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 admission-voluntary or involuntary-predicted the legal status and number of future admissions was examined among patients with schizophrenia. Methods: Data on all patients in Israel who had a nonforensic first admission between 1978 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 hospitalizations through 1995, demographic data, and diagnosis. Analyses adjusted for time since first admission, age at first admission, country of origin, and religion. Results: The first admission of 12.9 percent of the patients was involuntary. The legal status of the first admission was not related to the number of readmissions. However, female patients whose first admission was involuntary were 4.1 times more likely to have an involuntary second admission than female patients whose first admission was voluntary; these odds were 3.4 for males. Further analysis examined the percentage of involuntary admissions among all hospitalizations of the 3,420 patients who had four or more admissions (chronic patients). Among the chronic patients who had an involuntary first admission, 41 percent of subsequent admissions were involuntary. This figure was significantly lower among the chronic patients who had a voluntary first admission-13 percent. The percentage of involuntary admissions was not related to the number of admissions. Conclusions: The strong association of involuntary legal status at first admission with involuntary status at second admission and with the number of involuntary admissions over time suggests that involuntary first admission might be an important factor in assessing whether patients are likely to be readmitted involuntarily.