Study sheds light on risk factors for psychiatric rehospitalizations

Younger age at psychiatric disorder onset, previous hospitalizations, longer hospital stay, and history of suicide attempts have been identified as risk factors for psychiatric rehospitalizations in a recent naturalistic study.

“Previous studies have demonstrated that almost one in seven psychiatric patients are rehospitalized within 30 days of discharge. Psychiatric rehospitalization is often associated with severe psychological distress for both patients and their families, a worse course of illness, and loss of social and employment functioning,” noted the researchers. “Therefore, identifying predictors of rehospitalization is important for improved management of psychiatric patients.”

To explore the role of factors affecting rehospitalization, the researchers enrolled 1,001 adult inpatients (mean age, 40.5 years; female, 49.1 percent; previous hospitalizations, 55.9 percent) hospitalized in the Psychiatric Diagnosis and Care Service of the University Psychiatric Clinic, Sant’Andrea Hospital, Rome, Italy, between January 2018 and January 2022. Their psychiatric diagnoses included schizophrenia or other psychoses (32.2 percent), bipolar disorders (21.3 percent), substance use (19.5 percent), personality disorders (13.9 percent), and depressive disorders (13.8 percent). [BMC Psychiatry 2022;22:821]

Patients were divided into three groups, including the Zero-Re group (no readmission after index hospitalization; n=790), the One-Re group (one readmission; n=132), and Two-Re group (≥2 readmissions; n=79). The three groups did not differ in current suicide ideation, suicide attempt and psychiatric diagnosis at the index admission.

“The Zero-Re, One-Re, and Two-Re groups significantly differed according to age at onset of psychiatric disorder [F_2,887, 7.17; p<0.001], previous hospitalization [X²₂, 33.83; p<0.001], length of hospital stay [H₂, 27.21, p<0.001], and history of suicide attempts [X²₂, 23,21; p<0.001],” reported the researchers.

Specifically, the Two-Re group had a younger age of psychiatric disorder onset (22.8 years) than the Zero-Re and One-Re groups (27.7 years and 29.0 years, respectively).

“Both the One-Re and Two-Re groups were more likely to have a previous hospitalization vs the Zero-Regroup [71.1 percent and 77.2 percent vs 51.0 percent], suggesting that rehospitalized patients present with a more complex psychiatric symptomatology,” commented the researchers.

Furthermore, the Two-Re group had a longer length of stay at the index admission vs the Zero-Re group (14.7 days vs 9.7 days). “The association between duration of hospitalization and rehospitalization may be due to the difficulty in managing patients with severe psychiatric disorders who usually present with comorbidity and are less responsive to pharmacological treatments. That may explain the longer hospital stays and the need of future rehospitalizations,” explained the researchers.

In addition, the Two-Re group was more likely to have a history of suicide attempts vs the Zero-Re group (35.0 percent vs 14.8 percent). “In fact, about 40 percent of suicide attempters die as a result of their second or later attempt, and 80 percent die within a year of the first attempt,” added the researchers. “The higher lethality of the subsequent suicidal behaviours make patients with multiple suicide attempts a group at higher risk of rehospitalization.”

In summary, identifying patients at risk of rehospitalization could help predict future rehospitalization and facilitate the design of ad hoc prevention strategies.