title: [Crisis unit at the general hospital: Determinants of further hospitalization].
abstract: BACKGROUND
  The availability of short-stay beds for brief admission (less than 72hours) of crisis patients presenting to the emergency room is a model that has gained a growing interest because it allows time for developing alternatives to psychiatric hospitalization and favors a maintained functioning in the community. Still, the determinants influencing the disposition decision at discharge after crisis intervention remain largely unexplored.
  
  
  OBJECTIVE
  The primary objective of this study was to determine the factors predicting aftercare dispositions at crisis unit discharge: transfer for further hospitalization or return to the community. Secondary objectives included the description of clinical and socio-demographic characteristics of patients admitted to the crisis unit upon presentation to the emergency room.
  
  
  METHODS
  All patients (n=255) admitted to the short-stay unit of the emergency department of Rambouillet General Hospital during a one-year period were included in the study. Patient characteristics were collected in a retrospective manner from medical records: patterns of referral, acute stressors, presenting symptoms, initial patient demand, Diagnostic and Statistical Manual, 5th edition (DSM-5) disorders, psychiatric history, and socio-demographic characteristics were inferred. Logistic regression analysis was used to determine the factors associated with hospitalization decision upon crisis intervention at discharge.
  
  
  RESULTS
  Following crisis intervention at the short-stay unit, 100 patients (39.2%) required further hospitalization and were transferred. Statistically significant factors associated with a higher probability of hospitalization (P<0.05) included the patient's initial wish to be hospitalized (OR=4.28), the presence of a comorbid disorder (OR=3.43), a referral by family or friends (OR=2.89), a history of psychiatric hospitalization (OR=2.71) and suicidal ideation on arrival in the emergency room (OR=2.26). Conversely, significant factors associated with a lower probability of hospitalization were the presence of a personality disorder (OR=0.31), a precipitating conflict situation (OR=0.41), age between 20 and 39 years (OR=0.42), being employed (OR=0.49).
  
  
  CONCLUSIONS
  Our study confirms that clinical factors such as the presence of a personality disorder or the context of a precipitating conflict situation are predictive of a community return. Interestingly, it points out the importance of the patient's initial wish in the hospitalization decision.
authors.affiliation: Université Paris-Descartes, UFR de médecine, 75006 Paris, France. Electronic address: cyrillenorotte@yahoo.fr.
authors.forename: C
authors.initials: C
authors.lastname: Norotte
authors.affiliation: Pôle de psychiatrie adultes 78G16, centre hospitalier Jean-Martin-Charcot, 78370 Plaisir, France.
authors.forename: C
authors.initials: C
authors.lastname: Omnès
authors.affiliation: Département d'information médicale, centre hospitalier Jean-Martin-Charcot, 78370 Plaisir, France.
authors.forename: C
authors.initials: C
authors.lastname: Crozier
authors.affiliation: Pôle de psychiatrie adultes 78G16, centre hospitalier Jean-Martin-Charcot, 78370 Plaisir, France; Unité des urgences psychiatriques, centre hospitalier Général-de-Rambouillet, 78120 Plaisir, France.
authors.forename: C
authors.initials: C
authors.lastname: Verlyck
authors.affiliation: Pôle de psychiatrie adultes 78G16, centre hospitalier Jean-Martin-Charcot, 78370 Plaisir, France; Unité des urgences psychiatriques, centre hospitalier Général-de-Rambouillet, 78120 Plaisir, France.
authors.forename: M
authors.initials: M
authors.lastname: Romanos
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003419:Crisis Intervention / Q000706:statistics & numerical data; D004637:Emergency Services, Psychiatric / Q000706:statistics & numerical data; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006769:Hospitals, General / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis* / Q000453:epidemiology*; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult
keywords: Brief hospitalization; Crisis beds; Crisis intervention; Hospitalisation brève; Intervention de crise; Lits de crise; Psychiatric emergency; Short-stay unit; Urgence psychiatrique