Background

Disparities in involuntary psychiatric hospitalisation between population subgroups have been identified in adults, but little is known about the factors associated with involuntary hospitalisation in children or adolescents. We did a systematic review, meta-analysis, and narrative synthesis to investigate the social and clinical factors associated with involuntary psychiatric hospitalisation among children and adolescents.

Methods

We searched MEDLINE, PsycINFO, Embase, and the Cochrane Central Register of Controlled Trials for studies of any type up to July 22, 2020, that compared the characteristics of voluntary and involuntary psychiatric inpatients (mean age of sample ≤18 years). We synthesised results using random effects meta-analysis on unadjusted data and by narrative synthesis. Heterogeneity between studies was calculated using I². This study is registered on PROSPERO, CRD42020099892.

Findings

23 studies from 11 countries were included in the systematic review and narrative synthesis, of which 19 studies (n=31 212) were included in the meta-analysis. On meta-analysis, involuntary rather than voluntary hospitalisation of minors was associated with a diagnosis of psychosis (eight studies; odds ratio 3·63, 95% CI 2·43–5·44, p<0·0001), substance misuse (five studies; 1·87, 1·05–3·30, p=0·032), or intellectual disability (four studies; 3·33, 1·33–8·34, p=0·010), as well as presenting with a perceived risk of harm to self (eight studies; 2·05, 1·15–3·64, p=0·015) or to others (five studies; 2·37, 1·39–4·03, p=0·0015). Involuntary hospitalisation was also found to be associated with being aged 12 years or older (three studies; 3·57, 1·46–8·73, p=0·0052) and being from a Black rather than a White ethnic group (three studies; 2·72, 1·88–3·95, p<0·0001). There was substantial between-study heterogeneity for most factors included in the meta-analysis (I² from 51·3% to 92·3%). Narrative synthesis found that more severe illness and poorer global functioning was associated with involuntary hospitalisation.

Interpretation

Over-representation of involuntary psychiatric hospitalisation in certain groups might begin in childhood, potentially establishing a cycle of inequality that continues into adulthood. Further research into the systemic factors underlying these health-care inequalities and the barriers to accessing less coercive psychiatric treatment is urgently required, with specific consideration of racial and ethnic factors.

Funding

UK National Institute for Health Research and Wellcome Trust.

中文翻译：

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与儿童和青少年非自愿精神病住院相关的临床和社会因素：系统评价、荟萃分析和叙述综合

 背景

成人非自愿精神科住院治疗在不同人群之间存在差异，但对于儿童或青少年非自愿住院治疗的相关因素却知之甚少。我们进行了系统回顾、荟萃分析和叙述综合，以调查与儿童和青少年非自愿精神病住院相关的社会和临床因素。

 方法

我们检索了 MEDLINE、PsycINFO、Embase 和 Cochrane 对照试验中央注册库，查找截至 2020 年 7 月 22 日的任何类型的研究，这些研究比较了自愿和非自愿精神病住院患者的特征（样本平均年龄≤18 岁）。我们通过对未经调整的数据进行随机效应荟萃分析和叙述综合来综合结果。使用I ²计算研究之间的异质性。本研究已在 PROSPERO 上注册，CRD42020099892。

 发现

来自 11 个国家的 23 项研究被纳入系统评价和叙述综合，其中 19 项研究（n=31 212）被纳入荟萃分析。荟萃分析显示，未成年人非自愿而非自愿住院与精神病的诊断相关（八项研究；比值比 3·63，95% CI 2·43–5·44，p<0·0001）、物质滥用（五项研究；1·87、1·05–3·30，p=0·032），或智力障碍（四项研究；3·33、1·33–8·34，p=0·010）表现出对自我（八项研究；2·05、1·15–3·64、p=0·015）或他人（五项研究；2·37、1·39–4·03）伤害的感知风险，p=0·0015）。研究还发现，非自愿住院治疗与年龄为 12 岁或以上有关（三项研究；3·57、1·46–8·73，p=0·0052）以及来自黑人而不是白人（三项研究）。研究；2·72、1·88–3·95、p<0·0001）。荟萃分析中包含的大多数因素都存在显着的研究间异质性（ I ²从 51·3% 到 92·3%）。叙述综合发现，更严重的疾病和更差的整体功能与非自愿住院有关。

 解释

在某些群体中，非自愿精神病住院的比例过高可能会从童年开始，从而可能形成一个持续到成年的不平等循环。迫切需要进一步研究这些医疗保健不平等背后的系统性因素以及获得较少强制性精神治疗的障碍，并特别考虑种族和民族因素。

 资金

英国国家健康研究所和威康信托基金会。