Abstract
This study investigates the combinations of factors associated with involuntary psychiatric admission for persons living with their family and whether these are differentiated by type of family. Data from consecutive admissions in public acute psychiatric units of Thessaloniki, Greece, collected over one-year period were analyzed via Latent Profile Analysis. Of the three ensued profiles, only one, consisting mainly of younger men diagnosed with schizophrenia-spectrum disorders living with their family of origin, is linked to involuntary hospitalization. The other two profiles include mainly older people with recent onset of depressive disorder living with their created family and women living in socially deprived families, respectively. Severity and duration of psychopathology, inadequate contact with mental health services and socioeconomic adversity seem to constitute risk factors that might lead people living with their families to psychiatric hospitalization, when in crisis, despite the protective role that the family-related perceived social support and life satisfaction might play. Supporting families to manage their suffering member’s mental state through collaboration with appropriate mental health services, as well as empowering disadvantaged families to deal with the adverse effects of socioeconomic deprivation appear to be the main strategies to prevent psychiatric hospitalization, especially involuntary.
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Original data cannot be available at present, as this is an ongoing project, but will be made available at a later stage. Processed data is provided within the manuscript.
References
Stylianidis, S. et al. Involuntary psychiatric hospitalizations in Greece: Contemporary research and policy implications. Psychiatriki. 34, 204–211 (2023).
Turnpenny, A., Petri, G., Finn, A., Beadle-Brown, J. & Nyman, M. Mapping and understanding exclusion: Institutional, coercive and community-based services and practices across Europe. https://doi.org/10.22024/UniKent/01.02/64970 (2018).
Georgaca, E., Anastasopoulos, O., Stamovlasis, D., Zissi, A., Peppou, L. E., Arvaniti, A., Samakouri, M., Stylianidis, S. & the Thessaloniki MANE Group. What renders living alone a risk factor for involuntary psychiatric admission?. Curr Psychol. 43, 13828 (2024).
Rugkåsa, J. & Canvin, K. Mental health, coercion and family caregiving: issues from the international literature. BJPsych Int. 14(3), 56–58 (2017).
Koutra, K., Simos, P., Triliva, S., Lionis, C. & Vgontzas, A. N. Linking family cohesion and flexibility with expressed emotion, family burden and psychological distress in caregivers of patients with psychosis: A path analytic model. Psychiatry Res. 240, 66–75 (2016).
Stylianidis, S. et al. Mental health care in Athens: Are compulsory admissions in Greece a one-way road?. Int. J. Law Psychiatry 52, 28–34 (2017).
Fekadu, W., Mihiretu, A., Craig, T. K. J. & Fekadu, A. Multidimensional impact of severe mental illness on family members: Systematic review. BMJ Open 9(12), e032391 (2019).
Kuhney, F. S., Miklowitz, D. J., Schiffman, J. & Mittal, V. A. Family-based psychosocial interventions for severe mental illness: Social barriers and policy implications. Policy Insights Behav. Brain Sci. 10(1), 59–67 (2023).
Rugkåsa, J., Molodynski, A. & Burns, T. Family carers and coercion in the community. Coercion in Community Mental Health Care: International Perspectives. 161–178 (2016).
Dixon, J., Stone, K. & Laing, J. Beyond the call of duty: A Qualitative study into the experiences of family members acting as a Nearest Relative in Mental Health Act assessments. Br. J. Soc. Work. 52(7), 3783–3801 (2022).
Koutra, K., Triliva, S., Roumeliotaki, T., Lionis, C. & Vgontzas, A. N. Identifying the socio-demographic and clinical determinants of family functioning in Greek patients with psychosis. Int. J. Soc. Psychiatry 61(3), 251–264 (2015).
Ribé, J. M. et al. Quality of life in family caregivers of schizophrenia patients in Spain: caregiver characteristics, caregiving burden, family functioning, and social and professional support. Int. J. Psychiatry Clin. Pract. 22(1), 25–33 (2018).
Watson, P. et al. A meta-analysis of factors associated with quality of life in first episode psychosis. Schizophr. Res. 202, 26–36 (2018).
van der Post, L. F. M. et al. Social support and risk of compulsory admission: Part IV of the Amsterdam study of acute psychiatry. Psychiatr. Serv. 63(6), 577–583 (2012).
Guzzetta, F. et al. First-ever admitted psychiatric inpatients in Italy: Clinical characteristics and reasons contributing to admission: Findings from a national survey. Psychiatry Res. 176(1), 62–68 (2010).
Thoits, P. A. Perceived social support and the voluntary, mixed, or pressured use of mental health services. Soc. Mental Health. 1(1), 4–19 (2011).
Petkari, E., Giacco, D. & Priebe, S. Factorial structure of the Manchester short assessment of quality of life in patients with schizophrenia-spectrum disorders. Qual. Life Res. 29(3), 833–841 (2020).
