{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,11]],"date-time":"2025-09-11T19:46:13Z","timestamp":1757619973330,"version":"3.44.0"},"reference-count":65,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,9,8]],"date-time":"2025-09-08T00:00:00Z","timestamp":1757289600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p>The COVID-19 pandemic significantly reshaped involuntary psychiatric hospitalizations, disrupting the balance between patient rights, public safety, and healthcare delivery. This study aims to examine the pandemic\u2019s impact on involuntary admissions (IA) from a major psychiatric hospital in Sibiu Romania. Furthermore, it proposes a prediction model for informed consent refusal rates (ICRR).<\/jats:p><\/jats:sec><jats:sec><jats:title>Materials and methods<\/jats:title><jats:p>We conducted a retrospective, observational analysis of 781 involuntary admissions using records by comparing socio-demographic, clinical, and procedural variables across two periods: pre-pandemic (March 2018\u2013February 2020) and during the pandemic (March 2020\u2013March 2022). Variables analyzed included demographics, clinical symptoms, procedural circumstances, and hospitalization duration with Chi-Square, Cochran\u2013Mantel\u2013Haenszel (CMH), Breslow-Day, Cramer\u2019s V tests and logistic regression model applied as appropriate.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Psychomotor agitation, aggression, and suicidal behavior were leading reasons for involuntary admission. Confirmation rates were significantly higher among non-aggressive patients (<jats:italic>p<\/jats:italic>\u202f&amp;lt;\u202f0.0001). Schizophrenia spectrum disorders were predominant diagnoses, with significantly higher confirmation rates during the pandemic (<jats:italic>p<\/jats:italic>\u202f&amp;lt;\u202f0.0001). Police-initiated admissions increased significantly, while family-initiated admissions significantly declined (<jats:italic>p<\/jats:italic>\u202f&amp;lt;\u202f0.001). Other consistently significant predictors included insurance status, marital status, residence type, psychotic symptoms, psychiatric comorbidities, and the source initiating the involuntary admission request (all CMH tests <jats:italic>p<\/jats:italic>\u202f\u2264\u202f0.002). Logistic regression modeling demonstrated strong predictive performance (AUC\u202f=\u202f0.807, accuracy\u202f=\u202f80.7%), identifying education level, alcohol consumption, psychoactive substance use, and police involvement as significant predictors of ICRR.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The pandemic introduced significant procedural and management challenges to involuntary admissions at a tertiary hospital in Romania. Our predictive modeling highlights key factors influencing hospitalization outcomes, underscoring the critical need for streamlined ethical and procedural frameworks, strengthened multidisciplinary collaboration, and the integration of machine learning methodologies to enhance predictive accuracy and clinical decision-making in future public health crises.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fpubh.2025.1624219","type":"journal-article","created":{"date-parts":[[2025,9,8]],"date-time":"2025-09-08T04:12:07Z","timestamp":1757304727000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Impact and predictive modeling of risk factors for involuntary psychiatric admissions before and during COVID-19: insights from a Romanian tertiary hospital"],"prefix":"10.3389","volume":"13","author":[{"given":"Ciprian Ionu\u021b","family":"B\u0103cil\u0103","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Monica","family":"Cornea","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bogdan Ioan","family":"Vintil\u0103","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrei","family":"Lomnasan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adrian Gheorghe","family":"Boicean","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andreea Maria","family":"Grama","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Claudiu","family":"Matei","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bogdan","family":"Neamtu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2025,9,8]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"157","DOI":"10.23750\/abm.v91i1.9397","article-title":"WHO declares COVID-19 a pandemic","volume":"91","author":"Cucinotta","year":"2020","journal-title":"Acta Biomed"},{"year":"2024","key":"ref2"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"406","DOI":"10.1093\/ofid\/ofac406","article-title":"A randomized clinical trial of Regdanvimab in high-risk patients with mild-to-moderate coronavirus disease 2019","volume":"9","author":"Kim","year":"2022","journal-title":"Open Forum Infect Dis"},{"year":"2022","key":"ref4"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"567","DOI":"10.1016\/j.jad.2021.09.098","article-title":"A systematic review and meta-analysis of longitudinal cohort studies comparing mental health before versus during the COVID-19 pandemic in 2020","volume":"296","author":"Robinson","year":"2022","journal-title":"J Affect Disord"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"e406","DOI":"10.1016\/S2468-2667(22)00042-1","article-title":"Acute COVID-19 severity and mental health morbidity trajectories in patient populations of six nations: an observational study","volume":"7","author":"Magn\u00fasd\u00f3ttir","year":"2022","journal-title":"Lancet Public Health"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"17","DOI":"10.1186\/s12888-024-06436-1","article-title":"Changes in the number and characteristics of tertiary hospital psychiatric admissions in South Croatia before and during the COVID-19 pandemic: a retrospective study","volume":"25","author":"Vuki\u0107evi\u0107","year":"2025","journal-title":"BMC Psychiatry"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"301","DOI":"10.1007\/s11920-023-01426-8","article-title":"Global mental health: where we are and where we are going","volume":"25","author":"Moitra","year":"2023","journal-title":"Curr Psychiatry Rep"},{"key":"ref9","first-page":"204","article-title":"Controversies between mental health and disability standards in Mexico","volume":"61","author":"Sotelo-Monroy","year":"2023","journal-title":"Rev Med Inst Mex Seguro Soc"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"137","DOI":"10.1016\/S2215-0366(21)00395-3","article-title":"Global Burden of Disease 2019 Mental Disorders Collaborators, coordinated by the Institute for Health Metrics and Evaluation. 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