<b>Factors Associated with Psychiatric Readmissions: A Systematic Review</b>

Zanardo, Gabriela Lemos de Pinho; Moro, Larissa Moraes; Ferreira, Guilherme Severo; Rocha, Kátia Bones

doi:10.1590/1982-4327e2814

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Psychology of Health • Paidéia (Ribeirão Preto) 28 • 2018 • https://doi.org/10.1590/1982-4327e2814 copy

Factors Associated with Psychiatric Readmissions: A Systematic Review ¹ 1 Paper deriving from the Master’s dissertation by the first author, with the collaboration of the second and third authors and under supervision of the fourth author, defended in 2016 in the Postgraduate Program in Psychology at the Pontifícia Universidade Católica do Rio Grande do Sul. Support: Coordination for the Improvement of Higher Education Personnel (CAPES).

Fatores Associados às Reinternações Psiquiátricas: Uma Revisão Sistemática

Factores Asociados con los Reinternamientos Psiquiátricos: Una Revisión Sistemática

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Frequent Psychiatric Readmission (FPR) (revolving door phenomenon) is characterized by repeated and frequent hospitalizations that occur shortly after discharge. The aim was to analyze the criteria of FPR and associated factors: sociodemographic, clinic and care network data. We performed a systematic review in PubMed, VHL, and PsycINFO, using “readmission” and “mental disorder”. We selected empirical studies of adult populations, published in 2010-2014 in English,Portuguese and Spanish. Twenty-six articles were analyzed through the PRISMA protocol. High prevalence rates of FPR were found, between 9% (one month) and 84% (two years). Nevertheless, the different criteria used may have influenced contradictory results. The most consistent results indicate that young, single people, with less social support and involuntary admissions have higher chances of FPR, while community interventions seem to reduce FPR. We highlight the importance of establishing a consensus on the FPR criterion to develop future studies and interventions.

Keywords:
psychiatric hospitalization; mental disorders; systematic review; mental health

