title: Predictors of psychiatric readmission among patients with bipolar disorder at an academic safety-net hospital.
abstract: OBJECTIVE
  Even with treatment, approximately one-third of patients with bipolar disorder relapse into depression or mania within 1 year. Unfavorable clinical outcomes for patients with bipolar disorder include increased rates of psychiatric hospitalization and functional impairment. However, only a few studies have examined predictors of psychiatric hospital readmission in a sample of patients with bipolar disorder. The purpose of this study was to examine predictors of psychiatric readmission within 30 days, 90 days and 1 year of discharge among patients with bipolar disorder using a conceptual model adapted from Andersen's Behavioral Model of Health Service Use.
  
  
  METHODS
  In this retrospective study, univariate and multivariate logistic regression analyses were conducted in a sample of 2443 adult patients with bipolar disorder who were consecutively admitted to a public psychiatric hospital in the United States from 1 January to 31 December 2013.
  
  
  RESULTS
  In the multivariate models, several enabling and need factors were significantly associated with an increased risk of readmission across all time periods examined, including being uninsured, having ⩾3 psychiatric hospitalizations and having a lower Global Assessment of Functioning score. Additional factors associated with psychiatric readmission within 30 and 90 days of discharge included patient homelessness. Patient race/ethnicity, bipolar disorder type or a current manic episode did not significantly predict readmission across all time periods examined; however, patients who were male were more likely to readmit within 1 year. The 30-day and 1-year multivariate models showed the best model fit.
  
  
  CONCLUSIONS
  Our study found enabling and need factors to be the strongest predictors of psychiatric readmission, suggesting that the prevention of psychiatric readmission for patients with bipolar disorder at safety-net hospitals may be best achieved by developing and implementing innovative transitional care initiatives that address the issues of multiple psychiatric hospitalizations, housing instability, insurance coverage and functional impairment.
authors.affiliation: UT Center of Excellence on Mood Disorders, Department of Psychiatry and Behavioral Sciences, The University of Texas Medical School at Houston, Houston, TX, USA UTHealth Harris County Psychiatric Center, Department of Psychiatry and Behavioral Sciences, The University of Texas Medical School at Houston, Houston, TX, USA jane.e.hamilton@uth.tmc.edu.
authors.forename: Jane E
authors.initials: JE
authors.lastname: Hamilton
authors.affiliation: UT Center of Excellence on Mood Disorders, Department of Psychiatry and Behavioral Sciences, The University of Texas Medical School at Houston, Houston, TX, USA Bipolar Disorder Program and Laboratory of Molecular Psychiatry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil UTHealth Harris County Psychiatric Center, Department of Psychiatry and Behavioral Sciences, The University of Texas Medical School at Houston, Houston, TX, USA.
authors.forename: Ives C
authors.initials: IC
authors.lastname: Passos
authors.affiliation: UT Center of Excellence on Mood Disorders, Department of Psychiatry and Behavioral Sciences, The University of Texas Medical School at Houston, Houston, TX, USA Graduate Program in Health and Behavior, Catholic University of Pelotas, Pelotas, RS, Brazil.
authors.forename: Taiane
authors.initials: T
authors.lastname: de Azevedo Cardoso
authors.affiliation: UT Center of Excellence on Mood Disorders, Department of Psychiatry and Behavioral Sciences, The University of Texas Medical School at Houston, Houston, TX, USA Graduate Program in Health and Behavior, Catholic University of Pelotas, Pelotas, RS, Brazil.
authors.forename: Karen
authors.initials: K
authors.lastname: Jansen
authors.affiliation: UTHealth Harris County Psychiatric Center, Department of Psychiatry and Behavioral Sciences, The University of Texas Medical School at Houston, Houston, TX, USA.
authors.forename: Melissa
authors.initials: M
authors.lastname: Allen
authors.affiliation: Center for Health Services Research, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, USA UTHealth Harris County Psychiatric Center, Department of Psychiatry and Behavioral Sciences, The University of Texas Medical School at Houston, Houston, TX, USA.
authors.forename: Charles E
authors.initials: CE
authors.lastname: Begley
authors.affiliation: UT Center of Excellence on Mood Disorders, Department of Psychiatry and Behavioral Sciences, The University of Texas Medical School at Houston, Houston, TX, USA UTHealth Harris County Psychiatric Center, Department of Psychiatry and Behavioral Sciences, The University of Texas Medical School at Houston, Houston, TX, USA.
authors.forename: Jair C
authors.initials: JC
authors.lastname: Soares
authors.affiliation: UT Center of Excellence on Mood Disorders, Department of Psychiatry and Behavioral Sciences, The University of Texas Medical School at Houston, Houston, TX, USA Bipolar Disorder Program and Laboratory of Molecular Psychiatry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil UTHealth Harris County Psychiatric Center, Department of Psychiatry and Behavioral Sciences, The University of Texas Medical School at Houston, Houston, TX, USA.
authors.forename: Flavio
authors.initials: F
authors.lastname: Kapczinski
mesh_terms: D000328:Adult; D000367:Age Factors; D001714:Bipolar Disorder / Q000188:drug therapy*; D005260:Female; D006778:Hospitals, Psychiatric / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010351:Patient Discharge; D010359:Patient Readmission / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012307:Risk Factors; D064876:Safety-net Providers / Q000706:statistics & numerical data*; D014481:United States; D055815:Young Adult
keywords: Bipolar disorder; functional impairment; multiple hospitalizations; psychiatric readmissions