Biopsychosocial complexity and compulsory admission to the psychiatric ward: A retrospective observational study

Background: The INTERMED scale is a tool used to assess the biopsychosocial (BPS) complexity through a semi-structured interview that explores the psychological, biological, social and health-system domains. The objective of this study was to investigate the use of the INTERMED scale as a predictor of Compulsory Admission (CA) in patients with psychiatric disorders. Method: Sociodemographic and clinical information, including INTERMED and HoNOS scores, was collected retrospectively on patients admitted to the hospital psychiatric ward under both CA and Voluntary Admission (VA). The correlations between these variables and admission type were analysed using descriptive statistics and Chi2 and t-test. Then, univariate logistic regression was used to estimate Odds Ratios (ORs) with 95% confidence intervals (95% CIs) for CA based on different predictors, including the INTERMED score, as a measure of BPS complexity. Results: The entire sample of 332 CA and VA patients exhibited considerable BPS complexity (mean INTERMED total score 25.8 ± 8.4), but this was higher among CA patients (all INTERMED scores but the biological domain one); further significant differences were observed between CA and VA patients, e.g. diagnosis at discharge or dosage of antipsychotic medications. Moreover, high scores on the INTERMED scale were identified as predictors of CA, particularly the total score (OR:1.05[95% CI:1.02;1.08]), the psychological domain score (OR:1.30[95% CI:1.18;1.44]) and the health-system domain score (OR:1.15[95% CI:1.05;1.25]). Conclusions: This study found significant associations between some INTERMED dimensions and CA. INTERMED may be a useful screening instrument to identify specific areas of vulnerability in patients with psychiatric disorders, that could support clinical strategies to reduce hospitalization and CA.