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Psychiatr Serv. 2019 Oct 2:appips201900106. doi: 10.1176/ [Epub ahead of print]

Voluntary and Involuntary Admissions for Severe Mental Illness in China: A Systematic Review and Meta-Analysis.

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Unit of Psychiatry, Faculty of Health Sciences and Center for Cognition and Brain Sciences, University of Macau, Macao Special Administrative Region, China (Yang, Li, Xiang); Department of Psychiatry, Southern Medical University Nanfang Hospital, Guangdong-Hong Kong-Macao Greater Bay Area Center for Brian Science and Brain-Inspired Intelligence, Guangdong, China (Yang); National Clinical Research Center for Mental Disorders, Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, and the Advanced Innovation Center for Human Brain Protection, School of Mental Health, Capital Medical University, Beijing (An); Faculty of Health and Life Sciences, De Montfort University, Leicester, United Kingdom (Wang); Department of Psychiatry, University of Notre Dame Australia, Fremantle, and Division of Psychiatry, School of Medicine, University of Western Australia, Perth (Ungvari); Department of Psychiatry, University of Saskatchewan, Saskatoon, Canada (Balbuena).



The aim of this systematic review and meta-analysis was to examine the prevalence of voluntary and involuntary psychiatric admissions for severe mental illness in China and explore their associated factors.


The PubMed, Cochrane Library, PsycINFO, EMBASE, CNKI, CQVIP, and WanFang databases were systematically searched for the span since their inception to October 2018. Meta-analyses were conducted with the random-effects model.


Fourteen studies with 94,305 patients were included in the analyses. The voluntary and involuntary admission rates were 30.3% (95% confidence interval [CI]=18.06% to 46.23%) and 32.3% (95% CI=10.39% to 66.21%), respectively, for severe mental illness and 19.6% (95% CI=14.09% to 26.54%) and 44.3% (95% CI=5.98% to 90.88%), respectively, for schizophrenia. Meta-regression analyses found an increase in the voluntary admission rate between 1998 and 2018.


The voluntary admission rate for severe mental illness has increased in China, whereas the involuntary admission rate has remained high, particularly for schizophrenia. Concerted efforts should be made to further decrease the rate of involuntary admissions.


China; Mental health systems/hospitals; Patient rights; involuntary admission; meta-analysis; psychiatric; voluntary admission


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