Certain groups may be at increased risk for involuntary psychiatric hospitalization during childhood, which likely establishes a cycle of health care inequality. These findings, from a systematic review and meta-analysis, were published in Lancet Child and Adolescent Health.

Researchers at University College London searched publication databases through July of 2020 for studies of voluntary and involuntary psychiatric inpatients among children and adolescents. A total of 23 studies were included in the narrative review, 19 of which were used for the meta-analysis.

All studies were conducted in high-income countries (Finland, Germany, Netherlands, Switzerland, Belgium, Sweden, United Kingdom, United States, Canada, New Zealand, Israel). A total of 41,271 inpatients were represented in this study, 23.6% of whom were involuntarily hospitalized.

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Involuntary hospitalizations were associated with psychosis (odds ratio [OR], 3.63; 95% CI, 2.43-5.44; P <.0001; I2, 90.5%), intellectual disability (OR, 3.33; 95% CI, 1.33-8.34; P =.010; I2, 65.6%), violence or aggression (OR, 2.37; 95% CI, 1.39-4.03; P =.0015; I2, 62.9%), self-harm or suicidal ideation (OR, 2.05; 95% CI, 1.15-3.64; P =.015; I2, 77.7%), and primary substance misuse (OR, 1.87; 95% CI, 1.05-3.30; P =.032; I2, 84.9%).

Involuntary hospitalization was less likely among patients with anxiety (OR, 0.19; 95% CI, 0.05-0.81; P =.025; I2, 0.0%) or behavioral problems (OR, 0.71; 95% CI, 0.50-0.84; P =.0012; I2, 85.5%).

Compared with White patients, Black adolescents were at an increased risk for involuntary hospitalization (OR, 2.72; 95% CI, 1.88-3.95; P <.0001; I2, 0.0%) and Asians were not (OR, 1.12; 95% CI, 0.32-3.84; P =.86; I2, 8.1%).

As defined by the underlying studies, both children aged ³12 years (OR, 3.57; 95% CI, 1.46-8.73; P =.0052; I2, 90.4%) and older adolescents (OR, 2.82; 95% CI, 1.04-7.63; P =.042; I2, 83.7%) were associated with involuntary hospitalization compared with their younger counterparts.

There was no evidence for gender-specific bias with regards to involuntary hospitalization (OR, 0.78; 95% CI, 0.55-1.11; P =.17; I2, 80.4%).

This analysis reported significant heterogeneity among the underlying studies and was biased toward high-income countries.

These data indicated certain groups of children were more likely to be hospitalized involuntarily compared with others. These factors need to be considered such that a cycle of health care inequality does not begin early and persist throughout life.


Walker S, Barnett P, Srinivasan R, Abrol E, Johnson S. Clinical and social factors associated with involuntary psychiatric hospitalisation in children and adolescents: a systematic review, meta-analysis, and narrative synthesis. Lancet Child Adolesc Health. Published online April 27, 2021. doi:10.1016/S2352-4642(21)00089-4