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Compulsory admission is associated with an increased risk of readmission in patients with schizophrenia: a 7-year, population-based, retrospective cohort study

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Abstract

Purpose

The aim of this study was to assess the risk of psychiatric readmission in patients with schizophrenia, compare it between patients prescribed compulsory admission and those consenting to voluntary admission, and determine risk factors for psychiatric readmission.

Methods

This 7-year (2007–2013), population-based, cohort study retrospectively compared data of 2038 schizophrenic inpatients who initially underwent compulsory admission (the CA group) and of 8152 matched controls with schizophrenia who initially underwent voluntary admission (the VA group).

Results

During the study period, there were 1204 and 3806 readmissions in the CA and VA groups, respectively. Compared with the VA group, the CA group was associated with a greater risk of psychiatric readmission [adjusted hazard ratio (AHR) = 1.765; 95% confidence interval (CI) 1.389–2.243; P < 0.001]. Stratified analyses showed that the CA group was associated with a higher risk of subsequent compulsory (AHR = 1.307; 95% CI 1.029–1.661; P < 0.001) and voluntary (AHR = 1.801; 95% CI 1.417–2.289; P < 0.001) readmissions compared to the VA group. Sensitivity analyses, after excluding data from the first year of observation, also provided significant findings with respect to compulsory and voluntary readmissions. Kaplan–Meier curves revealed that cumulative survival rates of psychiatric readmissions, compulsory and voluntary readmissions were significantly lower in the CA group than in the VA group among patients with schizophrenia (log-rank test, P < 0.001).

Conclusions

CA was associated with higher subsequent psychiatric readmissions, compulsory, and voluntary readmissions. Clinicians would need to focus on patients undergoing CAs to reduce readmissions.

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Acknowledgements

This study was funded by Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taiwan (R.O.C.) (TCRD-TPE-107-03) and Tri-Service General Hospital (TSGH-C107-004).

Funding

This research was supported by Grants from Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation (TCRD-TPE-107-03) and Tri-Service General Hospital (TSGH-C107-004).

Author information

Authors and Affiliations

  1. Department of Psychiatry, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan, ROC

    Ching-En Lin

  2. School of Medicine, Tzu-Chi University, Hualien, Taiwan, ROC

    Ching-En Lin

  3. Department of Medical Research, Tri-Service General Hospital, Taipei, Taiwan, ROC

    Chi-Hsiang Chung & Wu-Chien Chien

  4. School of Public Health, National Defense Medical Center, Taipei, Taiwan, ROC

    Chi-Hsiang Chung & Wu-Chien Chien

  5. Graduate Institute of Life Science, National Defense Medical Center, Taipei, Taiwan, ROC

    Ching-En Lin & Wu-Chien Chien

  6. School of Medicine, National Defense Medical Center, Taipei, Taiwan, ROC

    Li-Fen Chen

  7. Department of Psychiatry, Hualien Armed Forces General Hospital, Hualien, Taiwan, ROC

    Li-Fen Chen

  8. Department of Nursing, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan, ROC

    Pei-Cih Chen & Hsin-Yi Cheng

  9. Department of Medical Research, National Defense Medical Center, Tri-Service General Hospital, 7115R, No.325, Section 2, Cheng-Kung Road, Neihu District, Taipei, 11490, Taiwan, ROC

    Wu-Chien Chien

Authors
  1. Ching-En Lin
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  2. Chi-Hsiang Chung
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  3. Li-Fen Chen
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  4. Pei-Cih Chen
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Contributions

CEL drafted the manuscript, developed the concept, designed the experiments, and supervised the manuscript preparation. CHC and LFC analyzed and interpreted the data. All authors have read and approved the final manuscript.

Corresponding author

Correspondence to Wu-Chien Chien.

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The authors declare that they have no conflict of interest.

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Lin, CE., Chung, CH., Chen, LF. et al. Compulsory admission is associated with an increased risk of readmission in patients with schizophrenia: a 7-year, population-based, retrospective cohort study. Soc Psychiatry Psychiatr Epidemiol 54, 243–253 (2019). https://doi.org/10.1007/s00127-018-1606-y

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  • DOI: https://doi.org/10.1007/s00127-018-1606-y

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