Involuntary commitment and detainment in adolescent psychiatric inpatient care.
OBJECTIVE
To evaluate whether adolescents committed to psychiatric inpatient care are the most disturbed, and whether psychosocial factors other than psychiatric symptoms are associated with commitment to and detainment in psychiatric care among adolescents.


METHODS
The case histories of 187 13- to 17-year-old adolescents consecutively admitted to the study clinic were scrutinized with the help of a structured data collection form. Psychiatric, demographic and family-related characteristics of those referred involuntarily (n = 93) and voluntarily (n = 94), and those detained involuntarily (n = 42) and treated on a voluntary basis (n = 145) were compared.


RESULTS
Involuntary referral and involuntary detainment were associated with psychotic symptoms, temper tantrums and breaking property, involuntary referral also with violent and hostile behaviours and suicidal ideation and talk. They were not associated to family adversities, previous treatment history or sociodemographic factors. The risk for being committed when presenting with aggressive behaviours was greater in girls.


CONCLUSIONS
Involuntary referral and detainment in adolescents is associated with symptom severity, and not with aspects of the adolescent's living conditions. This is in agreement with the legislation. Gender bias resulting in girls' greater risk of being involuntarily committed if displaying aggressive behaviours may be an ethical and legal problem.
Kaltiala-Heino
Riittakerttu
R
Department of Adolescent Psychiatry, Tampere University Hospital, 33380, Pitkäniemi, Finland, merihe@uta.fi.
D000293:Adolescent; D000294:Adolescent Behavior / Q000523:psychology; D000296:Adolescent Psychiatry / Q000706:statistics & numerical data*; D000374:Aggression / Q000523:psychology; D001526:Behavioral Symptoms / Q000175:diagnosis / Q000453:epidemiology; D002648:Child; D003134:Commitment of Persons with Psychiatric Disorders / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data*; D005260:Female; D005387:Finland / Q000453:epidemiology; D006302:Health Services Research / Q000706:statistics & numerical data; D006760:Hospitalization / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy; D015995:Prevalence; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012307:Risk Factors; D012720:Severity of Illness Index; D012737:Sex Factors; D013406:Suicide, Attempted / Q000523:psychology
Psychiatr Serv. 1997 Dec;48(12):1567-70
9406265
Soc Psychiatry Psychiatr Epidemiol. 1997 Feb;32(2):90-6
9050350
Soc Psychiatry Psychiatr Epidemiol. 2004 Jan;39(1):53-9
15022047
J Am Acad Psychiatry Law. 1998;26(4):587-94
9894215
Eur Child Adolesc Psychiatry. 2007 Jun;16(4):260-70
17171572
Med Law. 1995;14(7-8):635-40
8668012
J Pediatr. 1992 Oct;121(4):547-52
1403387
CMAJ. 1995 May 1;152(9):1495-7
7728701
Am J Psychiatry. 1984 Mar;141(3):384-9
6703103
Int J Law Psychiatry. 2007 Jan-Feb;30(1):81-94
17150252
Med Law. 1991;10(4):327-33
1775004
Int J Law Psychiatry. 1997 Summer;20(3):311-22
9347394
Med Law. 1995;14(5-6):325-9
8868494
Soc Psychiatry Psychiatr Epidemiol. 1999 Aug;34(8):425-31
10501712
Soc Psychiatry Psychiatr Epidemiol. 2007 May;42(5):360-5
17396204
Health Care Anal. 2004 Dec;12(4):285-94; discussion 265-72
15658083
Addict Behav. 2000 Mar-Apr;25(2):217-28
10795946
Int J Law Psychiatry. 2002 Mar-Apr;25(2):93-108
12071105
Science. 1973 Jan 19;179(4070):250-8
4683124
Psychol Med. 1991 Feb;21(1):197-208
2047496
J Am Acad Psychiatry Law. 1997;25(2):135-47
9213286
Br J Psychiatry. 1983 Oct;143:416-8
6354343
Law Hum Behav. 1995 Apr;19(2):105-26
11660290
Soc Psychiatry Psychiatr Epidemiol. 2006 Dec;41(12):981-8
17041737
Soc Psychiatry Psychiatr Epidemiol. 1997 Jul;32(5):303-8
9257522
Aust N Z J Psychiatry. 1996 Oct;30(5):623-9; discussion 630-2
8902169
Int J Law Psychiatry. 2004 Mar-Apr;27(2):193-205
15063643
Nord J Psychiatry. 2008;62(3):198-203
18609031
Soc Psychiatry Psychiatr Epidemiol. 2002 Jul;37(7):341-5
12111027
Soc Psychiatry Psychiatr Epidemiol. 2004 Dec;39(12):1000-9
15583909
Soc Psychiatry Psychiatr Epidemiol. 2007 Feb;42(2):146-52
17235444
Can J Psychiatry. 1990 May;35(4):285-9
2346892
J Med Ethics. 1993 Sep;19(3):142-7
8230145
Br J Psychiatry. 2004 Feb;184:163-8
14754830
Bull Am Acad Psychiatry Law. 1994;22(1):19-29
8193385
J Am Acad Child Adolesc Psychiatry. 2002 Apr;41(4):367-76; discussion 376-7
11931592
Soc Psychiatry Psychiatr Epidemiol. 1988 Oct;23(4):247-51
3149029
Acta Psychiatr Scand. 1991 Oct;84(4):353-6
1746287