Acta Scientific Neurology (ASNE) (ISSN: 2582-1121)

Research Article Volume 4 Issue 11

Pre-discharge Predicting the 5-years Hospital Readmission in Patients with Schizophrenia and Schizoaffective Disorders

Yael Ratner1 and Michael Ritsner1,2*

1Shaar Menashe Mental Health Center Affiliated to Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel
2National Insurance Institute in Israel, Haifa, Israel

*Corresponding Author: Michael Ritsner, Professor, National Insurance Institute in Israel, Haifa, Israel.

Received: September 25, 2021; Published: October 22, 2021



Background: Unplanned patient readmission (UPRA) is frequent and costly in healthcare settings. This study aimed to create a prediction model for predischarge detection of 5-years UPRA of patients with schizophrenia and schizoaffective (SZ/SA) disorders.

Methods: Consecutively admitted inpatients were comprehensively assessed before discharge from the hospital. After discharge, the readmission was tracked via computerized medical records for 5 years.

Results: Of 125 patients, 80.8% of participants were readmitted for the 5-year period (63.2% had readmissions within the first year). Regression analyses suggest the following predischarge predictors of readmissions: previous hospitalizations, elevated suicide risk, sensitivity and hostility scores, while better satisfaction with the quality of life and social support, lower depression and paranoid ideations, good adherence to treatment decreased readmission rates. Sociodemographic, background, and clinical variables did not reach a significant level to be predictors. The logistic regression model correctly classified 83.1% of subjects by their readmittance status.

Conclusion: The study revealed predischarge predictors for 5-years readmissions, and underlines the importance of assessing patient-reported outcome measures to identify patients at risk of readmission to the hospital.

Keywords: Mental Disorders; Readmissions; Predischarge Predictors; Distress; Quality of Life; Social Support