Time	Results - readmission rates (%)
1 month	9.5% (Byrne et al., 2010Byrne, S. L., Hooke, G. R., & Page, A.C. (2010). Readmission: A useful indicator of the quality of inpatient psychiatric care. Journal of Affective Disorders, 126(1-2), 206-213. doi:10.1016./j.jad.2010.02.135 https://doi.org/10.1016./j.jad.2010.02.1... ); 11.2% (Kroken et al.,2012Kroken, R. A., Mellesdal, L. S., Wentzel-Larsen, T., Jørgensen, H. A., & Johnsen, E. (2012). Time-dependent effect analysis of antipsychotic treatment in a naturalistic cohort study of patients with schizophrenia.European Psychiatry, 27(7), 489-495. doi:10.1016/j.eurpsy.2011.04.002 https://doi.org/10.1016/j.eurpsy.2011.04... ); 13% (Zilber et al., 2011Zilber, N., Hornik-Lurie, T., & Lerner, Y. (2011). Predictors of early psychiatric rehospitalization: A national case register study. TheIsraelJournal of PsychiatryandRelatedSciences, 48(1), 49-53. Retrieved fromhttps://doctorsonly.co.il/wp-content/uploads/2011/12/2011_1.1_9.pdf https://doctorsonly.co.il/wp-content/upl... ); 23% (Boaz et al., 2013Boaz, T. L., Becker, M. A., Andel, R., Van Dorn, R. A., Choi, J., & Sikirica, M. (2013). Risk factors for early readmissionto acute care for persons with schizophrenia taking antipsychotic medications. Psychiatric Services, 64(12), 1225-1229.doi:10.1176/appi.ps.003382012 https://doi.org/10.1176/appi.ps.00338201... ); 31% (Sánchez et al., 2013Sánchez, R., Jaramillo, L.E., & Herazo, M.I. (2013). Factoresasociados a rehospitalización temprana en psiquiatría [Factors associated with early psychiatric rehospitalization. Biomedica, 33(2),276-282. doi:10.7705/biomedica.v33i2.705 https://doi.org/10.7705/biomedica.v33i2.... )
3 months	49.5% (Sánchez et al., 2013Sánchez, R., Jaramillo, L.E., & Herazo, M.I. (2013). Factoresasociados a rehospitalización temprana en psiquiatría [Factors associated with early psychiatric rehospitalization. Biomedica, 33(2),276-282. doi:10.7705/biomedica.v33i2.705 https://doi.org/10.7705/biomedica.v33i2.... )
6 months	15.3% (Byrne et al., 2010Byrne, S. L., Hooke, G. R., & Page, A.C. (2010). Readmission: A useful indicator of the quality of inpatient psychiatric care. Journal of Affective Disorders, 126(1-2), 206-213. doi:10.1016./j.jad.2010.02.135 https://doi.org/10.1016./j.jad.2010.02.1... ); 21% (Moss et al., 2014Moss, J., Li, A., Tobin, J., Weinstein, I.S., Harimoto, T., & Lanctôt, K.L. (2014). Predictors of readmissionto a psychiatry inpatient unit. Comprehensive Psychiatry, 55(3), 426-430. doi:10.1016/j.comppsych.2013.11.019 https://doi.org/10.1016/j.comppsych.2013... ); 31.2% (Kroken et al., 2012Kroken, R. A., Mellesdal, L. S., Wentzel-Larsen, T., Jørgensen, H. A., & Johnsen, E. (2012). Time-dependent effect analysis of antipsychotic treatment in a naturalistic cohort study of patients with schizophrenia.European Psychiatry, 27(7), 489-495. doi:10.1016/j.eurpsy.2011.04.002 https://doi.org/10.1016/j.eurpsy.2011.04... )
1 year	10% (Martínez-Ortega et al., 2012Martínez-Ortega, J. M., Gutiérrez-Rojas, L., Jurado, D., Higueras, A., Diaz, F. J., & Gurpegui, M. (2012). Factors associated with frequent psychiatric admissions in a general hospital in Spain. International Journal of Social Psychiatry, 58(5), 532-535. doi:10.1177/0020764011413061 https://doi.org/10.1177/0020764011413061... ); 20.5% (Kikuchi et al., 2013Kikuchi, H., Abo, M., Kumakura, E., Kubota, N., & Nagano, M. (2013). Efficacy of continuous follow-up for preventing the involuntary readmission of psychiatric patients in Japan: A retrospective cohort study. International Journal of Social Psychiatry, 59(3), 288-295. doi:10.1177/0020764011433631 https://doi.org/10.1177/0020764011433631... ); 30% (Schmutte et al., 2010Schmutte, T., Dunn, C. L., & Sledge, W. H. (2010). Predicting time to readmission in patients with recent histories of recurrent psychiatric hospitalization: A matched-control survival analysis. The Journal of Nervous and Mental Disease, 198(12), 860-863. doi:10.1097/NMD.0b013e3181fe726b