Factors associated with the revolving door phenomenon in patients with schizophrenia: results from an acute psychiatric hospital in Romania.

Abstract

Background: The revolving door phenomenon refers to patients with frequent hospital admissions and emerged after deinstitutionalization reforms have been implemented. Schizophrenia is a severe and debilitating mental disorder and has frequently been identified as one of the most prevalent disorders among revolving door patients. Therefore, this research aimed to identify socio-demographic and clinical factors associated with the revolving door phenomenon in patients with schizophrenia.

Methods: We conducted an observational and retrospective cohort study and collected data from the medical records of individuals admitted to the largest psychiatric hospital in Romania during a 2-year period. Patients with three or more admissions during a 12-month period were identified as revolving door.

Results: Of the total of 635 patients included in this study, 108 met the criteria for revolving door. Patients had a mean age of 44.55±12.83 years and most of them were single (81.7%) and receiving a disability pension (68.7%) and had an illness duration of more than 5 years (81.9%). Male gender (p=0.000), younger age (p<0.05), presence of psychiatric comorbidity (p<0.05), substance use disorder (p=0.000) and alcohol use disorder (p<0.01) were associated with the revolving door patients. A binary linear logistic regression revealed that male gender (OR=1.92, 95%CI:1.21-3.08), shorter hospitalization (OR=0.982, 95%CI:0.964-1.000), substance use disorder (OR=2.47, 95%CI:1.16-5.26), verbal (OR=1.44, 95%CI:1.05-1.98) and physical (OR=1.331, 95%CI:1.017-1.744) aggression were predictive factors for frequent use of inpatient services.

Conclusions: The results may facilitate development of future reform policies aimed at reducing the revolving door phenomenon, including implementing transitional care interventions between hospital and community services.