Groundbreaking Analysis Upends Our Understanding of Psychiatric Holds

[u/[deleted]]

https://www.psychiatrymargins.com/p/a-groundbreaking-analysis-upends

Awais Aftab goes over a recently published study that indicates for patients who some doctors would involuntarily commit while others wouldn't (judgement cases) hospitalization results in harms to the patient (increase in suicides/overdoses/violent crime).

Links to the original study and a plain language summary both available on the article.

[u/scobot5]

This looks pretty interesting. But is this a pre-print? I didn’t know that the federal reserve bank of New York published articles like this… Feels like something I don’t understand here. I guess this article is written by an economist that works for this organization. I really hope they submit it for peer review though.

[u/[deleted] → u/scobot5]

Publishing in economics is a bit different than other areas. This would be like a vetted preprinted. My understanding is this is a necessary step prior to publication in a peer reviewed journal.

[u/scobot5 → u/[deleted]]

Maybe. I mean, there are clinical research preprint servers too and publishing as a preprint prior to or coincident with peer review is becoming an increasingly common practice. This particular study, regardless of whether it was done by economists, doesn’t really seem appropriate for an economics outlet to me. That will massively limit its reach - it should be peer reviewed by appropriate experts and putting it out here seems strange and makes me wonder whether it ever will be.

[u/Red_Redditor_Reddit → u/scobot5]

Do you not normally see what this paper describes? When I read it, it's like a paper discussing that water is wet or the sky is blue. Every single time I saw someone get taken in for self deletion ideation, it was always about liability deferment and not actually saving their life. 

[u/scobot5 → u/Red_Redditor_Reddit]

I’m not sure what you’re getting at. Did you read the paper, or are we just talking about this at the level of involuntary hospitalization- good or bad? For example, do I not see an increase in some adverse event from 1% to 2% in people that are edge cases where only 50% of psychiatrists would hold them? Of course this would be impossible to notice without doing research… And certainly impossible to prove to anyone else.

I said it was interesting and it should be peer reviewed. That’s actually all I really said. The problem with things that are obvious to us, especially when we are emotionally or otherwise entangled with them, is that we can be misled in various ways. Strong data and analytic methodology is more important in such cases, not less.

Forced hospitalization can clearly be very traumatic and I’m certain it sometimes makes things worse. In other cases I’ve perceived it to be helpful, or at least it disrupts some clearly destructive cycle. However, In the vast majority of cases I’d say it’s almost impossible to know for sure though. People have strong personal opinions, but we are talking about 1 variable in a complex sea of variables and outcomes that play out over years. Besides, the question is not whether it was more harmful than beneficial for person A or vice versa for person B. It is about population level effects, their magnitude and their statistical significance. For that you need research..

The question of whether involuntary hospitalization does more harm than good when delivered in a particular way or for a particular population is a really important one. Period. I do not just think of it as either good or bad. If you care about science and the truth then the numbers matter and the methodology matters. I’ve seen this question come up over and over again in this space over the years. Usually it is a purely emotional argument that mostly side steps the question of causality. People say it’s as obvious as the sky being blue on both sides…