分析台灣某精神科專科醫院思覺失調症與情感性疾病病人之再住院率與相關危險因子的差異

Re-hospitalization Rates and Associated Risk Factors in Schizophrenia and Affective Disorder Patients at a Local Mental Hospital in Taiwan

目的：嚴重精神科病人的再住院率比一般人來的高，而這些病人的過高住院費用已經在醫療上造成巨大的負擔，目前雖然已有部分資料探討台灣精神科的再住院率，然而目前尚未有直接比較思覺失調症與情感性疾病再住院率的研究，因此我們分析南台灣某精神科專科醫院這兩種病人再住院率的區別，並分析可能的危險因子。方法：我們在南台灣某精神科專科醫院取樣，取樣時間與對象為2007年這一年之間剛從急性病房出院的病人，且病人須符合思覺失調症或情感性疾病診斷，同時，我們持續追蹤這些個案維持一年的時間。結果：總計收案267人，其中有142位診斷為思覺失調症而有125位為情感性疾病病人。思覺失調症與情感性疾病病人一年內的再住院率分別是37.3%及39.2%，這兩組病人間，「出院後到再住院之間的時間」並無顯著的差異，我們也發現「之前住院次數較多」(p<0.01)及「發病時間越短」(p<0.01)這兩個危險因子都會明顯的增加再住院風險。另一方面，相較於未再住院的病人，再住院的病人年紀顯著比較輕p<0.05)、上次住院時間顯著的較短(p<0.05)、且過去較顯著的多次住院(p<0.05)。討論：本研究的主要發現為：在思覺失調症與情感性疾病病人之間，「出院至再住院間的時間長度」並無明顯差別，且「過去較多次住院」及「發病時間較短」的病人顯著的比較容易再住院。

Background: The “revolving-door” patients have become a challenge for psychiatric care because of the high cost of repeated hospitalizations. The re-hos-pitalization rate in Taiwan is estimated at 6.1%, 22.3%, and 37.8% in periods of “less than 14 days,” “one year,” and “five years” after discharge, respectively. But, a direct comparison of re-hospitalization rates for patients with schizophrenia and affective disorders and the associated risk factors in Taiwan is still lacking. We conducted a retrospective study evaluating the re-hospitalization rate and associ-ated risk factors for patients with schizophrenia or affective disorders in southern Taiwan. Methods: We recruited subjects with a diagnosis of schizophrenia or af-fective disorder, who were discharged in 2007, from the acute ward of one local mental hospital and follow-up. Results: We recruited 267 subjects (142 subjects with schizophrenia and 125 subjects with affective disorder). The re-hospitaliza-tion rates in a one-year follow-up were 37.3% and 39.2% for patients with schizo-phrenia and affective disorder, respectively. No significant differences were found in the “time to re-hospitalization” between the two diagnostic groups. In addition, we found that patients with rehospitalization had significantly greater number of previous hospitalizations (p < 0.01) and significantly shorter length of illness (p < 0.01). The re-hospitalized patients were younger significantly (p< 0.05), had a significantly shorter length of illness (p < 0.05), and significantly more previous hospitalizations (p < 0.05) than the non-re-hospitalized patients. Discussion: Our main finding in this study was that no significant difference was found in the “time to re-hospitalization” within one year. Those with a shorter length of illness and more previous hospitalizations had a higher risk of re-hospitalization.