[Comparison between Swiss and foreign patients characteristics at the psychiatric emergencies department and the predictive factors of their management strategies].

UNLABELLED: Many studies are searching clinical and social-demographic predictive factors of the management options in psychiatric emergency. The greater part of these researches are published in US and are seeking about patients and about conditions of psychiatric practice different of the European circumstances. Such differences have motivated us to perform a comparison between the characteristics of the native Swiss and of the foreign patients in the psychiatric emergencies. The other aim of the study was to detect, if differences are proven, some predictive factors of their management strategies. This study describes the social-demographic and clinical characteristics of a sample of 1 028 unduplicated consultations and investigates possible relationships between these clinical characteristics and different management strategies, with a particular focus on the foreign patients, covering 46.5% of all consultations. Because quite half of the psychiatric emergency visits occur with foreigners, it plays a potentially important role in searching the disparities in diagnosis and management. To verify these differences, we studied two specific questions: 1) are there nationalities differences in diagnosis with respect to the Swiss native population, and 2) are there nationality differences in management of patients visiting a psychiatric emergency service?

METHODOLOGY: Demographic and clinical data were obtained prospectively from the psychiatric emergency service of Geneva, located in the county general hospital, during a 13 weeks period. The study involved all patients aged between 18 and 65 years, inhabitants of county of Geneva-Switzerland, presented at the psychiatric emergency service of the general hospital. To limit the bias of screening the chronic patients, we have included only once, at the first examination, the patients with more than one emergency consultation in the considered interval.

RESULTS: As a general trend, the probability for the foreign patients to consult the emergency psychiatrist is greater than for the Swiss natives: OR=1.44, p=0.000. The social-demographic factors show significant differences between the foreigners and Swiss population: the immigrating population is younger, more active and clustered to a familial structure. Despite the availability and use of the same clinical criteria, foreign patients are disproportionately differently diagnosed, with less alcohol abuse (14.7% for foreigners versus 23.9% in the Swiss population), less personality disorders (8.1% versus 13%), more affective disorders (54.7% versus 43%) and more anxious disorders (18.4% versus 12.3%). Furthermore, on the sum of all diagnoses, the single statistically significant difference in management is found in respect to the recommendation for a Short-term Therapeutic Centre , done more frequently for the foreigners: 15.5% versus 11.3%. Some immigration-related predictive factors of diagnosis and management are found and detailed.

DISCUSSION: The apparent habit of the foreigners to appeal to the hospital emergencies could be, at least partially, due to a minority or cultural factor: the patients seem to be easily appealing to a great hospital rather than to a territorial policlinic by failure to find a psychiatrist into the Swiss health network. This hypothesis is to be confirmed by further studies. The inexistence of significant differences in management of the patients with the same diagnosis between the two patient groups suggests the equality of resources spent for the two patient groups. The main methodological limit of this study consists of the gathering of different immigrated nationalities in a unique patient group in order to find, if any, significant differences in comparison to the Swiss patients, whereas may be matter of heterogeneous populations.

CONCLUSION: These observations suggest that further researches are needed to clarify the decision-making process in diagnosis and patient management in psychiatric emergency department, especially for foreigners, and to distinguish different cultural groups rather than different nationalities. The reassessment of all patients with their clinical evolution and the allocated health resources could lead to the question on the relevance of health management decisions in psychiatric emergency circumstances, as well as to the question on the influence of the foreigner status on therapeutic decisions.