title: Health service use and costs associated with aggressiveness or agitation and containment in adult psychiatric care: a systematic review of the evidence.
abstract: BACKGROUND
  Agitation and containment are frequent in psychiatric care but little is known about their costs. The aim was to evaluate the use of services and costs related to agitation and containment of adult patients admitted to a psychiatric hospital or emergency service.
  
  
  METHODS
  Systematic searches of four electronic databases covering the period January 1998-January 2014 were conducted. Manual searches were also performed. Paper selection and data extraction were performed in duplicate. Cost data were converted to euros in 2014.
  
  
  RESULTS
  Ten studies met inclusion criteria and were included in the analysis (retrospective cohorts, prospective cohorts and cost-of-illness studies). Evaluated in these studies were length of stay, readmission rates and medication. Eight studies assessed the impact of agitation on the length of stay and six showed that it was associated with longer stays. Four studies examined the impact of agitation on readmission and a statistically significant increase in the probability of readmission of agitated patients was observed. Two studies evaluated medication. One study showed that the mean medication dose was higher in agitated patients and the other found higher costs of treatment compared with non-agitated patients in the unadjusted analysis. One study estimated the costs of conflict and containment incurred in acute inpatient psychiatric care in the UK. The estimation for the year 2014 of total annual cost per ward for all conflict was €182,616 and €267,069 for containment based on updated costs from 2005.
  
  
  CONCLUSIONS
  Agitation has an effect on healthcare use and costs in terms of longer length of stay, more readmissions and higher drug use. Evidence is scarce and further research is needed to estimate the burden of agitation and containment from the perspective of hospitals and the healthcare system.
authors.affiliation: Fundació Sant Joan de Déu, Esplugues de Llobregat, Spain. mrubio@pssjd.org.|Primary Care Prevention and Health Promotion Research Network (RedIAPP), Barcelona, Spain. mrubio@pssjd.org.|School of Pharmacy, Universitat de Barcelona, Barcelona, Spain. mrubio@pssjd.org.|Research & Development Unit, Parc Sanitari Sant Joan de, 22 Déu. C/ Dr. Antoni Pujadas 42, 08830, Sant Boi de Llobregat, Barcelona, Spain. mrubio@pssjd.org.
authors.forename: Maria
authors.initials: M
authors.lastname: Rubio-Valera
authors.affiliation: Fundació Sant Joan de Déu, Esplugues de Llobregat, Spain. jvluciano@pssjd.org.|Primary Care Prevention and Health Promotion Research Network (RedIAPP), Barcelona, Spain. jvluciano@pssjd.org.|Open University of Catalonia (UOC), Barcelona, Spain. jvluciano@pssjd.org.
authors.forename: Juan V
authors.initials: JV
authors.lastname: Luciano
authors.affiliation: Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain. jmortiz@pssjd.org.
authors.forename: José Miguel
authors.initials: JM
authors.lastname: Ortiz
authors.affiliation: Centre for Disability Research and Policy, Faculty of Health Sciences, and Mental Health Policy Unit, Brain and Mind Research Institute, University of Sydney, Sydney, Australia. luis.salvador-carulla@sydney.edu.au.
authors.forename: Luis
authors.initials: L
authors.lastname: Salvador-Carulla
authors.affiliation: Scientific Area, Ferrer, Barcelona, Spain. alfredogracia@ferrer.com.
authors.forename: Alfredo
authors.initials: A
authors.lastname: Gracia
authors.affiliation: Primary Care Prevention and Health Promotion Research Network (RedIAPP), Barcelona, Spain. aserrano@pssjd.org.|Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain. aserrano@pssjd.org.
authors.forename: Antoni
authors.initials: A
authors.lastname: Serrano-Blanco
mesh_terms: D000374:Aggression; D017048:Health Care Costs; D006760:Hospitalization / Q000191:economics*; D006801:Humans; D008605:Mental Health Services / Q000191:economics* / Q000706:statistics & numerical data*; D011595:Psychomotor Agitation / Q000191:economics* / Q000628:therapy*; D012149:Restraint, Physical