Table 1_Factors associated with the revolving door phenomenon in patients with schizophrenia: results from an acute psychiatric hospital in Romania.docx

BackgroundThe 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.
MethodsWe 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.
ResultsOf 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.
ConclusionsThe 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.

【背景】回旋门现象（revolving door phenomenon）指频繁住院的患者群体，该现象于去机构化改革（deinstitutionalization reforms）推行后出现。精神分裂症是一种严重且致残性的精神障碍，常被认定为回旋门现象患者中最常见的疾病之一。本研究旨在明确精神分裂症患者出现回旋门现象相关的社会人口学与临床危险因素。
【方法】本研究为观察性回顾性队列研究，收集了罗马尼亚最大精神专科医院2年内收治患者的病历资料。将12个月内住院次数≥3次的患者判定为回旋门现象患者。
【结果】本研究共纳入635例患者，其中108例符合回旋门现象患者判定标准。纳入患者的平均年龄为44.55±12.83岁，多数为未婚状态（81.7%）、领取伤残抚恤金（68.7%）且病程超过5年（81.9%）。男性性别（p=0.000）、年龄较轻（p<0.05）、存在精神共病（psychiatric comorbidity）、物质使用障碍（substance use disorder）及酒精使用障碍（alcohol use disorder）与回旋门现象患者显著相关。二元线性逻辑回归（binary linear logistic regression）分析显示，男性性别（优势比（odds ratio，OR）=1.92，95%置信区间（95%CI）:1.21-3.08）、住院时长较短（OR=0.982，95%CI:0.964-1.000）、物质使用障碍（OR=2.47，95%CI:1.16-5.26）、言语攻击（verbal aggression）及躯体攻击（physical aggression）是患者频繁使用住院服务（inpatient services）的预测因素。
【结论】本研究结果可为未来制定降低回旋门现象的改革政策提供依据，包括推行医院与社区服务间的过渡性照护干预措施（transitional care interventions）。