Sociodemographic and Clinical Correlates Associated with the Frequent Service Users in an Italian Psychiatric Emergency Department

Background: The aim of the present study is to identify the main sociodemographic and clinical correlates associated with frequent service users (FSUs) in an Italian psychiatric emergency department. Methods: This study is an observational and prospective clinical investigation. All subjects (N = 549) consecutively admitted to the Psychiatric Inpatient Unit of the IRCCS Ospedale Policlinico San Martino ((Genoa, Italy) were recruited over a period of 18 months. Results: On average, FSUs were more likely to be single (75.0% vs. 64.0, p = 0.001), younger (38.79 years +/- 14.68 vs. 45.94 years +/- 16.94, p = 0.028), with an earlier onset (20.15 years +/- 7.22 vs. 29.33 years +/- 15.96, p < 0.001), and longer length of hospitalisation (13.65 days +/- 12.40 vs. 9.89 +/- 10.15, p = 0.006) compared to non-FSUs. While bipolar disorder was the most common primary diagnosis in both FSUs and non-FSUs, cluster B personality disorder was particularly elevated in FSUs (30.3% vs. 10.4%, p < 0.001). Furthermore, FSUs were more prone to substance use disorder (63.6% vs. 40.0%, p < 0.001), particularly cannabis (45.5% vs. 15.3%, p < 0.001), cocaine (33.3% vs. 10.4%, p < 0.001), and heroin (19.7% vs. 5.8%, p < 0.001), and were more likely to have non-suicidal self-injuries (21.2% vs. 6.8%, p < 0.001). FSUs were significantly more likely to be discharged against medical advice (18.2% vs. 5.6%, p < 0.001) or to have at least one escape attempt from the psychiatric ward (12.1% vs. 0.8%, p < 0.001). Conclusions: Specific clinical and social profiles of patients who repeatedly utilised the services of a psychiatric emergency department have been identified. Our findings can be used to develop suitable structures to support and reintegrate FSUs into society and work life.

Automated summary

The aim of this study is to identify the main sociodemographic and clinical correlates associated with frequent service users (FSUs) in an Italian psychiatric emergency department. The results showed that FSUs were more likely to be single, younger, with an earlier onset, and have a longer length of hospitalisation compared to non-FSUs. They were also more prone to bipolar disorder, cluster B personality disorder, substance use disorder, and non-suicidal self-injuries. Furthermore, FSUs were more likely to be discharged against medical advice or have escape attempts from the psychiatric ward.