title: Predictors of inpatient psychiatric admission in patients presenting to the emergency department: the role of dimensional assessment.
abstract: OBJECTIVE
  To identify which patient factors predict psychiatric hospitalization in patients presenting to the emergency department and to examine the role of the dimensional approach to psychopathology in predicting hospitalization.
  
  
  METHODS
  We consecutively recruited 312 patients undergoing psychiatric evaluation in the emergency room of a hospital in Rome over a 6-month period. Patients were rated on the SVARAD (Scala per la Valutazione Rapida Dimensionale), a scale designed for the rapid assessment of the main psychopathological dimensions. Information about patient history, as well as sociodemographic and clinical variables, was also collected. Univariate analysis was performed to detect the variables associated with recommendation of psychiatric hospitalization. Multiple logistic regression analysis was used to identify independent predictors of hospitalization and compare their strength. A replication study was performed in another hospital on a random sample of 118 patients.
  
  
  RESULTS
  In both studies, patients who were recommended for psychiatric hospitalization showed significantly higher levels of anger/aggressiveness, apathy, impulsivity, reality distortion, thought disorganization and activation. Multivariate analysis identified psychopathological dimensions (reality distortion, impulsivity, apathy), diagnosis of psychotic or mood disorders and proposal for compulsory admission as independent predictors of psychiatric hospitalization. Hierarchical regression analysis revealed that the dimensional evaluation was the strongest predictor.
  
  
  CONCLUSIONS
  Our findings suggest that, in emergency setting, a systematic dimensional assessment may usefully complement the categorical assessment. Future research should aim at developing an operational assessment model, including both categorical and dimensional approaches to psychopathology.
authors.affiliation: Marconi University, Via Plinio 44, 00193 Rome, Italy; Department of Neurology and Psychiatry, Sapienza University of Rome, Viale dell'Università 30, 00185 Rome, Italy. Electronic address: f.dazzi@unimarconi.it.
authors.forename: Federico
authors.initials: F
authors.lastname: Dazzi
authors.affiliation: Mental Health Unit, Center of Epidemiology, Surveillance, and Health Promotion, Italian National Institute of Health, Viale Regina Elena 299, 00161 Rome, Italy.
authors.forename: Angelo
authors.initials: A
authors.lastname: Picardi
authors.affiliation: Department of Neurology and Psychiatry, Sapienza University of Rome, Viale dell'Università 30, 00185 Rome, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Orso
authors.affiliation: Department of Neurology and Psychiatry, Sapienza University of Rome, Viale dell'Università 30, 00185 Rome, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Biondi
mesh_terms: D000293:Adolescent; D000328:Adult; D004636:Emergency Service, Hospital; D005260:Female; D006760:Hospitalization; D006801:Humans; D016015:Logistic Models; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis; D028642:Persons with Psychiatric Disorders; D008875:Middle Aged; D015999:Multivariate Analysis; D010343:Patient Admission / Q000706:statistics & numerical data*; D011379:Prognosis; D011599:Psychopathology; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: Admission predictor; Dimensional assessment; Emergency psychiatry; Psychiatric admission; Psychopathological dimension