Comparison of adolescent referred involuntarily or voluntarily to psychiatric hospitalization

Purpose of the study To study in an adolescent clinical inpatient population how clinical, background and psychological factors differ between adolescents referred voluntarily or involuntarily. Methods In this prospective cohort study, we compared adolescents (age 13-17 years, n = 206) who had been referred to psychiatric hospitalization for the first time in their life either voluntarily (n = 144) or involuntarily (n = 62). We gathered from clinical records data on the source, mode and reason for referral as well as on whether after referral the subjects were admitted to the hospital voluntarily or not, and whether they were committed to involuntary hospitalization after the observation period. Diagnostics was based on Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version (K-SADS-PL) interview, supplemented by information from clinical records. Structured self-reports provided information on family background, depressive symptoms, substance use, defense styles, self-image and perceived social support. Results The majority of referrals due to psychotic symptoms were involuntary, whereas self-harm was the primary reason for involuntary and voluntary referrals in comparable extent. After diagnostic evaluation, no significant difference in psychotic disorders was observed between the two groups, but anxiety disorders were more prevalent among inpatients referred voluntarily than involuntarily. Among adolescents referred involuntary, parents were more often unemployed and had mental health problems. In self-assessments, mature defense style and more positive self-image were associated with adolescents referred involuntarily compared with those referred voluntarily. Conclusions Not only psychiatric but also psychological and social factors were associated with involuntary referral for psychiatric hospitalization in adolescents.