The proportion of people with a first episode of psychosis admitted to hospital at initial presentation: a systematic review and meta-analysis.

IF 5.5 2区医学 Q1 PSYCHIATRY

Psychological Medicine Pub Date : 2025-08-11 DOI:10.1017/S0033291725101256

Louisa Gannon, Victoria Teague, Sheri Oduola, Fiona McNicholas, Mary Clarke, Stephen McWilliams, Brian O'Donoghue

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引用次数: 0

Abstract

Background: In psychiatry, there is a drive to reduce institutionalization, the risk of which starts with the index admission. In first-episode psychosis (FEP), the proportion of people admitted to hospital at initial presentation is still unknown.

Methods: This systematic review aimed to determine the proportion of people with FEP who are admitted at initial presentation (within 30 days from point of first contact with psychiatry) and the influence of individual, clinical, and service factors on admission risk. Four databases were searched from inception until June 2023: PubMed, Embase, PsycINFO, and CINAHL. The pooled proportion of people admitted was calculated using a random-effects model. Analyses were further stratified according to individual, clinical, and service factors.

Results: Of 7,455 abstracts screened, 18 studies with 19,854 participants were included. The proportion of people admitted overall was 51% (k = 18, 95% confidence interval [CI]: 37-65%; I²: 99.56%). The proportion admitted involuntarily was 31% (k = 6, 95% CI: 23-40%; I²: 95.26%). Sub-analyses for sex, diagnosis, and early intervention service access did not show significant differences between groups. The proportion of people with a short duration of untreated psychosis (DUP) admitted was 59% (k = 2, 95% CI: 56-63%) vs. 37% (k = 2, 95% CI: 33-41%) for long DUP, which was significant (p < 0.001). High inter-study heterogeneity was observed.

Conclusions: Results demonstrate that over half of the people are hospitalized when initially presenting for FEP, a high proportion, with consequences for individuals and health services at large. First, service contact must be prioritized as an opportunity for appropriate intervention, to either avoid unwarranted hospitalizations or if hospitalization is required, to ensure the application of focused therapeutic objectives within intended timeframes.

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首次精神病发作入院患者的比例：系统回顾和荟萃分析。

背景：在精神病学中，有一种减少机构化的动力，其风险从入院指数开始。在首发精神病（FEP）中，在初次表现时入院的人的比例仍然未知。方法：本系统综述旨在确定首次就诊时（从第一次接触精神病学开始30天内）入院的FEP患者比例，以及个人、临床和服务因素对入院风险的影响。从成立到2023年6月检索了四个数据库：PubMed， Embase， PsycINFO和CINAHL。录取人数的总比例是用随机效应模型计算出来的。根据个人、临床和服务因素进一步分层分析。结果：在筛选的7,455篇摘要中，纳入了18项研究，共19,854名参与者。总体被录取的人数比例为51% (k = 18, 95%置信区间[CI]: 37-65%；I2: 99.56%)。非自愿入院的比例为31% (k = 6, 95% CI: 23-40%；I2: 95.26%)。性别、诊断和早期干预服务获取的亚分析在组间没有显着差异。短期未治疗精神病（DUP）的住院患者比例为59% (k = 2, 95% CI: 56-63%)，而长期未治疗精神病（DUP）的住院患者比例为37% (k = 2, 95% CI: 33-41%)，这是显著的(p结论：结果表明，超过一半的患者在最初出现FEP时住院，这一比例很高，对个人和整个卫生服务都有影响。首先，必须将服务接触作为进行适当干预的机会加以优先考虑，以避免不必要的住院，或者在需要住院的情况下，确保在预定的时间框架内实现重点治疗目标。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Psychological Medicine 医学-精神病学

CiteScore

11.30

自引率

4.30%

发文量

711

审稿时长

3-6 weeks

期刊介绍： Now in its fifth decade of publication, Psychological Medicine is a leading international journal in the fields of psychiatry, related aspects of psychology and basic sciences. From 2014, there are 16 issues a year, each featuring original articles reporting key research being undertaken worldwide, together with shorter editorials by distinguished scholars and an important book review section. The journal''s success is clearly demonstrated by a consistently high impact factor.