Abstract
Psychiatric involuntary hospitalization (IH) rates differ across the United States (U.S.), but few studies have investigated what physician characteristics influence the decision-making process for IH. This cross-sectional survey study used the Psychiatric Involuntary Hospitalization Decision-making (PIHD) instrument, a previously validated, vignette-based tool, to measure individual psychiatrists' likelihood to admit patients involuntarily and their confidence in IH decision-making. Psychiatrists and psychiatry trainees (N = 246) from eight pre-selected academic psychiatry departments across major U.S. regions completed an online survey that included the PIHD instrument and questions on physician demographics, clinical experience, attitudes and beliefs about patient care, and level of paternalism. Results indicated that demographic factors and years of experience were not associated with likelihood of admittance or physician confidence in decision-making. Likelihood of IH admittance was higher among participants in the Northeast and Southeast. Among attending physicians, likelihood of IH admittance was higher among those with inpatient experience and lower among those with experience in psychiatric emergency services. Likelihood of admittance was also positively correlated with higher levels of paternalism and physician beliefs that IH is beneficial. Among trainees, greater worries about patient safety were associated with higher likelihood of IH admittance. In the full sample, confidence in IH decision-making was highest in the Northeast, Southeast, and Southwest, and was positively correlated with emergency psychiatry experience. Confidence in IH decision-making was associated with paternalism, but only among attending physicians. This study is one of the first to identify individual factors that may influence psychiatrist decision-making around IH in the U.S.