Skip to main content Accessibility help

Patterns of admission to acute psychiatric in-patient facilities: a national survey in Italy

  • A. Preti (a1), P. Rucci (a2) (a3), G. Santone (a4), A. Picardi (a5), R. Miglio (a6), R. Bracco (a7), B. Norcio (a7) and G. de Girolamo (a8)...



A proper understanding of patterns of care represents a crucial step in improving clinical decision making and enhancing service provision. Only a few studies, however, have explored global patterns of psychiatric admissions nationwide, and none have been undertaken in Italy.


Sociodemographic, clinical and treatment-related information was collected for 1577 patients admitted to 130 public and 36 private in-patient facilities in Italy during an index period in the year 2004. All patients were also rated using the 24-item Brief Psychiatric Rating Scale (BPRS) and the Personal and Social Performance (PSP) rating scales.


Non-affective psychoses (36%) were the most common diagnoses and accounted to a large extent for compulsory admissions. Private facilities were more likely to admit patients with organic mental disorders and substance abuse/dependence and less likely to admit patients with non-affective psychoses. Overall, 77.8% of patients had been receiving treatment by a mental health professional in the month prior to admission. In 54% of cases, the admission was solicited by patients' family members. The main factors preceding admission were impairment in work or social functioning, social withdrawal, and conflict with family members. Agitation, delusions and/or hallucinations, and the presence of multiple problems were associated with compulsory admissions, whereas depressive and anxiety symptoms were associated with voluntary admissions.


In a mixed, public–private psychiatric care system, like the Italian one, public and private facilities admit patients with widely different clinical characteristics and needs. Family support represents an important resource for most patients, and interventions specifically addressed to relieving family burden are warranted.


Corresponding author

*Address for correspondence: G. de Girolamo, M.D., IRCCS Centro S. Giovanni di Dio-Fatebenefratelli, Brescia, Italy. (Email:


