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A Case-Control Study of Factors Associated With Multiple Psychiatric Readmissions

Ms. Silva and Dr. Palazzo are affiliated with the Postgraduate and Masters Program in Public Health, Lutheran University of Brazil, Canoas. Dr. Bassani is with the Dalla Lana School of Public Health, University of Toronto, and the Centre for Global Health Research, St. Michael's Hospital, Toronto. Send correspondence to him at 70 Richmond St., East, Toronto, Ontario, Canada M5C 1N8 (e-mail: diego.bassani{at}utoronto.ca).

OBJECTIVE: This case-control study explored factors associated with multiple psychiatric admissions, focusing on service-related and individual-level factors. METHODS: The case group consisted of 307 adults admitted to either of two public psychiatric hospitals in southern Brazil during a 12-month period; they had had three or more psychiatric admissions in the two years before the current admission. To account for the recurrent nature of psychiatric admissions, a concurrent case-control design was adopted, which allowed patients in the case group to return at discharge to the population at risk of readmission. The control group consisted of individuals who had their first inpatient readmission in 2006 (N=354). A hierarchical model with four levels was used for data analysis. RESULTS: Individuals who had been referred to community psychosocial support units after their most recent discharge had about 20% lower odds of multiple readmissions than those referred to usual outpatient care. Those who lived closer to the hospital (residents of the same city) were more likely to have multiple readmissions. The adjusted multivariate hierarchical analysis revealed that a diagnosis of schizophrenia or psychotic symptoms was associated with multiple readmissions, as were younger age at first admission and a greater number of previous admissions. CONCLUSIONS: The study suggests that community psychosocial support services play a strong role in preventing multiple psychiatric admissions. Further research is needed to identify the specific components of these services that reduce readmission and to analyze their cost-effectiveness.

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