  1. Donisi V., et al. “Pre-discharge factors predicting readmissions of psychiatric patients: a systematic review of the literature”. BMC Psychiatry 16 (2016): 449.
  2. Zanardo G Lde P., et al. “Factors Associated with Psychiatric Readmissions: A Systematic Review”. Paidéia (Ribeirão Preto) 28 (2018): e2814.
  3. Havassy BE and Hopkin JT. “Factors predicting utilization of acute psychiatric inpatient services by frequently hospitalized patients”. Hospital and Community Psychiatry 40 (1989): 820-823.
  4. Roick C., et al. “Factors contributing to frequent use of psychiatric inpatient services by schizophrenia patients”. Social Psychiatry and Psychiatric Epidemiology 39 (2004): 744-751.
  5. Jaramillo-Gonzalez LE., et al. “The frequency of rehospitalization and associated factors in Colombian psychiatric patients: a cohort study”. BMC Psychiatry 14 (2014): 161.
  6. Lorine K., et al. “Risk factors associated with psychiatric readmission”. The Journal of Nervous and Mental Disease 203 (2015): 425-430.
  7. Bartoli F., et al. “Pre-Discharge Predictors of 1-Year Rehospitalization in Adolescents and Young Adults with Severe Mental Disorders: A Retrospective Cohort Study”. Medicina (Kaunas) 56 (2020): 613.
  8. Rubio-Valera M., et al. “Health service use and costs associated with aggressiveness or agitation and containment in adult psychiatric care: a systematic review of the evidence”. BMC Psychiatry 4 (2015): 35.
  9. Niehaus DJ., et al. “Crisis discharges and readmission risk in acute psychiatric male inpatients”. BMC Psychiatry 17 (2008): 8:44.
  10. Reininghaus U and Priebe S. “Measuring patient-reported outcomes in psychosis: conceptual and methodological review”. The British Journal of Psychiatry 201 (2012): 262-267.
  11. Ritsner M., et al. “Differences in quality of life domains and psychopathologic and psychosocial factors in psychiatric patients”. The Journal of Clinical Psychiatry 61 (2000): 880-889.
  12. Ratner Y., et al. “Patients' satisfaction with hospital health care: Identifying indicators for people with severe mental disorder”. Psychiatry Research 270 (2018): 503-509.
  13. Ritsner MS and Ratner Y. “Predicting predischarge anhedonia among inpatients with schizophrenia and schizoaffective disorders: A large-scale analysis”. The Journal of Nervous and Mental Disease 207 (2019): 12-21.
  14. “Diagnostic and statistical manual of mental disorders”. 5th ed, Washington, DC: American Psychiatric Association (2013).
  15. Guy W. “ECDU assessment manual for psychopharmacology”. Rockville, MD: US Department of Health and Human Services (1976).
  16. Khan A., et al. “Use of non-parametric item response theory to develop a shortened version of the Positive and Negative Syndrome Scale (PANSS)”. BMC Psychiatry 16 (2011): 11-178.
  17. “Diagnostic and statistical manual of mental disorders”. American Psychiatric Association. Washington, DC. (1994).
  18. Plutchik R., et al. “Correlates of suicide and violence risk: The Suicide Risk Measure”. Comprehensive Psychiatry 30 (1989): 296-302.
  19. Yudofsky SC., et al. “The Overt Aggression Scale for the objective rating of verbal and physical aggression”. The American Journal of Psychiatry 143 (1986): 35-39.
  20. Byerly MJ., et al. “The Brief Adherence Rating Scale (BARS) validated against electronic monitoring in assessing the antipsychotic medication adherence of outpatients with schizophrenia and schizoaffective disorder”. Schizophrenia Research 100 (2008): 60-69.
  21. Ritsner M., et al. “The Talbieh Brief Distress Inventory: A brief instrument to measure psychological distress among immigrants”. Comprehensive Psychiatry 36 (1995): 448-453.
  22. Ritsner M., et al. “Assessing psychological distress in psychiatric patients: Validation of the Talbieh Brief Distress Inventory”. Comprehensive Psychiatry 43 (2002) :229-234.
  23. Zimet GD., et al. “The Multidimensional Scale of Perceived Social Support”. The Journal of Personality Assessment 52 (1988): 30-41.
  24. Ritsner M., et al. “Validity of an abbreviated Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q-18) for schizophrenia, schizoaffective, and mood disorder patients”. Quality of Life Research 14 (2005): 1693-1703.
  25. Hintze JL. NCSS 6.0. Statistical System for Windows. User’s Guide. Number Cruncher Statistical Systems. Kaysville, Utah (2007).
  26. Zhou X-H., et al. “Statistical methods in diagnostic medicine”. New York: Wiley and Sons Interscience. (2002) 437.
  27. Rumball-Smith J and Hider P. "The validity of readmission rate as a marker of the quality of hospital care, and a recommendation for its definition”. The New Zealand Medical Journal 122 (2009): 63-70.
