Schmutte Timothy, Dunn Christine L, Sledge William H
Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA.
J Nerv Ment Dis. 2010 Dec;198(12):860-3. doi: 10.1097/NMD.0b013e3181fe726b.
The most robust predictor of future psychiatric hospitalization is the number of previous admissions. About half of psychiatric inpatients with histories of repeated hospitalizations are readmitted within 12 months. This study sought to determine which patient characteristics predicted time-to-readmission within 12 months after controlling for the number of previous hospitalizations in 75 adults with recent histories of recurrent admissions and 75 matched controls. Results revealed multiple clinical and demographic between-group differences at index hospitalization. However, the only predictors of shorter time-to-readmission in multivariate Cox proportional hazards were unemployment (hazards ratio = 9.26) and residential living status (hazards ratio = 2.05) after controlling for prior hospitalizations (hazard ratio = 1.24). Unemployment and residential living status were not proxies of psychosis or moderated by illness severity or comorbid substance use. Results suggest that early psychiatric readmission may be more influenced by residential and employment status than by severe mental illness.
未来精神科住院治疗最有力的预测因素是既往住院次数。约一半有反复住院史的精神科住院患者在12个月内再次入院。本研究旨在确定在75名近期有反复入院史的成年人及75名匹配的对照组中，在控制既往住院次数后，哪些患者特征可预测12个月内的再次入院时间。结果显示，在初次住院时，两组在多个临床和人口统计学方面存在差异。然而，在多变量Cox比例风险模型中，控制既往住院情况（风险比=1.24）后，再次入院时间较短的唯一预测因素是失业（风险比=9.26）和居住状况（风险比=2.05）。失业和居住状况并非精神病的替代指标，也不受疾病严重程度或合并物质使用情况的影响。结果表明，早期精神科再次入院可能更多地受居住和就业状况的影响，而非严重精神疾病。