Hide All
Abas, M, Vanderyl, J, Le Prou, T, Kydd, R, Emery, B, Foliaki, SA (2003). Psychiatric hospitalization: reasons for admission and alternatives to admission in South Auckland, New Zealand. Australian and New Zealand Journal of Psychiatry 37, 620625.
Amaddeo, F, Zambello, F, Tansella, M, Thronicroft, G (2001). Accessibility and pathways to psychiatric care in a community-based mental health system. Social Psychiatry and Psychiatric Epidemiology 36, 500507.
Baruch, Y, Kotler, M, Lerner, Y, Benatov, J, Strous, RD (2005). Psychiatric admissions and hospitalization in Israel: an epidemiologic study of where we stand today and where we are going. Israel Medical Association Journal 7, 803807.
Bindman, J, Tighe, J, Thornicroft, G, Leese, M (2002). Poverty, poor services, and compulsory psychiatric admission in England. Social Psychiatry and Psychiatric Epidemiology 37, 341345.
Burge, P, Ouellette-Kuntz, H, Saeed, H, McCreary, B, Paquette, D, Sim, F (2002). Acute psychiatric inpatient care for people with a dual diagnosis: patient profiles and lengths of stay. Canadian Journal of Psychiatry 47, 243249.
Commission for Healthcare Audit and Inspection (2007). Count me in 2007. The Healthcare Commission: UK.
Cougnard, A, Kalmi, E, Desage, A, Misdrahi, D, Abalan, F, Brun-Russeau, H, Salmi, LR, Verdoux, H (2004). Factors influencing compulsory admission in first-admitted subjects with psychosis. Social Psychiatry and Psychiatric Epidemiology 39, 804809.
de Girolamo, G, Barbato, A, Bracco, R, Gaddini, A, Miglio, R, Morosini, P, Norcio, B, Picardi, A, Rossi, E, Rucci, P, Santone, G, Dell'Acqua, G (2007). The characteristics and activities of acute psychiatric inpatient facilities: a national survey in Italy. British Journal of Psychiatry 191, 170177.
de Girolamo, G, Bellini, M, Bocchia, S, Ruggeri, M (1995). Brief Psychiatric Rating Scale version 4.0 (BPRS 4.0) [in Italian]. Epidemiologia e Psichiatria Sociale 4, 6985.
De Salvia, D, Barbato, A (1993). Recent trends in mental health services in Italy: an analysis of national and local data. Canadian Journal of Psychiatry 38, 195202.
Fioritti, A, Lo Russo, L, Melega, V (1997). Reform said or done? The case of Emilia-Romagna within the Italian psychiatric context. American Journal of Psychiatry 154, 9498.
Gaddini, A, Biscaglia, L, Bracco, R, de Girolamo, G, Miglio, R, Norcio, B, Rossi, E, Rucci, P, Santone, G (in press). A one-day of acute psychiatric inpatient facilities in Italy: findings from the PROGRES-Acute project. Psychiatric Services.
George, L, Durbin, J, Sheldon, T, Goering, P (2002). Patient and contextual factors related to the decision to hospitalize patients from emergency psychiatric services. Psychiatric Services 53, 15861591.
Gigantesco, A, Miglio, R, Santone, G, de Girolamo, G, Bracco, R, Morosini, P, Norcio, B, Picardi, A (2007). The process of care in general hospital psychiatric units: a national survey in Italy. Australian and New Zealand Journal of Psychiatry 41, 509518.
Hogson, RE, Lewis, M, Boardman, AP (2001). Prediction of readmission to acute psychiatric units. Social Psychiatry and Psychiatric Epidemiology 36, 304309.
Issakidis, C, Andrews, G (2006). Who treats whom? An application of the Pathways to Care model in Australia. Australian and New Zealand Journal of Psychiatry 40, 7086.
Kisely, S, Preston, N, Rooney, M (2000). Pathways and outcomes of psychiatric care: does it depend on who you are, or what you've got? Australian and New Zealand Journal of Psychiatry 39, 10091014.
Kjellin, L, Høyer, G, Engberg, M, Kaltiala-Heino, R, Sigurjónsdóttir, M (2006). Differences in perceived coercion at admission to psychiatric hospitals in the Nordic countries. Social Psychiatry and Psychiatric Epidemiology 41, 241247.
Magliano, L, Fiorillo, A, De Rosa, C, Malangone, C, Maj, M (2004). Beliefs about schizophrenia in Italy: a comparative nationwide survey of the general public, mental health professionals and patients' relatives. Canadian Journal of Psychiatry 49, 171179.
Magliano, L, Marasco, C, Fiorillo, A, Malangone, C, Guameri, M, Maj, M, and the Working Group of the Italian National Study on Families of Persons with Schizophrenia (2002). The impact of professional and social network support on the burden of families of patients with schizophrenia in Italy. Acta Psychiatrica Scandinavica 106, 291298.
Mattioni, T, Di Lallo, D, Roberti, R, Miceli, M, Stefani, M, Maci, CA, Perucci, CA (1999). Determinants of psychiatric inpatient admission to the general hospital psychiatric wards: an epidemiological study in a region of central Italy. Social Psychiatry and Psychiatry Epidemiology 34, 425431.
Mitchell, PB, Malhi, GS (2004). Bipolar depression: phenomenological overview and clinical charactersitics. Acta Psychiatrica Scandinavica 6, 530539.
Morosini, PL, Magliano, L, Brambilla, L, Ugolini, S, Pioli, R (2000). Development, reliability and acceptability of a new version of the DSM-IV Social and Occupational Functioning Assessment Scale (SOFAS) to assess routine social functioning. Acta Psychiatrica Scandinavica 101, 323329.
Oluwatayo, O, Gater, R (2004). The role of engagement with services in compulsory admission of African/Caribbean patients. Social Psychiatry and Psychiatric Epidemiology 39, 739743.
Rittmannsberger, H, Sartorius, N, Brad, M, Burtea, V, Capraru, N, Cernak, P, Dernovçek, M, Dobrin, I, Frater, R, Hasto, J, Hategan, M, Haushofer, M, Kafka, J, Kasper, S, Macrea, R, Nabelek, L, Nawka, P, Novotny, V, Platz, T, Pojar, A, Silberbauer, C, Fekete, S, Wancata, J, Windhager, E, Zapotoczky, H-G, Zöchling, R (2004). Changing aspects of psychiatric inpatient treatment: a census investigation in five European countries. European Psychiatry 19, 483488.
Schuepbach, D, Goetz, I, Boeker, H, Hell, D (2006). Voluntary v. involuntary hospital admission in acute mania of bipolar disorder: results from the Swiss sample of the EMBLEM study. Journal of Affective Disorders 90, 5761.
Singh, SP, Grange, T (2006). Measuring pathways to care in first-episode psychosis: a systematic review. Schizophrenia Research 81, 7582.
Steel, Z, McDonald, R, Silove, D, Bauman, A, Sandford, P, Herron, J, Minas, H (2006). Pathway to the first contact with specialist mental health care. Australian and New Zealand Journal of Psychiatry 40, 347354.
Steinert, T, Lepping, P, Barananyai, R, Hoffmann, M, Leherr, H (2005). Compulsory admission and treatment in schizophrenia. A study of ethical attitudes in four European countries. Social Psychiatry and Psychiatric Epidemiology 40, 635641.
Thompson, A, Shaw, M, Harrison, G, Verne, J, Ho, D, Gunnell, D (2004). Patterns of hospital admission for adult psychiatric illness in England: analysis of hospital episode statistics data. British Journal of Psychiatry 185, 334341.
Wade, D, Harrigan, S, Harris, MG, Edwards, J, McGorry, PD (2006). Pattern and correlates of inpatient admission during the initial acute phase of first-episode psychosis. Australian and New Zealand Journal of Psychiatry 40, 429436.
Way, BB, Banks, S (2001). Clinical factors related to admission and release decision in psychiatric emergency services. Psychiatric Services 52, 214218.
Webber, M, Huxley, P (2004). Social exclusion and risk of emergency compulsory admission. A case–control study. Social Psychiatry and Psychiatric Epidemiology 39, 10001009.
Yung, A, Gill, L, Sommerville, E, Dowling, B, Simon, K, Pirkis, J, Livingston, J, Schweitzer, I, Tanaghow, A, Hermann, H, Trauer, T, Grigg, M, Burgess, P (2006). Public and private psychiatry: can they work together and is it worth the effort? Australian and New Zealand Journal of Psychiatry 39, 6773.


Patterns of admission to acute psychiatric in-patient facilities: a national survey in Italy

  • A. Preti (a1), P. Rucci (a2) (a3), G. Santone (a4), A. Picardi (a5), R. Miglio (a6), R. Bracco (a7), B. Norcio (a7) and G. de Girolamo (a8)...


Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed