For patients with schizophrenia or schizoaffective disorder, younger age was significantly associated with an increased rate of readmission (15.2%) at 3 months after involuntary hospitalization, according to a study published in PLoS ONE.
Taiwanese researchers also found that 4 factors were associated with an increased rate of readmission (33.3%) at 1 year after involuntary hospital admission: unmarried status, prior history of involuntary admission, longer involuntary admission in days, and fewer total admission days. The researchers suggest that focusing on younger patients and those with the 4 risk factors may reduce subsequent readmissions, a key indicator of the prognosis for people with schizophrenia.
The retrospective chart review study included 138 patients diagnosed with schizophrenia or schizoaffective disorder admitted involuntarily to Taoyuan Psychiatric Center, Taiwan, between July 2008 and June 2013, 8 of whom had multiple such admissions. Patients with schizoaffective disorder included 43 with bipolar disorder, 22 with psychotic disorder not otherwise specified, 13 with organic brain syndrome, 11 with delusional disorder, 11 with alcoholic psychosis, 9 with substance-induced psychotic disorder, 8 with depressive disorder not otherwise specified, 3 with dementia, and 1 with autistic disorder.
The mean age of the 138 patients was 38.7±10.9 years, and 61.6% were men. For 35 patients (24.6%), the index involuntary admission was their first psychiatric hospital admission. Of the 138 patients, 112 (81.2%) agreed to convert to voluntary admission during the index hospitalization of the study.
Although young age was the only significant risk factor for 3-month readmission, other factors included a lower proportion of converting to voluntary admission during the index involuntary hospitalization (61.9% vs 85.7%; P =.025) and lower proportion of referral to homecare programs after the index hospitalization (0.0% vs 17.0%, P = .042). The researchers suggest providing such high-risk patients with programs to improve disease insight, social and family support, and case management with active follow-up measures after hospital discharge. They also suggest providing this support to patients at high risk for readmission 1 year after involuntary hospitalization for schizophrenia or schizoaffective disorder.
“To reduce readmission rates, health care providers can focus on patients with these characteristics and provide them with more comprehensive service programs such as programs to enhance disease insight and socio-family support, as well as case management with active follow-up modalities after discharge,” the study authors concluded.
Hung Y-Y, Chan H-Y, Pan Y-J. Risk factors for readmission in schizophrenia patients following involuntary admission [published online October 26, 2017]. PLoS One. 2017;12(10):e0186768.