Involuntary psychiatric treatment of first generation immigrants with acute mental disorders in Italy. The role of forced migration

Background of the study: Migration is a risk factor for the development of mental disorders, especially psychotic disorders and severe mood disorders. Forced immigrants are frequently exposed to traumatic events and they are at higher risk of being diagnosed with a mental disorder than economic immigrants. Nevertheless, immigrated persons have difficulty to access community mental health care and a delayed treatment may lead to increased disease severity and consequent emergency referrals. Immigrants in Europe appear at higher risk of psychiatric coercive interventions. Reasons include cultural, ethnic and language differences leading to communication problems between immigrants and mental health professionals. Objective: Aim of the study is to explore clinical and migratory factors associated with involuntary treatment in a sample of first generation immigrants admitted to a Psychiatric Intensive Care Unit of a large Italian academic hospital. Methods: Socio-demographic, clinical and migratory variables were collected in all immigrant patients admitted in the ward from 2013 to 2016 and compared with age- gender- and DSM-IV diagnosis-matched sample of native patients admitted in the same period. Brief Psychiatric Rating Scale (BPRS) and Clinical Global Impression (CGI) scale were administered. Results: One hundred and seventeen immigrated patients were compared to 117 natives. Involuntary treatment rates were not significantly different in immigrants as compared to controls (32% vs 24% respectively). Among immigrants, asylum seekers were involuntary admitted more frequently than patients immigrated for economic or family reasons (50% vs 27% respectively; p=0,040). The lenght of stay in Italy appears to be a protective factor against involuntary treatment: 56% of patients in Italy from less than 2 years, 34% of those staying from 2 to 5 years and 23% from more than 5 year were admitted involuntarily (p=0,030). Conclusion: Recently immigrated asylum seekers with an acute mental disorder appear at risk of involuntary treatment. Since coercive interventions can be traumatic and can affect outcomes, strategies to prevent this phenomenon are needed