https://doi.org/10.1097/NMD.0b013e3181fe... ); 34% (Castro et al., 2010Castro, S. A., Furegato, A. R. F., & Santos, J. L. F. (2010). Sociodemographic and clinical characteristics of psychiatric re-hospitalizations. Revista Latino-Americana de Enfermagem, 18(4), 800-808. doi:10.1590/S0104-11692010000400020 https://doi.org/10.1590/S0104-1169201000... ); 42.6% (Loch, 2012Loch, A. A. (2012). Stigma and higher rates of psychiatric re-hospitalization: São Paulo public mental health system. Revista Brasileira de Psiquiatria, 34(2), 185-192. doi:10.1590/S1516-44462012000200011 https://doi.org/10.1590/S1516-4446201200... ); 44.8% (Kroken et al., 2012Kroken, R. A., Mellesdal, L. S., Wentzel-Larsen, T., Jørgensen, H. A., & Johnsen, E. (2012). Time-dependent effect analysis of antipsychotic treatment in a naturalistic cohort study of patients with schizophrenia.European Psychiatry, 27(7), 489-495. doi:10.1016/j.eurpsy.2011.04.002 https://doi.org/10.1016/j.eurpsy.2011.04... ); 46% (Zhang et al., 2011Zhang, J., Harvey, C., & Andrew, C. (2011). Factors associated with length of stay and the risk of readmission in an acute psychiatric inpatient facility: A retrospective study. Australian and New Zealand Journal of Psychiatry, 45(7), 578-585. doi:10.3109/00048674.2011.585452 https://doi.org/10.3109/00048674.2011.58... ); 60% (Jaramillo-Gonzalez et al., 2014Jaramillo-Gonzalez, L.E., Sanchez-Pedraza, R., & Herazo, M.I. (2014). The frequency of rehospitalization and associated factors in Colombian psychiatric patients: A cohort study. BMC Psychiatry, 14, 161. doi:10.1186/1471-244X-14-161 https://doi.org/10.1186/1471-244X-14-161... ); 72% (Boaz et al., 2013Boaz, T. L., Becker, M. A., Andel, R., Van Dorn, R. A., Choi, J., & Sikirica, M. (2013). Risk factors for early readmissionto acute care for persons with schizophrenia taking antipsychotic medications. Psychiatric Services, 64(12), 1225-1229.doi:10.1176/appi.ps.003382012 https://doi.org/10.1176/appi.ps.00338201... )
2 years	79.8% (Bowersox et al., 2012Bowersox, N. W., Saunders, S. M., & Berger, B. D. (2012). Predictors of rehospitalization in high-utilizing patients in the VA psychiatric medical system.Psychiatric Quarterly, 83(1), 53-64. doi:10.1007/s11126-011-9182-2 https://doi.org/10.1007/s11126-011-9182-... ); 84% (Boaz et al. 2013Boaz, T. L., Becker, M. A., Andel, R., Van Dorn, R. A., Choi, J., & Sikirica, M. (2013). Risk factors for early readmissionto acute care for persons with schizophrenia taking antipsychotic medications. Psychiatric Services, 64(12), 1225-1229.doi:10.1176/appi.ps.003382012 https://doi.org/10.1176/appi.ps.00338201... )
3 years	55.6% (Kroken et al., 2012Kroken, R. A., Mellesdal, L. S., Wentzel-Larsen, T., Jørgensen, H. A., & Johnsen, E. (2012). Time-dependent effect analysis of antipsychotic treatment in a naturalistic cohort study of patients with schizophrenia.European Psychiatry, 27(7), 489-495. doi:10.1016/j.eurpsy.2011.04.002 https://doi.org/10.1016/j.eurpsy.2011.04... )
7 years	27.6% (Batalla et al., 2013Batalla, A., Garcia-Rizo, C., Castellví, P., Fernandez-Egea, E., Yücel, M., Parellada, E.,... Bernardo, M. (2013). Screening for substance use disorders in first-episode psychosis: Implications forreadmission. Schizophrenia Research, 146(1-3), 125-131.doi:10.1016/j.schres.2013.02.031 https://doi.org/10.1016/j.schres.2013.02... ).

Universidade de São Paulo, Faculdade de Filosofia Ciências e Letras de Ribeirão Preto, Programa de Pós-Graduação em Psicologia Av.Bandeirantes 3900 - Monte Alegre, 14040-901 Ribeirão Preto - São Paulo - Brasil, Tel.: (55 16) 3315-3829 - Ribeirão Preto - SP - Brazil
E-mail: paideia@usp.br

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[1] * Correspondence address: Pontifícia Universidade Católica do Rio Grande do Sul. Programa de Pós-Graduação em Psicologia. Avenida Ipiranga, nº 6681, Prédio 11, Sala 931, Partenon, Porto Alegre-RS, Brazil. CEP 90.619-900. E-mail: katia.rocha@pucrs.br