The new revolving-door patients: results from a national cohort of first admissions

Abstract

A cohort of all first admissions to New Zealand psychiatric hospitals and psychiatric wards of general hospitals in 1980 and 1981 was followed up for 5 years. The cohort consisted of 3875 males and 3965 females aged from 15 to 64 years. Of these subjects, 59.4% had only one admission; 14.6% met our criteria for a revolving-door patient, as they had 4 or more admissions within the 5-year follow-up period. Based on first-admission information, patients who were younger and had a psychotic diagnosis had an increased likelihood of becoming a revolving-door patient. Stepwise logistic regression showed that younger age and psychotic diagnosis independently and in interaction were associated with a high probability of becoming a revolving-door patient. Although patients with a first-admission diagnosis of schizophrenia constitute a large group of the new revolving-door patients for both males and females, for women those with affective disorders and for men those with substance abuse comprise the largest proportion of the new revolving-door patients. This is because affective disorders in women and substance abuse in men are the most common diagnoses on first admission, rather than because the disorders themselves are associated with a high probability of the patients having multiple admissions.