Sullivan G, Wells K B, Morgenstern H, Leake B
Social Policy Department, RAND Corp., Santa Monica, CA 90406, USA.
Am J Psychiatry. 1995 Dec;152(12):1749-56. doi: 10.1176/ajp.152.12.1749.
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.
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.
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.
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.
作者试图确定重症精神病患者再次住院的风险因素，重点关注有可能通过社区干预加以改变的因素。
采用病例对照设计，101名“病例”受试者（近期再次入院的精神病患者）与101名社区对照受试者相匹配，这些对照受试者曾与病例受试者同时住院，但未再次入院，匹配因素包括性别、种族以及再次住院风险期时长。研究背景为1988年第一季度的密西西比州公共精神卫生系统，包括密西西比州立医院及其服务区域内的10个社区精神卫生区域。受试者年龄在18至55岁之间，至少有过一次密西西比州立医院的入院记录，且主要病历诊断为精神分裂症；197名 informant（大多为家庭成员）也纳入了研究。数据收集自对受试者和 informant 的结构化访谈、对受试者的直接观察评分、密西西比州立医院行政记录以及社区精神卫生中心行政记录。
药物治疗不依从、合并酒精滥用以及 informant 对受试者的高度批评与再次住院的较高风险相关，而门诊服务使用的类型和程度、获得医疗服务的机会、生活质量以及人口统计学变量（种族和性别除外）则无关。
这些发现表明，旨在提高药物治疗依从性、减少酒精滥用以及帮助家庭应对其精神病亲属的干预措施，可降低该人群的住院风险。