Dayton, C. M. & Dayton, M. C. Latent class scaling analysis (Sage.1998).
Magidson, J. & Vermunt, J. K. Latent class factor and cluster models, bi-plots, and related graphical displays. Sociol. Methodol. 31(1), 223–264 (2001).
Georgaca, E. et al. Clinical determinants of involuntary psychiatric hospitalization: A clinical profile approach. J. Clin. Psychol. 79, 2081–2100 (2023).
Mollborn, S., Lawrence, E. M. & Hummer, R. A. A gender framework for understanding health lifestyles. Soc. Sci. Med. 265, 113182 (2020).
Read, S. et al. Public preferences for paying for social care in later life in England: A latent class analysis. Soc. Sci. Med. 274, 113803 (2021).
Bakk, Z., Tekle, F. B. & Vermunt, J. K. Estimating the association between latent class membership and external variables using bias-adjusted three-step approaches. Sociol. Methodol. 43(1), 272–311 (2013).
Stamovlasis, D., Papageorgiou, G., Tsitsipis, G., Tsikalas, T. & Vaiopoulou, J. Illustration of step-wise latent class modeling with covariates and taxometric analysis in research probing children’s mental models in learning sciences. Front. Psychol. 9, 532 (2018).
de Medina-Moragas, A. J., Lima-Serrano, M., Fernández-Fernández, M. J. & Lima-Rodríguez, J. S. Quality of life of individuals with serious mental illness and family caregivers. Curr. Psychol. 43(25), 21756–21767 (2024).
Wakim, M. L., Al Haddad, C., Haddad, C., Mouawad, M. & Hachem, D. The relationship between perceived social support and quality of life among hospitalized patients with schizophrenia. Sci. Rep. 15(1), 36039 (2025).
Degnan, A., Berry, K., Humphrey, C. & Bucci, S. The relationship between stigma and subjective quality of life in psychosis: A systematic review and meta-analysis. Clin. Psychol. Rev. 85, 102003 (2021).
Georgaca, E., Zissi, A. & Cromby, J. Internalized stigma and self-presentation strategies of persons with psychotic and psychiatric experiences. J. Commun. Psychol. 50, 2875–2891 (2022).
Walker, S. et al. Clinical and social factors associated with increased risk for involuntary psychiatric hospitalisation: a systematic review, meta-analysis, and narrative synthesis. Lancet Psychiatry. 6(12), 1039–1053 (2019).
Economou, M., Lazaratou, H. & Ploumpidis, D. Compulsory admissions in Greece: multifaceted action is required. The Lancet. 391(10129), 1481 (2018).
Koutra, K. et al. Family functioning in first-episode and chronic psychosis: The role of patient’s symptom severity and psychosocial functioning. Commun. Ment. Health J. 52, 710–723 (2016).
Haarmans, M. Everything you always wanted to know about sex (and gender) in psychosis but were afraid to ask: A narrative review in Psychopathology in women (ed. M. Sáenz-Herrero) 453–479 (Springer Nature Switzerland, 2019).
van der Post, L. F. M. et al. Involuntary admission of emergency psychiatric patients: Report from the Amsterdam study of acute psychiatry. Psychiatr. Serv. 60(11), 1543–1546 (2009).
Smyth, N., Siriwardhana, C., Hotopf, M. & Hatch, S. L. Social networks, social support and psychiatric symptoms: Social determinants and associations within a multicultural community population. Soc. Psychiatry Psychiatr. Epidemiol. 50(7), 1111–1120 (2015).
Weich, S. et al. Variation in compulsory psychiatric inpatient admission in England: A cross-classified, multilevel analysis. Lancet Psychiatry 4(8), 619–626 (2017).
Feeney, A., Umama-Agada, E., Gilhooley, J., Asghar, M. & Kelly, B. D. Gender, diagnosis and involuntary psychiatry admission in Ireland: a report from the Dublin Involuntary Admission Study (DIAS). Int. J. Law Psychiatry 66, 101472 (2019).
McCarthy, M. Poor people view hospitals as providing better access, care, and social support. BMJ 17(347), f4556 (2013).
Klingemann, J., Świtaj, P., Lasalvia, A. & Priebe, S. Behind the screen of voluntary psychiatric hospital admissions: A qualitative exploration of treatment pressures and informal coercion in experiences of patients in Italy, Poland and the United Kingdom. Int. J. Soc. Psychiatry 68(2), 457–464 (2022).
Hempeler, C., Potthoff, S., Scholten, M., Juckel, G. & Gather, J. Strategies to promote treatment compliance: a grounded theory study with relatives of people with a serious mental health condition. BMC Psychiatry 24(1), 490 (2024).
