Predicting community tenure in patients with recurrent utilization of a psychiatric emergency service

Factors determining community tenure (CT) between subsequent referrals to a psychiatric emergency room (PER) are only partly understood. We investigated the differential effect of patient and health system characteristics on the CT of patients with a previous referral to a PER.

Data were collected for patients with a history of PER referrals (N=531) in a university hospital in Leuven, Belgium, between March 2000 and March 2002. Using logistic regression analysis, we compared patients with a short (<2 months), intermediate (2--12 months) and long (>or=12 months) CT between previous and current referrals.

A short CT (53% of the patients) was predicted by not receiving aftercare at the previous PER visit (OR=6.43) or by not complying with recommended aftercare (OR=3.89). An intermediate CT (38% of the patients) was predicted by an adjustment disorder (OR=6.72) or a substance use disorder (OR=3.47) or by the absence of a mental disorder (OR=4.13). Nine percent had a long CT. Protective factors of a long CT were noncompliance with aftercare at the last PER visit (OR=0.09) and currently being in outpatient treatment (OR=0.05).

For patients with a previous use of a PER, short CT was highly influenced by aftercare arrangements and not by clinical characteristics.