Use of psychiatric inpatient services by heavy users: Findings from a national survey in Italy

Purpose: To analyze factors associated with a patient's probability of being a Heavy User (HU) of inpatient psychiatric services and to compare the HU inpatient population with Non-Heavy Users (NHUs). Patients and methods: The survey was conducted among inpatients enrolled in the PROGRES-Acute-project, an Italian nationwide survey of public and private inpatient facilities. Patients with three or more admissions over the last 12 months were considered HUs, and patients who had undergone one or two admissions during the same period made up the NHU group. Results: Four hundred and thirty-five (40.5%) were HUs, and 640(59.5%) NHUs. HUs were younger, more frequently unmarried, unemployed, receiving a disability-pension, and either homeless or living in a residential facility. HUs were more likely to have experienced conflicts with their partners or family members during the week prior to admission. A logistic regression analysis revealed that age, age at first admission, number of life-time admissions, and having been the victim of violence were the most important predictive factors for the HU phenomenon. Conclusion: Our study suggests that specific attention should be given to patients' family context, due to its crucial role in daily informal care and in the triggering of events leading to rehospitalization. (C) 2010 Published by Elsevier Masson SAS.