Patterns and determinants of acute psychiatric readmissions.

OBJECTIVES Deinstitutionalisation and shortage of psychiatric beds worldwide has led to extensive research into the risk factors and interventions associated with rapid and recurrent admission to hospital. Little research of this nature has taken place in South Africa, particularly with regard to acute hospital admissions. This study attempted primarily to assess the effect of length of stay and administration of depot antipsychotics in hospital on time to readmission. DESIGN A retrospective cohort of 180 admissions was followed up for 12 months, after an index discharge, by means of multiple hospital and community-based record reviews. Each readmission was analysed as an event using a survival analysis model. SETTING Chris Hani Baragwanath Hospital, Gauteng. SUBJECTS A random sample of patients admitted during a 6-month period in 1996. OUTCOME MEASURES Time to readmission. RESULTS Two hundred and eighty-four admissions were analysed. The only factor that provided a significant protective effect was being married or cohabiting (P = 0.015). Clinic attendance showed a slight protective effect early on but conferred a significantly higher risk of readmission on those who had been out of hospital for a long period (P = 0.001). Only 21% of discharged patients ever attended a clinic. The overall risk of readmission was significantly higher in the first 90 days post discharge. CONCLUSIONS The lack of impact of length of hospital stay and use of depot neuroleptics on time to readmission may indicate that patients are being kept for appropriate duration and that the most ill patients are receiving depot medication. Several sampling and statistical artefacts may explain some of our findings. These results confirm the worldwide difficulty in finding consistent and accurate predictors of readmission. Low rates of successful referral to community aftercare need to be addressed before their effectiveness can be reasonably assessed. The inherent instability of the post-discharge period is a potential area for further investigation and intensive management.