Psychiatric Bulletin (2000) 24: 59-61. doi: 10.1192/pb.24.2.59
© 2000 The Royal College of Psychiatrists
Psychiatric Bulletin (2000) 24: 59-61
© 2000 The Royal College of Psychiatrists
Admission patterns by psychiatric trainees. Are women patients as likely as men to be admitted for major mental illness?
Polash M. Shajahan, Specialist Registrar
MRC Brain Metabolism Unit, Royal Edinburgh Hospital, Morningside Park,
Edinburgh EH10 5HF
Andrew M. McIntosh, Senior House Officer
Royal Edinburgh Hospital, Morningside Park, Edinburgh
Jonathan T. O. Cavanagh, Research Fellow
University Department of Psychiatry, Royal Edinburgh Hospital
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Abstract
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AIMS AND METHODS
We hypothesised that the increased admission rate for men with major mental
illness may be the result of men being preferentially admitted by
psychiatrists. A questionnaire survey was devised and sent to all psychiatric
trainees on the South-East Scotland rotation. The questionnaire contained a
series of psychiatric vignettes representing conditions varying in severity of
risk.
RESULTS
Seventy-eight per cent responded to the questionnaire. Trainees were more
likely to admit patients representing a greater degree of risk irrespective of
the gender of the patient.
CLINICAL IMPLICATIONS
The increasing admission rates for men with major mental illness is
unlikely to be due to admission bias by trainees.
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Introduction
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In-patient resources in psychiatry are increasingly limited, with only the
most seriously ill or at risk patients being admitted in many regions
throughout the country. Evidence is emerging for increased admission rates for
young men with major mental illnesses in Scotland
(Cavanagh & Shajahan,
1999). There may be many potential reasons for this, including
increased morbidity in men, changing diagnostic patterns or even preferential
admission of men. We hypothesised that the increased admission rate for men
may be the result of men being preferentially admitted by psychiatrists, even
though their ‘severity’ of illness may be the same as that of
women.
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The study
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A questionnaire survey was devised and sent to all junior and higher
psychiatric trainees (senior house officers (SHOs) and specialist registrars
(SpRs) in the Lothian Region/South-East Scotland rotation. The questionnaire
contained four psychiatric scenarios or case vignettes (see Appendix). These
vignettes represented a range of severity of risk in terms of self-harm. At
one end of the range (Scenario 1) the risk of self-harm could be perceived as
relatively low. At the other end (Scenario 4) the risk could be considered
substantial. The psychiatrists were asked to rate along a five-point scale
(definitely to definitely not) how likely they were to admit the person that
the scenario related to. Half the psychiatrists received a questionnaire where
Scenarios 1 and 3 related to female patients and Scenarios 2 and 4 related to
male patients. The other half received a questionnaire where Scenarios 1 and 3
related to male patients and Scenarios 2 and 4 related to female patients.
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Findings
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One hundred and fourteen questionnaires were sent out randomly to 79 SHOs
and 35 Registrars. Eighty-nine were returned representing a response rate of
78%. Figures 1a to d show the
response patterns for the various case scenarios. The distributions did not
follow a normal distribution and non-parametric statistics (Kruskal-Wallis)
were used to analyse the data. The Kruskal-Wallis test showed a significant
effect of admission by scenario (
2=244, P<0.0001),
but no overall effect on admission due to the gender of the patient
(2=0.86, P=0.35).
Figure 1a, Scenario 1, shows
that the majority of psychiatric trainees were unlikely to admit the patient
concerned irrespective of whether they were male or female. At the other
extreme (Fig. 1d, Scenario 4)
all trainees were either ‘definite’ or ‘very likely’
to admit, irrespective of whether male or a female. Scenarios 2 and 3
represented a more ‘grey’ area where there was a greater
difference of opinion as to whether admission was appropriate or not. If
anything, a trend was seen in a more likely admission for a woman than a man
for Scenario 3.
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Comment
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Our hypothesis was not supported. Admission patterns for men and women are
approximately the same. We managed a satisfactory response rate in terms of
questionnaire surveys which represents the views of the majority of
psychiatric trainees in this region. It is not surprising, and indeed
reassuring, that psychiatric trainees are more likely to admit those patients
with serious illness and who are obviously at risk of self-harm, and that
there is no bias when it comes to assessing a man or a woman. It is of
interest that there is less consensus when the case (Scenario 3) is less clear
cut in terms of clinical risk of self-harm.
The increased first admission rate for men with major mental illness is
unlikely to be due to preferential admission by psychiatrists and is more
likely due to other reasons such as increased morbidity of major mental
illness in men.
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Appendix
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Scenario 1
A 22-year-old male is referred with an eight-month history of low mood and
feeling that life is not worth living. He has disturbance of sleep and
appetite. On questioning he is not psychotic and does not have immediate
suicidal plans. He has not responded to firstline antidepressants.
How likely are you to admit this patient?
Definitely
- Likely
- Unsure
- Unlikely
- Definitely not
Scenario 2
A 20-year-old female is referred with a two-month history of low mood and
feeling that life is not worth living. She has disturbance of sleep and
concentration. On questioning she feels people are talking about her and she
is contemplating suicide. She has been on fluoxetine 40 mg/day for the last
four weeks.
How likely are you to admit this patient?
- Definitely
- Likely
- Unsure
- Unlikely
- Definitely not
Scenario 3
A 21-year-old male is referred with a four-week history of worsening
auditory hallucinations and anxiety. He states that his mood is low. On
questioning he feels neighbours are discussing him. He does not have any
suicidal ideas. He was started on chlorpromazine 100 mg/day by his GP two
weeks ago.
How likely are you to admit this patient?
- Definitely
- Likely
- Unsure
- Unlikely
- Definitely not
Scenario 4
A 20-year-old female is referred with a six-month history of bizarre
behaviour and social withdrawal. She has boarded up the windows in her flat
saying that people are spying on her. She has impaired sleep and appetite. On
further questioning she has paranoid delusions and third person auditory
hallucinations. She states that she is seriously contemplating suicide.
How likely are you to admit this patient?
- Definitely
- Likely
- Unsure
- Unlikely
- Definitely not
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References
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CAVANAGH, J.T.O. & SHAJAHAN, P. M. (1999)
Increasing rates of hospital admission for men with major mental illnesses:
Data from Scottish mental health units, 1980-1995. Acta
Psychiatrica Scandinavica, 99,
353-359.[Medline]
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Abstract
Introduction
