Department of Psychiatry and Psychotherapy I, Centres for Psychiatry Südwürttemberg, Ulm University, Weissenau, ZfP Südwürttemberg, Versorgungsforschung, Weingartshofer Str. 2, 88214, Ravensburg, Germany.
Soc Psychiatry Psychiatr Epidemiol. 2014 Nov;49(11):1719-27. doi: 10.1007/s00127-014-0892-2. Epub 2014 May 8.
The aim of the study was to examine the differences between former involuntary and voluntary patients with a schizophrenic disorder with regard to time to and frequency of rehospitalization.
In this prospective observational study, 374 patients with a diagnosis of schizophrenia or schizoaffective disorder were included. At the time of inclusion, 290 (77.5 %) were hospitalized voluntarily and 84 (22.5 %) involuntarily. Follow-up assessments were conducted half-yearly over a 2-year period with measures of PANSS, GAF, sociodemographic data and cognitive functioning. These data served as covariates for adjustment in statistical models that included a Cox regression model, a random-effect logit model and a random-effect tobit model.
After adjustment for other relevant covariates, the Cox regression showed that involuntary treatment is a significant risk factor of subsequent rehospitalization (HR = 1.53; CI = 1.06, 2.19; p = 0.02). The involuntary group had higher half-year incidence rates of rehospitalization, and in case of rehospitalization the duration of hospital stay was longer.
Involuntary hospitalization seems to be associated with a higher risk of rehospitalization and longer subsequent hospital stays in patients with schizophrenia and schizoaffective disorders. Further studies are needed to examine in detail the processes and interventions that are suitable for interrupting circles of repeated hospitalizations, especially in former involuntary patients.
本研究旨在探讨精神分裂症患者中既往非自愿和自愿入院患者的再入院时间和频率差异。
在这项前瞻性观察研究中，纳入了 374 名诊断为精神分裂症或分裂情感障碍的患者。纳入时，290 名（77.5%）患者自愿住院，84 名（22.5%）非自愿住院。在 2 年的半年期内进行随访评估，评估指标包括 PANSS、GAF、社会人口学数据和认知功能。这些数据作为调整统计模型的协变量，包括 Cox 回归模型、随机效应逻辑回归模型和随机效应 Tobit 模型。
在调整其他相关协变量后，Cox 回归显示非自愿治疗是随后再入院的显著风险因素（HR=1.53；CI=1.06，2.19；p=0.02）。非自愿组的半年再入院发生率较高，且再入院时住院时间较长。
非自愿住院似乎与精神分裂症和分裂情感障碍患者的再入院风险增加和随后的住院时间延长相关。需要进一步研究详细探讨适合中断反复住院循环的过程和干预措施，特别是对既往非自愿住院的患者。
