LENGTH OF FIRST HOSPITALIZATION AND OTHER PREDICTORS FOR RE-HOSPITALIZATION IN PSYCHOSES Jouko Miettunen, PhD Department of Psychiatry University of Oulu, Finland NORTHERN FINLAND 1966 BIRTH COHORT STUDY

Psychiatric hospitalizations n Easy to study in countries with good registers (e.g. in Finland) n Marker of need and availability of psychiatric services

Previous studies n Re-hospitalization rates u Varying results, e.g. in a case register study (Australia, Denmark, USA, UK) F In 2 years 35 to 65 % F In 5 years 45 to 75 % Eaton et al., Schizophr Bull 1992; Ram et al., Schizophr Bull 1992; Ayuso-Gutiérrez & del Rio Vega, Schizophr Res 1997.

Previous studies n Re-hospitalization rates u Varying results, e.g. in a case register study (Australia, Denmark, USA, UK) F In 2 years 35 to 65 % F In 5 years 45 to 75 % n Risk factors for re-hospitalization u Early onset age u Negative symptoms u Alcohol/drug abuse u Non-compliance with medication u etc. Eaton et al., Schizophr Bull 1992; Ram et al., Schizophr Bull 1992; Ayuso-Gutiérrez & del Rio Vega, Schizophr Res 1997.

Aims n to find out re-hospitalization rates in a population based sample of psychotic patients n to find out if length of the first hospitalization, and other social and illness related factors around illness onset have an effect on risk for re- hospitalization

Oulu Northern Finland 1966 Birth Cohort

The Northern Finland 1966 Birth Cohort n 12,068 pregnant women who were u living in the provinces of Oulu and Lapland u expected to give birth during 1966 n N = 12,058 live births n Several data sources u large follow-up studies at age 14 and 31 years u register data e.g. from Finnish Hospital Discharge Register

n Psychiatric hospitalizations after onset of psychotic symptoms u All hospital treatments u Treatments in health centre ward with psychiatric specialized care n Current sample includes all hospital treated cases with psychosis by the year 1997 (N=150) in the Northern Finland 1966 Birth Cohort n Information on hospitalizations were available until December 31st 2000 Information on psychiatric hospitalizations

Included predictor variables n sex n diagnosis (schizophrenia vs. other) n familial risk (parental psychosis) n onset age for first psychotic symptoms (<20 yrs vs. later) n marital status around time of onset (single vs. others) n alcohol abuse around time of onset n premorbid work adjustment n premorbid social adjustment n psychosocial stressor prior to onset

Survival Functions years to re-hospitalization Cum Survival 1,0,8,6,4,2 0,0 Short (<1 month) first hospitalization yes no Results Mean follow-up time 9.6 years (max. 19 yrs)

Survival Functions years to re-hospitalization Cum Survival 1,0,8,6,4,2 0,0 Short (<1 month) first hospitalization yes no Results Re-hospitalization rates 2 years 61.2 % 5 years 72.8 % in follow-up time 78.0 % Mean follow-up time 9.6 years (max. 19 yrs)

Short first treatment n 67% of those with short (< 6 months) and 53% of those with longer 1st hospitalization were readmitted in 2 years n Short (< 6 months) first hospital treatment predicted re- hospitalization in two years (adjusted odds ratio 2.0; 95% CI ) Adjusted for onset age, parental psychosis, diagnosis (schz/other) and gender

Other statistically significant predictors for re-hospitalization in 2 years n Schizophrenia diagnosis (Adjusted OR 2.9; ) n Parental psychosis (Adjusted OR 3.0; ) n Definite psychosocial stressor prior to onset protected from re- hospitalization (Adjusted OR 0.2; )

Discussion Rapid decrease in psychiatric hospital beds n In Finland there were u 20,000 beds in 1982 u 10,000 beds in 1992 u currently appr. 6,000 beds n This may have an effect on quality of care and thereby on re-hospitalization rates

Conclusions n Too short hospitalization may lead to inadequate improvement in patient’s psychiatric status n Also other predictors were found for re-hospitalization

Research Group Jouko Miettunen, PhD Erika Lauronen, B Med Juha Veijola, MD, PhD, professor Hannu Koponen, MD, PhD, professor Matti Isohanni, MD, PhD, professor Department of Psychiatry and Department of Public Health Science and General Practice University of Oulu, Finland