Mental State Examination.Google Scholar
Green, B. & Baglioni, A.J. (1998). Length of stay, leave and re-offending by patients from a Queensland security patients hospital. Australia and New Zealand Journal of Psychiatry 32(6), 839–847.CrossRefGoogle ScholarPubMed
Harris, G.T., Rice, M.E. & Cormier, C. (1991). Length of detention in matched groups of insanity acquittees and convicted offenders. International Journal of Law and Psychiatry 14, 223–236.CrossRefGoogle ScholarPubMed
Hodgins, S. & Muller-Isberner, J.R. (2000). Violence, Crime and Mentally Disordered Offenders. Concepts and Methods for Effective Treatment and Prevention. Wiley: Chichester.Google Scholar
Leff, J. (1993). The TAPS Project: Evaluating Community Placement of Long-stay Psychiatric Patients. British Journal of Psychiatry, Suppl. No. 19, pp. 56.Google Scholar
Link, B.G., Stueve, A. & Phelan, J.C. (1998). Psychotic symptoms and violent behaviors: probing the components of “threat/control-override” symptoms. Social Psychiatry and Psychiatric Epidemiology 33, s55–s60.CrossRefGoogle ScholarPubMed
Lloyd, M.G. & Benezec, M. (1994). The psychiatric services in French prison. Journal of Forensic Psychiatry 4 n. 1, 59–73.Google Scholar
Pantle, M.L, Pasewark, R.A. & Steadman, H.J. (1980). Comparing istituzionalization periods and subsequent arrest of insanity acquittees and convicted felons. Journal of Psychiatry and Law 8, 305–316.CrossRefGoogle Scholar
Pasewark, R.A., P.M.L., & Steadman, H.J. (1982). Insanity acquittees and felons: a controlled study of their detention and rearrest. American Journal of Psychiatry 139, 892–897.Google Scholar
Phillips, B.L. & Pasewark, R.A. (1980). Insanity plea in Connecticut. Bullettin of the American Academy Psychiatry and the Law 8, 335–344.Google ScholarPubMed
Pogrebin, M., Regoli, R. & Perry, K. (1986). Not guilty by reason of insanity: a research note. International Journal of Law and Psychiatry 8, 237–241.CrossRefGoogle ScholarPubMed
Ruggeri, M. & de Girolamo, G. (1995). Brief Psychiatric Rating Scale (BPRS) 4.0. (Italian Version). 1995.Google Scholar
Ruggeri, M. & Nicolaou, S. (1994). WHO Psychiatric Disability Assessment Schedule (WHO/DAS-II). Italian version. Epidemiologia e Psichiatria Sociale 3, 212–221.Google Scholar
Steadman, H.J., Pasewark, R.A., Hawkins, M.Kiser, M. & Bieber, S. (1983). Hospitalization length of insanity acquittees. your/ia/o/C/i- pronical Psychology 39, 115–126.Google ScholarPubMed
Swanson, J.W., Borum, R., Swartz, M.S. & Monahan, J. (1996). Psychotic symptoms and disorders and the risk of violent behaviour in the community. Criminal Behavour and Mental Health 6, 309–329.CrossRefGoogle Scholar
Tardiff, K., Marzuk, P.M., Leon, A.C, Portera, L. & Weiner, C. (1997a). Violence by patients admitted to private psychiatric hospital. Anteschizophrerican Journal of Psychiatry 154, 88–93.Google Scholar
Tardiff, K., Marzuk, P.M., Leon, A.C. & Portera, L. (1997b). A pronical spective study of violence by psychiatric patients after hospital discharge. Psychiatric Services 48, 678–681.Google Scholar
Taylor, P.J., Leese, M., Williams, D., Butwell, M., Daly, R. & Larkin, E. (1998). Mental disorder and violence: A special (high security) hospital study. British Journal of Psychiatry 172, 218–226.CrossRefGoogle ScholarPubMed
Wessely, S. (1998). The Camberwell study of crime and schizophrericannia. Social Psychiatry and Psychiatric Epidemiology 33, s24–s28.CrossRefGoogle Scholar