title: The revolving door phenomenon revisited: time to readmission in 17’145 [corrected] patients with 37'697 hospitalisations at a German psychiatric hospital.
abstract: OBJECTIVE
  Despite the recurring nature of the disease process in many psychiatric patients, individual careers and time to readmission rarely have been analysed by statistical models that incorporate sequence and velocity of recurrent hospitalisations. This study aims at comparing four statistical models specifically designed for recurrent event history analysis and evaluating the potential impact of predictor variables from different sources (patient, treatment process, social environment).
  
  
  METHODS
  The so called Andersen-Gil counting process model, two variants of the conditional models of Prentice, Williams, and Peterson (gap time model, conditional probability model), and the so called frailty model were applied to a dataset of 17’145 [corrected] patients observed during a 12 years period starting from 1996 and leading to 37’697 psychiatric hospitalisations Potential prognostic factors stem from a standardized patient documentation form.
  
  
  RESULTS
  Estimated regression coefficients over different models were highly similar, but the frailty model best represented the sequentiality of individual treatment careers and differing velocities of disease progression. It also avoided otherwise likely misinterpretations of the impact of gender, partnership, historical time and length of stay. A widespread notion of psychiatric diseases as inevitably chronic and worsening could be rejected. Time in community was found to increase over historical time for all patients. Most important protective factors beyond diagnosis were employment, partnership, and sheltered living situation. Risky conditions were urban living and a concurrent substance use disorder.
  
  
  CONCLUSIONS
  Prognostic factors for course of diseases should be determined only by statistical models capable of adequately incorporating the recurrent nature of psychiatric illnesses.
authors.affiliation: Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany ; Döpfer University of Applied Sciences, Department of Psychology, Cologne, Germany ; Research Institute on Public Health and Addiction, University of Zurich, Zurich, Switzerland.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Frick
authors.forename: Hannah
authors.initials: H
authors.lastname: Frick
authors.forename: Berthold
authors.initials: B
authors.lastname: Langguth
authors.forename: Michael
authors.initials: M
authors.lastname: Landgrebe
authors.forename: Bettina
authors.initials: B
authors.lastname: Hübner-Liebermann
authors.forename: Göran
authors.initials: G
authors.lastname: Hajak
mesh_terms: D000328:Adult; D005260:Female; D005858:Germany; D006778:Hospitals, Psychiatric / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000628:therapy*; D008875:Middle Aged; D015233:Models, Statistical; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011379:Prognosis; D012008:Recurrence; D012307:Risk Factors; D012737:Sex Factors; D013997:Time Factors