Haarmans, M., McKenzie, K., Kidd, S. A. & Bentall, R. P. Gender role strain, core schemas, and psychotic experiences in ethnically diverse women: A role for sex- and gender-based analysis in psychosis research?. Clin. Psychol. Psychother. 25(6), 774–784 (2018).
Di Lorenzo, R. et al. Involuntary Hospitalizations in an Italian Acute Psychiatric Ward: A 6-Year Retrospective Analysis. Patient Prefer. Adher. 17, 3403–3420 (2023).
Berghöfer, A., Martin, L., Hense, S., Weinmann, S. & Roll, S. Quality of life in patients with severe mental illness: a cross-sectional survey in an integrated outpatient health care model. Qual. Life Res. 29, 2073–2087 (2020).
Thomas, P. A., Liu, H. & Umberson, D. Family relationships and well-being. Innovation in Aging. 1(3), igx025 (2017).
Adrien, V. et al. Association between family functioning and psychotic transition in ultra-high risk adolescents and young adults. Front. Psych. 21(14), 1177311 (2023).
Harries, C. I., Smith, D. M., Gregg, L. & Wittkowski, A. Parenting and Serious Mental Illness (SMI): A Systematic Review and Metasynthesis. Clin. Child. Fam. Psychol. Rev. 26(2), 303–342 (2023).
Thompson, E. et al. Family functioning moderates the impact of psychosis-risk symptoms on social and role functioning. Schizophr. Res. 204, 337–342 (2019).
Stylianidis, S. et al. Patients’ views and experiences of involuntary hospitalization in Greece: A focus group study. Int. J. Cult. Ment. Health 11(4), 425–436 (2018).
Abou Seif, N., Wood, L. & Morant, N. Invisible experts: A systematic review & thematic synthesis of informal carer experiences of inpatient mental health care. BMC Psychiatry. 22, 347 (2022).
Bartl, G. et al. A qualitative meta-synthesis of service users’ and carers’ experiences of assessment and involuntary hospital admissions under mental health legislations: a five-year update. BMC Psychiatry 24(1), 476 (2024).
Rains, L. S. et al. Understanding increasing rates of psychiatric hospital detentions in England: development and preliminary testing of an explanatory model. BJPsych Open. 6(5), e88 (2020).
Loukidou, E. et al. Greek mental health reform: Views and perceptions of professionals and service users. Psychiatriki. 24, 37–44 (2013).
Alegría, M., NeMoyer, A., Falgàs Bagué, I., Wang, Y. & Alvarez, K. Social determinants of mental health: Where we are and where we need to go. Curr. Psychiatry Rep. 20(11), 95 (2018).
Allen, J., Balfour, R., Bell, R. & Marmot, M. Social determinants of mental health. Int. Rev. Psychiatry 26(4), 392–407 (2014).
Pūras, D. Final report of the Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health. UN. Human Rights Council. https://digitallibrary.un.org/record/1298436?v=pdf (2020).
Silva, M., Loureiro, A. & Cardoso, G. Social determinants of mental health: A review of the evidence. Eur. J. Psychiatry. 30(4), 259–292 (2016).
American Psychological Association. Fact sheet: Women and socioeconomic status. https://www.apa.org/pi/ses/resources/publications/women (2025).
Christiansen, D. M., McCarthy, M. M. & Seeman, M. V. Where sex meets gender: How sex and gender come together to cause sex differences in mental illness. Front. Psych. 13, 856436 (2022).
Georgaca, E. & Zissi, A. Socially differentiated life trajectories of individuals with experience of psychosis: A biographical study. Mental Health & Prevention. 14, 100153 (2019).
Tan, J. H. P., Conlon, C., Tsamparli, A., O’Neill, D. & Adamis, D. The association between family dysfunction and admission to an acute mental health inpatient unit: A prospective study. Irish J. Psychol. Med. 39(4), 340–350 (2022).
Falkenburg, J. & Tracy, D. K. Sex and schizophrenia: a review of gender differences. Psychosis 6(1), 61–69 (2014).
Aluh, D. O. et al. Beyond Patient Characteristics: A Narrative Review of Contextual Factors Influencing Involuntary Admissions in Mental Health Care. Healthcare. 11(14), 1986 (2023).
Xu, Z. et al. Effectiveness of interventions to promote help-seeking for mental health problems: systematic review and meta-analysis. Psychol. Med. 48(16), 2658–2667 (2018).
Naughton-Doe, R. et al. Interventions that support unpaid carers of adult mental health inpatients: a scoping review. J. Ment. Health 34(1), 105–121 (2025).
Jankovic, J. et al. Family caregivers’ experiences of involuntary psychiatric hospital admissions of their relatives: A qualitative study. PLoS ONE 6(10), e25425 (2011).
