Involuntary first admission of patients with schizophrenia as a predictor of future admissions

Objective: The extent to which the legal status of a first psychiatric admi ssion-voluntary or involuntary-predicted the legal status and number of fut ure admissions was examined among patients with schizophrenia. Methods: Dat a on all patients in Israel who had a nonforensic first admission between 1 978 and 1992 and a diagnosis of schizophrenia (N=9,081) were extracted from the national psychiatric hospitalization case registry. Also obtained from the registry was information about the patients' subsequent hospitalizatio ns through 1995, demographic data, and diagnosis. Analyses adjusted for tim e since first admission, age at first admission, country of origin, and rel igion. Results: The first admission of 12.9 percent of the patients was inv oluntary. The legal status of the first admission was not related to the nu mber of readmissions. However, female patients whose first admission was in voluntary were 4.1 times more likely to have an involuntary second admissio n than female patients whose first admission was voluntary; these odds were 3.4 for males. Further analysis examined the percentage of involuntary adm issions among all hospitalizations of the 3,420 patients who had four or mo re admissions (chronic patients). Among the chronic patients who had an inv oluntary first admission, 41 percent of subsequent admissions were involunt ary. This figure was significantly lower among the chronic patients who had a voluntary first admission-13 percent. The percentage of involuntary admi ssions was not related to the number of admissions. Conclusions: The strong association of involuntary legal status at first admission with involuntar y status at second admission and with the number of involuntary admissions over time suggests that involuntary first admission might be an important f actor in assessing whether patients are likely to be readmitted involuntari ly.