Frequently hospitalised psychiatric patients: a study of predictive factors.

The purpose of this study was to investigate the factors predicting readmission and the interval between readmissions to psychiatric hospital during the early 1990s in Finland. Data were retrieved using the national register of all discharges from psychiatric hospitals during the early 1990s. Frequently admitted patients were an identifiable group. The factors associated with an increased risk of multiple readmissions were: previous admissions, long length of stay (LOS) and diagnosis of psychosis or personality disorder. Patients with psychosis or personality disorder were also readmitted more rapidly than patients with an organic disorder. There seemed to be a small proportion of psychiatric patients in need of frequent or lengthy hospital treatment. The expansion of community care did not as such seem to have diminished the need and use of psychiatric hospital care. However, the differences between the years 1990 and 1993 were less important than the other factors that predicted readmission, namely LOS and diagnosis.

Regional differences in the use of psychiatric hospital beds in Finland: a national case-register study.

We investigated the possible differences in the utilization of psychiatric hospital beds among five social security areas in Finland, and the association between the variables related to the psychiatric services and the use of hospital beds. The use of hospital beds varied quite distinctly among these areas, as did the total rate of in-patients, readmissions, and rates of in-patients with psychotic and affective disorders. The treatment practices appeared to vary as the length of stay (LOS) and the rate of committal differed regionally in a significant manner. There was a significant positive correlation between the total rate of in-patients and the rate of readmitted patients (r=0.92, P<0.001), and a significant negative correlation between the number of visits per worker in out-patient care and the rate of readmissions (r=-0.94, P<0.001).

Patterns of psychiatric hospital service use in Finland: a national register study of hospital discharges in the early 1990s.

We were interested in studying the possible concurrent changes in the psychiatric inpatient population during a rapid phase of deinstitutionalisation, and severe economic recession with a record level unemployment rate, and after the amendment of the mental health legislation. Although there were 4540 fewer beds in the psychiatric hospitals in 1993 compared to 1990, the rate of patient admissions remained the same. There was a significant increase in readmissions (P < 0.001) to the psychiatric hospitals, and particularly in multiple (three or more) readmissions among new inpatients (P < 0.001). The prevalence of inpatients with major depression increased by 0.2/1000 in the whole cohort and by 0.12/1000 among first-timers from 1990 to 1993 (P < 0.001). In addition, the rate of involuntary admissions decreased significantly (P < 0.001).

Factors predicting readmissions in personality disorders and other nonpsychotic illnesses. A retrospective study on 64 first-ever admissions to the Psychiatric Clinic of Turku, Finland.

A retrospective study of factors predicting readmissions and follow-up treatment was undertaken of all first-ever episodes of inpatient care (age under 65), excluding psychotic and organic mental disorders, during 1987 and 1988 in University Psychiatric Clinic in Turku City Hospital, Finland. The cohort consisted of 64 subjects, 24 men and 40 women. The study was carried out in the end of 1993, thus allowing about 5 years of follow-up. The diagnosis of personality disorder did not predict readmission. The only factor predicting readmission nearly significantly was not having a relationship. The incidence of the revolving door syndrome, defined as 4 or more admissions within 5 years, was 12.5%. Women had a greater risk of readmission, but not that of the revolving door. Patients who had psychotherapy as follow-up treatment showed a frequency of 8% for 4 or more admissions, whereas patients who had no follow-up treatment had a frequency of 21% for 4 or more readmissions. The only factor significantly predicting follow-up treatment arrangement was previous treatment contact.