Predictors of Compulsory Re-admission to Psychiatric Inpatient Care

Abstract

Objective: This prospective study addresses risk factors of compulsory re-admission focusing on the role of the patient's subjective symptom distress and perceived social support, based on comprehensive patient and external (clinicians, study staff) assessments. Methods: Of the baseline sample, 168 (71%) patients with serious mental disorders, who had been compulsorily admitted to psychiatric inpatient care, were followed over 24 months after discharge within the framework of a RCT. Results: During this time 36% had compulsory re-admissions; risk was highest immediately after discharge. Regression models identified a history of previous compulsory hospitalisations and compulsory admission due to endangerment of others as the predictors most strongly associated with the outcome. Patients diagnosed with a psychotic disorder or an emotionally instable or combined personality disorder were most likely to experience compulsory re-hospitalisation, with poor response to treatment further significantly increasing the risk. The patient ratings of subjective symptom distress or perceived social support had no predictive value for compulsory re-admission, and this study did not provide evidence for a significant prognostic relevance of sociodemographic background factors. Conclusions: The present findings suggest that within individual-level variables disease-related factors are essentially the strongest predictors, but including the patients' subjective perspective does not enhance the prediction of compulsory re-hospitalisation. The psychiatric treatment of patients with recurrent and often challenging behavioural problems, at the more severe end of the spectrum of mental disorders, deserves closer attention if the use of compulsory hospitalisation is to be reduced.

Risk factors for repeated emergency compulsory psychiatric admissions

“…We also found that two-thirds of second ECPAs (66.1%) occurred within 6 months of the first. This is similar first to the findings of Lay et al, who reported a peak of compulsory readmissions shortly after discharge; 10 and also to the findings of van der Post et al, who reported a higher risk of readmission in the first year after discharge than in the subsequent follow-up years. 8 However, in the first year of follow-up, the study by Lin et al showed relatively low rates of compulsory readmissions.…”

“…Our findings with regard to history of mental healthcare and age are similar to those in the other studies, in which younger age and an existing treatment history in mental healthcare were consistently identified as important risk factors for repeated ECPAs. [8][9][10] Our findings with regard to various factorslevel of self-care, housing problems and lower GAF scoresalso indicate that patients with severe mental illnesses 14,15 who show lower level of functioning are particularly susceptible to repeated compulsory psychiatric admissions. This, too, is in accordance with the literature on revolving-door patients.…”

“…9 Finally, a prospective study in Switzerland with a 24-month follow-up period found a frequency of repeated compulsory psychiatric admissions of 36% and that two factors were associated with such admissions: previous compulsory admissionespecially when it had been because of endangerment of othersand a diagnosis on the psychosis spectrum. 10 One important reason for performing these studies is to identify risk factors that may be modifiable targets for interventions intended to reduce repeated compulsory psychiatric admissions. Two of the studies referred to above identified two such risk factors in two different countries: living alone and endangerment of others.…”

“…9 Finally, a prospective study in Switzerland with a 24-month follow-up period found a frequency of repeated compulsory psychiatric admissions of 36% and that two factors were associated with such admissions: previous compulsory admission – especially when it had been because of endangerment of others – and a diagnosis on the psychosis spectrum. 10…”

Virtual Reality Cognitive Therapy in Inpatient Psychiatric Wards: Protocol for a Qualitative Investigation of Staff and Patient Views Across Multiple National Health Service Sites

“…Leaving hospital often leads to the re-emergence of the pre-existing stressors that contributed to admission [ 23 , 24 ]. This may explain why the risk of relapse and rehospitalization immediately postdischarge is high [ 25 ]. Rates of suicide among patients in their first 3 months after discharge are also high, estimated at 100 times the global suicide rate, with a particular risk in the first week after discharge [ 23 ].…”