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PeerJ. 2019 Jul 19;7:e7339. doi: 10.7717/peerj.7339. eCollection 2019.

Manic episode, aggressive behavior and poor insight are significantly associated with involuntary admission in patients with bipolar disorders.

Luo C1,2,3,4, Chen H1,2,3,4, Zhong S1,2,3,4, Guo H1,2,3,4, Li Q1,2,3,4, Cai W5, de Girolamo G6, Zhou J1,2,3,4, Wang X1,2,3,4.

Author information

Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China.
National Clinical Research Center on Mental Disorders, Changsha, Hunan, China.
National Technology Institute on Mental Disorders, Changsha, Hunan, China.
Hunan Key Laboratory of Psychiatry and Mental Health, Changsha, Hunan, China.
Shanghai Forensic Service Platform, Academy of Forensic Science, Shanghai Key Laboratory of Forensic Medicine, Shanghai, China.
IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy.



Serious mental illnesses, such as bipolar disorders and schizophrenia, are closely associated with involuntary admission. Many studies have focused on involuntary admission in people with schizophrenia, but little is known about the factors associated with involuntary admission in Chinese patients with bipolar disorders. This study aimed to investigate socio-demographic and clinical factors associated with involuntary admission in Chinese patients with bipolar disorders.


In this multi-center cross-sectional survey in China, a total of 155 newly admitted patients with bipolar disorders were consecutively recruited from 16 psychiatric institutions from 15 March to 14 April, 2013. Patients' socio-demographic and clinical data were collected from their medical records. The Modified Overt Aggression Scale and the Insight and Treatment Attitudes Questionnaire were used to measure patients' level of aggression and insight of current psychiatric illness.


The prevalence of involuntary admission was 52% in this sample of Chinese inpatients with bipolar disorders. In multiple logistic regression, a high level of aggression (odds ratio (OR) = 2.48), diagnosis of manic episode (OR = 3.65), poor insight (OR = 7.52), and a low level of education (OR = 3.13) were significantly associated with involuntary admission.


Manic episode, aggressive behavior, and poor insight were the significant contributing factors to involuntary admission in Chinese patients with bipolar disorders.


Aggressive behavior; Bipolar disorder; Involuntary admission

Conflict of interest statement

The authors declare that they have no competing interests.

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