  28. Bowersox NW., et al. “Predictors of Rehospitalization in High-Utilizing Patients in the VA Psychiatric Medical System”. Psychiatric Quarterly 83 (2012): 53-64.
  29. Boaz TL., et al. “Risk factors for early readmission to acute care for persons with schizophrenia taking antipsychotic medications”. Psychiatric Services 64 (2013): 1225-1229.
  30. Vogel S and Hugelet P. “Factors associated with multiple admissions to a public psychiatric hospital”. Acta Psychiatrica Scandinavica 95 (1997): 244-253.
  31. Graca J., et al. “Characteristics of frequent users of an acute psychiatric inpatient unit: a five-year study in Portugal”. Psychiatric Services 64 (2013): 192-195.
  32. Hosmer D and Lemeshow S. Applied Logistic Regression. New York: John Wiley and Sons, Inc. Mathematics, (2004). 392 pages.
  33. Ho WW., et al. “Recovery components as determinants of the health-related quality of life among patients with schizophrenia: structural equation modelling analysis”. Australian and New Zealand Journal of Psychiatry 44 (2010): 71-84.
  34. Pallanti S., et al. “Social anxiety in outpatients with schizophrenia: a relevant cause of disability”. The American Journal of Psychiatry 161 (2004): 53-58.
  35. Kim HM., et al. “Intensity of outpatient monitoring after discharge and psychiatric rehospitalization of veterans with depression”. Psychiatric Services 62 (2011): 1346-1352.
  36. Chung DT., et al. “Suicide rates after discharge from psychiatric facilities: a systematic review and meta-analysis”. JAMA Psychiatry 74 (2017): 694-702.
  37. Cohen S and Wills TA. “Stress, social support and the buffering hypothesis”. Psychological Bulletin 98 (1985): 310-357.
  38. Ritsner M., et al. “Determinants of changes in perceived quality of life in the course of schizophrenia”. Quality of Life Research 15 (2006): 515-526.
  39. McColl MA., et al. “Structural relationships between social support and coping”. Social Science and Medicine 41 (1995): 395-407.
  40. Dahlan R., et al. “Hospital-based community psychiatric service for patients with schizophrenia in Kuala Lumpur: A 1-year follow-up study of re-hospitalization”. Asia-Pacific Psychiatry 5 (2013): 127-133.
  41. de Castro SA., et al. “Sociodemographic and clinical characteristics of psychiatric rehospitalizations”. Revista Latino-Americana de Enfermagem 18 (2010): 800-808.
  42. Frick U., et al. “The revolving door phenomenon revisited: Time to readmission in 17’415 patients with 37’697 hospitalizations at a German psychiatric hospital”. PLoS One 8 (2013): e75612.
  43. Sledge WH., et al. “Effectiveness of peer support in reducing readmissions of persons with multiple psychiatric hospitalizations”. Psychiatric Services 62 (2011): 541-544.
  44. Postrado LT and Lehman AF. “Quality of life and clinical predictors of rehospitalization of persons with severe mental illness”. Psychiatric Services 46 (1995): 1161-1165.
  45. Diaz E., et al. “Use of the Medication Event Monitoring System to estimate medication compliance in patients with schizophrenia”. Journal of Psychiatry and Neuroscience 26 (2001): 325-329.
  46. Kottsieper P. “Predicting initial aftercare appointment adherence and rehospitalization for individuals with serious mental illness discharged from an acute inpatient stay”. Drexel University Publisher (Ph.D. Thesis). (2006).
  47. Al-Shehhi AI., et al. “Rate and Predictors of 1-year Readmission in Tertiary Psychiatric Hospitals”. Saudi Journal of Medicine and Medical Sciences 5 (2017): 224-231.
  48. Cohen J. “Statistical power analysis for the behavioral sciences”. 2nd ed., Lawrence Earlbaum Associates, Erlbaum, Hillsdale, NJ (1988) 567.


Citation: Yael Ratner and Michael Ritsner. “Pre-discharge Predicting the 5-years Hospital Readmission in Patients with Schizophrenia and Schizoaffective Disorders”. Acta Scientific Neurology 4.11 (2021): 39-52.


Acceptance rate32%
Acceptance to publication20-30 days

Indexed In

News and Events

  • Certification for Review
    Acta Scientific certifies the Editors/reviewers for their review done towards the assigned articles of the respective journals.
  • Submission Timeline for Upcoming Issue
    The last date for submission of articles for regular Issues is July 30, 2024.
  • Publication Certificate
    Authors will be issued a "Publication Certificate" as a mark of appreciation for publishing their work.
  • Best Article of the Issue
    The Editors will elect one Best Article after each issue release. The authors of this article will be provided with a certificate of "Best Article of the Issue"
  • Welcoming Article Submission
    Acta Scientific delightfully welcomes active researchers for submission of articles towards the upcoming issue of respective journals.

Contact US