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Soc Psychiatry Psychiatr Epidemiol. 2019 Feb;54(2):243-253. doi: 10.1007/s00127-018-1606-y. Epub 2018 Sep 24.

Compulsory admission is associated with an increased risk of readmission in patients with schizophrenia: a 7-year, population-based, retrospective cohort study.

Lin CE1,2,3, Chung CH4,5, Chen LF6,7, Chen PC8, Cheng HY8, Chien WC9,10,11,12.

Author information

1
Department of Psychiatry, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan, ROC.
2
School of Medicine, Tzu-Chi University, Hualien, Taiwan, ROC.
3
Graduate Institute of Life Science, National Defense Medical Center, Taipei, Taiwan, ROC.
4
Department of Medical Research, Tri-Service General Hospital, Taipei, Taiwan, ROC.
5
School of Public Health, National Defense Medical Center, Taipei, Taiwan, ROC.
6
School of Medicine, National Defense Medical Center, Taipei, Taiwan, ROC.
7
Department of Psychiatry, Hualien Armed Forces General Hospital, Hualien, Taiwan, ROC.
8
Department of Nursing, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan, ROC.
9
Department of Medical Research, Tri-Service General Hospital, Taipei, Taiwan, ROC. chienwu@ndmctsgh.edu.tw.
10
School of Public Health, National Defense Medical Center, Taipei, Taiwan, ROC. chienwu@ndmctsgh.edu.tw.
11
Graduate Institute of Life Science, National Defense Medical Center, Taipei, Taiwan, ROC. chienwu@ndmctsgh.edu.tw.
12
Department of Medical Research, National Defense Medical Center, Tri-Service General Hospital, 7115R, No.325, Section 2, Cheng-Kung Road, Neihu District, Taipei, 11490, Taiwan, ROC. chienwu@ndmctsgh.edu.tw.

Abstract

PURPOSE:

The aim of this study was to assess the risk of psychiatric readmission in patients with schizophrenia, compare it between patients prescribed compulsory admission and those consenting to voluntary admission, and determine risk factors for psychiatric readmission.

METHODS:

This 7-year (2007-2013), population-based, cohort study retrospectively compared data of 2038 schizophrenic inpatients who initially underwent compulsory admission (the CA group) and of 8152 matched controls with schizophrenia who initially underwent voluntary admission (the VA group).

RESULTS:

During the study period, there were 1204 and 3806 readmissions in the CA and VA groups, respectively. Compared with the VA group, the CA group was associated with a greater risk of psychiatric readmission [adjusted hazard ratio (AHR) = 1.765; 95% confidence interval (CI) 1.389-2.243; P < 0.001]. Stratified analyses showed that the CA group was associated with a higher risk of subsequent compulsory (AHR = 1.307; 95% CI 1.029-1.661; P < 0.001) and voluntary (AHR = 1.801; 95% CI 1.417-2.289; P < 0.001) readmissions compared to the VA group. Sensitivity analyses, after excluding data from the first year of observation, also provided significant findings with respect to compulsory and voluntary readmissions. Kaplan-Meier curves revealed that cumulative survival rates of psychiatric readmissions, compulsory and voluntary readmissions were significantly lower in the CA group than in the VA group among patients with schizophrenia (log-rank test, P < 0.001).

CONCLUSIONS:

CA was associated with higher subsequent psychiatric readmissions, compulsory, and voluntary readmissions. Clinicians would need to focus on patients undergoing CAs to reduce readmissions.

KEYWORDS:

Compulsory admission; Involuntary; Readmission; Risk; Schizophrenia

PMID:
30251025
DOI:
10.1007/s00127-018-1606-y
[Indexed for MEDLINE]

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