title: Retrospective assessment of factors associated with readmission in a large psychiatric hospital in Guangzhou, China.
abstract: BACKGROUND
  Most psychiatric inpatients in China are involuntarily admitted by their families, resulting in relatively long admissions and relatively low readmission rates. However, this pattern may change after implementation of China's new national mental health law (promulgated in 2013), which restricts involuntary psychiatric admissions to the small proportion of mentally ill individuals who are a danger to self or others.
  
  
  OBJECTIVE
  Assess the factors associated with readmission rates of psychiatric inpatients in Guangzhou, China.
  
  
  METHODS
  A retrospective analysis of data from the Guangzhou Psychiatric Hospital, one of the largest psychiatric hospitals in China, used Cox regression models to evaluate the relationship between age, gender, diagnosis, marital status, employment status, relationship with the primary caregiver, type of medical insurance, length of stay of the index admission, and the number of previous admissions to estimate the risk of readmission over the year following discharge. Multivariate regression is used to assess factors associated with the total time of readmission during the year of follow-up.
  
  
  RESULTS
  Among 3455 patients admitted from 1 January 2011 to 31 December 2012 who had a mean (sd) length of stay of 65.7 (66.3) days, 476 (13.8%) were readmitted one or more times within one year of discharge. After considering all potential predictors of readmission in a multivariate survival analysis, the number of previous hospitalizations prior to the index admission was the only statistically significant predictor of readmission. The only factor that was significantly related to the total time of readmission was the duration of the index admission.
  
  
  CONCLUSIONS
  Shorter length of stay was not associated with increased readmission rates in patients admitted to a large public psychiatric hospital in southern China. This suggests that the expected decrease in the length of psychiatric inpatient admissions that is likely to occur when, based on China's new regulations, most patients are admitted voluntarily may not lead to increased rates of readmission. Prospective studies with a more comprehensive set of outcome measures (including patient functioning, medication adherence, and family burden) are needed to monitor the effect of the law on patients and on the distribution of mental health services.
authors.affiliation: Neuropsychiatric Research Institute, Guangzhou Psychiatric Hospital, Guangzhou Medical University, Guangzhou, China.
authors.forename: Yanling
authors.initials: Y
authors.lastname: Zhou
authors.affiliation: Department of Psychiatry, Yale University School of Medicine, New Haven, United States.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Rosenheck
authors.affiliation: Department of Psychiatry, Yale University School of Medicine, New Haven, United States.
authors.forename: Somaia
authors.initials: S
authors.lastname: Mohamed
authors.affiliation: Neuropsychiatric Research Institute, Guangzhou Psychiatric Hospital, Guangzhou Medical University, Guangzhou, China.
authors.forename: Ni
authors.initials: N
authors.lastname: Fan
authors.affiliation: Neuropsychiatric Research Institute, Guangzhou Psychiatric Hospital, Guangzhou Medical University, Guangzhou, China.
authors.forename: Yuping
authors.initials: Y
authors.lastname: Ning
authors.affiliation: Neuropsychiatric Research Institute, Guangzhou Psychiatric Hospital, Guangzhou Medical University, Guangzhou, China.
authors.forename: Hongbo
authors.initials: H
authors.lastname: He
keywords: China; length of stay; mental health law; psychiatric inpatients; readmission; survival analysis
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