PREDICTING THE REVOLVING-DOOR PHENOMENON AMONG PATIENTS WITH SCHIZOPHRENIC, SCHIZOAFFECTIVE, AND AFFECTIVE-DISORDERS

Objective: A subpopulation of chronically mentally ill patients, somet imes referred to as ''revolving door'' patients, are frequently readmi tted to psychiatric units. This study examined the relationships among demographic features, diagnostic characteristics, and frequency of ho spitalization of patients from four state hospitals. Method: Two semis tructured, standardized instruments, the Schedule for Affective Disord ers and Schizophrenia and a life events history, were administered to 135 inpatients who met the Research Diagnostic Criteria for schizophre nia (N=56), schizoaffective disorder (N=33), unipolar major depressive disorder (N=23), and bipolar disorder (N=23). Criminal history was as sessed by arrest records. The main outcome measure was the number of h ospitalizations. Results: Chi-square and trend test analyses indicated that substance abuse and noncompliance with medication regimens were significantly associated with higher frequencies of hospitalization. A multiple regression model, which included alcohol/drug problems, medi cation noncompliance, and six sociodemographic and diagnostic variable s (age, gender, race, marital status, years of education, and diagnosi s) accounted for a significant proportion of the ability to predict fr equency of hospitalization. Half of this predictability was due to the relationship of substance abuse and medication noncompliance with num ber of hospitalizations. Conclusions: Alcohol/drug problems and noncom pliance with medication were the most important factors related to fre quency of hospitalization. Preventing these behaviors through patient education may reduce rehospitalization rates.