Gooding, P., McSherry, B. & Roper, C. Preventing and reducing ‘coercion’ in mental health services: An international scoping review of English-language studies. Acta Psychiatr. Scand. 142(1), 27–39 (2020).
Zoladl, M. et al. Applying collaborative care model on intensive caregiver burden and resilient family caregivers of patients with mental disorders: A randomized controlled trial. Iran. J. Psychiatry 15(1), 17 (2020).
Barbui, C. et al. Efficacy of interventions to reduce coercive treatment in mental health services: umbrella review of randomised evidence. Br. J. Psychiatry 218, 185–195 (2021).
Marshall, M. & Lockwood, A. Assertive community treatment for people with severe mental disorders. Cochrane Database Syst. Rev. Cd001089 (2000).
Dieterich, M. et al. Intensive case management for severe mental illness. Cochrane Database of Syst. Rev. 1:CD007906 (2017).
van Veldhuizen, J. R. FACT: Α Dutch version of ACT. Commun. Ment. Health J. 43(4), 421–433 (2007).
Schöttle, D. et al. Reduction of involuntary admissions in patients with severe psychotic disorders treated in the ACCESS integrated care model including therapeutic Assertive Community Treatment. Front. Psych. 10, 736 (2019).
Wullschleger, A., Berg, J., Bermpohl, F. & Montag, C. Can, “Model Projects of Need-Adapted Care” reduce involuntary hospital treatment and the use of coercive measures?. Front. Psych. 9, 168 (2018).
Wheeler, C. et al. Implementation of the Crisis Resolution Team model in adult mental health settings: A systematic review. BMC Psychiatry 15, 74 (2015).
Berring, L. L. Factors and processes facilitating recovery from coercion in mental health services: A meta-ethnography. Healthcare. 12, 628 (2024).
Stefanis, N. C. et al. A proposal for the implementation of Early Intervention in Psychosis (EIP) services in Greece: If not now, when?. Psychiatrike = Psychiatriki 29(2), 107–117 (2018).
Chronister, J., Chou, C. C., Kwan, K. L. K., Lawton, M. & Silver, K. The meaning of social support for persons with serious mental illness. Rehabil. Psychol. 60(3), 232 (2015).
Castillo, E. G. et al. Community interventions to promote mental health and social equity. Curr. Psychiatry Rep. 21, 35 (2019).
Gaino, L. V. et al. The role of social support in the psychological illness of women. Rev. Lat. Am. Enfermagem 18(27), e3157 (2019).
Mowbray, C. T., Bybee, D., Hollingsworth, L., Goodkind, S. & Oyserman, D. Living arrangements and social support: Effects on the well-being of mothers with mental illness. Soc. Work Res. 29(1), 41–55 (2005).
Shooshtari, S., Abedi, M. R., Bahrami, M. & Samouei, R. Empowerment of women and mental health improvement with a Preventive approach. J. Educ. Health Promotion. 7, 31 (2018).
Acknowledgements
The authors wish to thank the MSc in Clinical Psychology and Neuropsychology of the Aristotle University of Thessaloniki, the MSc in Social Psychiatry of Democritus University of Thrace and the Association for Regional Development and Mental Health for their support for the research work that led to this publication and for agreeing to fund the publication of this paper.
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No funds, grants, or other support was received for conducting this study. Publication of this article is funded by the MSc in Clinical Psychology and Neuropsychology of the Aristotle University of Thessaloniki, the MSc in Social Psychiatry of Democritus University of Thrace and the Association for Regional Development and Mental Health.
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Conceptualization : Odysseas Anastasopoulos, Eugenie Georgaca, Anastasia Zissi, Stelios Stylianidis; Methodology : Odysseas Anastasopoulos, Eugenie Georgaca, Anastasia Zissi, Lily Peppou; Formal analysis and investigation : Odysseas Anastasopoulos, Julie Vaiopoulou; Writing - original draft preparation : Odysseas Anastasopoulos, Eugenie Georgaca, Julie Vaiopoulou; Writing - review and editing : Anastasia Zissi, Lily Peppou, Aikaterini Arvaniti, Maria Samakouri, Stelios Stylianidis, Thessaloniki Mane Group; Resources: Thessaloniki Mane Group; Supervision : Eugenie Georgaca.
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The study was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. Approval was granted by the Hospital Scientific Boards of all participating clinics, the National Data Protection Agency, the Regional Health Authority and the Research Ethics Committee of the School of Psychology of Aristotle University of Thessaloniki.
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Anastasopoulos, O., Georgaca, E., Vaiopoulou, J. et al. Exploring factors associated with psychiatric hospitalization for persons living with family. Sci Rep (2026). https://doi.org/10.1038/s41598-026-39394-7
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DOI: https://doi.org/10.1038/s41598-026-39394-7


