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Am J Psychiatry 1995; 152:1749-1756
Copyright © 1995 by American Psychiatric Association
Identifying modifiable risk factors for rehospitalization: a case- control study of seriously mentally ill persons in Mississippi
G Sullivan, KB Wells, H Morgenstern and B Leake
Social Policy Department, RAND Corp., Santa Monica, CA 90406, USA.
OBJECTIVE: The authors sought to identify risk factors for
rehospitalization in a seriously mentally ill population, focusing on
factors that have the potential to be modified through community-based
interventions. METHOD: A case-control design was used in which 101 "case"
subjects (recently readmitted psychiatric patients) and a comparison group
of 101 subjects living in the community who had been previously
hospitalized at the same time as the case subjects, but who in contrast had
not been readmitted, were matched on gender, ethnicity, and length of time
at risk for rehospitalization. The setting was the Mississippi public
mental health system during the first 3 months of 1988, including
Mississippi State Hospital and the 10 community mental health regions in
its catchment area. The subjects were between the ages of 18 and 55 years,
had had at least one previous Mississippi State Hospital admission, and had
a primary chart diagnosis of schizophrenia; 197 informants, mostly family
members, were also included in the study. Data were collected from
structured interviews of subjects and informants, direct observation
ratings of subjects, Mississippi State Hospital administrative records, and
community mental health center administrative records. RESULTS: Medication
noncompliance, comorbid alcohol abuse, and a high level of criticism of
subjects by informants were associated with greater risk of
rehospitalization, while types and extent of outpatient service use, access
to care, quality of life, and demographic variables (other than ethnicity
and gender) were not. CONCLUSIONS: These findings imply that interventions
aimed at improving medication compliance, reducing alcohol abuse, and
helping families cope with their mentally ill relatives could reduce the
risk of hospitalization in this population.
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