Biopsychosocial Complexity of Revolving Door Admissions in an Acute Psychiatric Unit: A Retrospective Cohort Study

Frequent psychiatric rehospitalizations, commonly referred to as revolving door (RD) pose major challenges to community mental healthcare system and may reflect patients' bio-psycho-social (BPS) complexity.

The aim of the current study was to investigate the association between BPS complexity and RD in an acute psychiatric hospital ward, located in a Northern Italy province serving around 500,000 inhabitants.

A retrospective cohort study design was implemented to review all adult admissions between December 2021 and March 2023. Sociodemographic, clinical, and service-related data were extracted from the electronic clinical records. BPS complexity was assessed using the INTERMED tool. RD was defined as ⩾3 hospitalizations within 12 months. Survival analyses estimated hazard ratios (HRs) with corresponding 95% confidence intervals (95% CIs) for time-to-RD, under the assumption of proportional hazards.

A total of 322 patients were analyzed, and 31 (9.63%) met RD criteria. Compared to non-RD, RD patients displayed higher INTERMED scores, especially in psychological (HR: 1.28, 95% CI [1.06, 1.54]) and social (HR: 1.15 [1.05, 1.26]) domains. Living in a residential facility compared to a private house (HR: 7.14 [3.31, 15.38]), previous compulsory admissions (HR: 4.27 [1.73, 10.54]), long-acting injectable antipsychotic use at the first admission (HR: 3.46 [1.63, 7.35]), and receiving an individualized treatment plan at the community mental health center compared to not receiving it at the time of the first admission (HR: 5.30 [1.25, 22.42]) were all associated with an increased risk of RD during the follow-up.

Higher complexity in psycho-social domains and history of coercive treatments increased the risk of RD. Addressing psychological distress, social disconnection, and agency in community care may support clinicians in recognizing and anticipating risk factors for RD.