Stigma and higher rates of psychiatric re-hospitalization: São Paulo public mental health system.
OBJECTIVE
The aim of this study was to assess re-hospitalization rates of individuals with psychosis and bipolar disorder and to study determinants of readmission.


METHODS
Prospective observational study, conducted in São Paulo, Brazil. One hundred-sixty-nine individuals with bipolar and psychotic disorder in need of hospitalization in the public mental health system were followed for 12 months after discharge. Their families were contacted by telephone and interviews were conducted at 1, 2, 6 and 12 months post-discharge to evaluate readmission rates and factors related.


RESULTS
One-year re-hospitalization rate was of 42.6%. Physical restraint during hospital stay was a risk factor (OR = 5.4-10.5) for readmission in most models. Not attending consultations after discharge was related to the 12-month point readmission (OR = 8.5, 95%CI 2.3-31.2) and to the survival model (OR = 3.2, 95%CI 1.5-7.2). Number of previous admissions was a risk factor for the survival model (OR = 6.6-11.9). Family's agreement with permanent hospitalization of individuals with mental illness was the predictor associated to readmission in all models (OR = 3.5-10.9) and resulted in shorter survival time to readmission; those readmitted were stereotyped as dangerous and unhealthy.


CONCLUSIONS
Family's stigma towards mental illness might contribute to the increase in readmission rates of their relatives with psychiatric disorders. More studies should be conducted to depict mechanisms by which stigma increases re-hospitalization rates.
Department and Institute of Psychiatry, School of Medicine, Universidade de São Paulo, Brazil. alexandre.loch@usp.br
Alexandre Andrade
AA
Loch
D000293:Adolescent; D000328:Adult; D000368:Aged; D001714:Bipolar Disorder / Q000523:psychology; D001938:Brazil; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011446:Prospective Studies; D011618:Psychotic Disorders / Q000523:psychology; D012307:Risk Factors; D012720:Severity of Illness Index; D057545:Social Stigma; D014505:Urban Population; D055815:Young Adult