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Am J Psychiatry 1995; 152:856-861
Copyright © 1995 by American Psychiatric Association
Predicting the "revolving door" phenomenon among patients with schizophrenic, schizoaffective, and affective disorders
TW Haywood, HM Kravitz, LS Grossman, JL Cavanaugh Jr, JM Davis and DA Lewis
Department of Psychiatry, Rush-Presbyterian-St. Luke's Medical Center, Chicago, Ill.
OBJECTIVE: A subpopulation of chronically mentally ill patients, sometimes
referred to as "revolving door" patients, are frequently readmitted to
psychiatric units. This study examined the relationships among demographic
features, diagnostic characteristics, and frequency of hospitalization of
patients from four state hospitals. METHOD: Two semistructured,
standardized instruments, the Schedule for Affective Disorders and
Schizophrenia and a life events history, were administered to 135
inpatients who met the Research Diagnostic Criteria for schizophrenia (N =
56), schizoaffective disorder (N = 33), unipolar major depressive disorder
(N = 23), and bipolar disorder (N = 23). Criminal history was assessed by
arrest records. The main outcome measure was the number of
hospitalizations. RESULTS: Chi-square and trend test analyses indicated
that substance abuse and noncompliance with medication regimens were
significantly associated with higher frequencies of hospitalization. A
multiple regression model, which included alcohol/drug problems, medication
noncompliance, and six sociodemographic and diagnostic variables (age,
gender, race, marital status, years of education, and diagnosis) accounted
for a significant proportion of the ability to predict frequency of
hospitalization. Half of this predictability was due to the relationship of
substance abuse and medication noncompliance with number of
hospitalizations. CONCLUSIONS: Alcohol/drug problems and noncompliance with
medication were the most important factors related to frequency of
hospitalization. Preventing these behaviors through patient education may
reduce rehospitalization rates.
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