Family Stressors as the Cause of Rehospitalization in Psychotic Disorders

  • Victoria Omranifard Mail 1-Psychiatric department, Isfahan University of Medical Sciences, Isfahan, Iran 2-Behavioral Science
  • Mohsen Yazdani Nursing faculty, Isfahan University of Medical Sciences, Isfahan, Iran
  • Mohammad Yaghoubi Psychiatric department, Isfahan University of Medical Sciences, Isfahan, Iran
  • Mahshid Namdari Medicine and Health Promotion Institute, Tehran, Iran
Psychosis, Psychotic disorders, Psychiatric readmission, Cause of readmission, Family issues


Objective: This study aimed to describe attributors of family stressors which cause rehospitalizations in patients with psychotic disorders.Materials and methods: In a cross sectional study (during 2006-7) 203 randomly selected psychiatric readmitted patients with psychotic diagnosis and registered demographic and psychiatric clinical data were included. Family stressors as the possible cause of readmission were asked through a structured interview by the psychiatrist.Results: Family factors were reported as a cause in 132 (60.6%) cases. Poor family support (n=88; 43.3%) and family conflict (n=58; 28.6%) were the two most prevalent family stressors, respectively. Bivariate analysis showed that admission due to family issues was different among men and women (79.1% vs. 38.7%, respectively p<0.001) and according to job situation (p<0.001), and literacy (p=0.036). According to logistic regression, gender (men) was the only predictor of admission due to family issues (OR=5.989, CI=3.220-11.141, p<0.001).Conclusion: Family factors are prevalent causes of return to hospital in patients with psychotic disorders, and this is more prevalent in men. An approach to decrease the marital stressors is needed in patients with psychotic disorders. In this approach, increasing family support and decreasing family conflict are essential.


Carpenter MD, Mulligan JC, Bader IA, Meinzer AE. Multiple admissions to an urban psychiatric center: A comparative study. Hosp Comm Psychiatry 1985; 36: 1305–8.

Casper ES, Donaldson B. Subgroups in the population of frequent users of inpatient services. Hosp Comm Psychiatry 1990; 41: 189–91.

Casper ES, Pastva G. Admission histories, patterns, and subgroups of the heavy users of a state psychiatric hospital. Psychiatr Q 1990; 61 : 121–34.

Green JH. Frequent rehospitalization and noncompliance with treatment. Hosp Comm Psychiatry 1988; 39: 963–6.

Havassy BE, Hopkin JT. Factors predicting utilization of acute psychiatric inpatient services by frequently hospitalized patients. Hosp Comm Psychiatry 1989; 40: 820–3.

Lucas B, Harrison-Read P, Tyrer P, Ray J, Shipley K, Hickman M, et al. Costs and characteristics of heavy inpatient service users in outer London. Int J Soc Psychiatry 2001; 47: 63–74.

Surber RW, Winkler EL, Monteleone M, Havassy BE, Goldfinger SM, Hopkin JT. Characteristics of high users of acute psychiatric inpatient services. Hosp Community Psychiatry 1987: 38: 1112–4.

Voineskos G, Denault S. Recurrent psychiatric hospitalization. Can Med Assoc J 1978; 118: 247–50.

Woogh CM.A Cohort through the revolving door. Can J Psychiatry 1986; 31: 214–21 .

Rosenblatt A, Mayer JE. Revolving-door patients at Bronx State Hospital: a preliminary report. Journal of Bronx State Hospital 1973; 1: 5–11.

Postrado LT, Lehman AF. Quality of life and clinical predictors of rehospitalization of persons with severe mental illness. Psychiatr Serv 1995; 46: 1161 – 5 .

Kent S, Fogarty M, Yellowlees P. Heavy utilization of inpatient and outpatient services in a public mental health service. Psychiatr Serv 1995; 46: 1254 – 7 .

Segal SP, Burgess PM. Use of community treatment orders to prevent psychiatric hospitalization. Aust N Z J Psychiatry 2008; 42: 732-9.

Van Meijel B, Kruitwagen C, van der Gaag M, Kahn RS, Grypdonck MH. An intervention study to prevent relapse in patients with schizophrenia. J Nurs Scholarsh 2006; 38 : 42 - 9 .

Brems C, Johnson ME, Corey S, Podunovich A, Burns R. Consumer perspectives on services needed to prevent psychiatric hospitalization. Adm Policy Ment Health 2004; 32 : 57 - 61 .

Barbaro B. Influence of family factors in the first occu-rrence of psychiatric hospitalization of patients suffering from schizophrenia. Psychiatr Pol 1992; 26 : 78 - 85 .

Blader JC. Symptom, family, and service predictors of children's psychiatric rehospitalization within one year of discharge. J Am Acad Child Adolesc Psychiatry 2004; 43: 440-51.

Pitschel-Walz G, Leucht S, Bäuml J, Kissling W, Engel RR. The effect of family interventions on relapse and rehospitalization in schizophrenia--a meta-analysis. Schizophr Bull 2001; 27: 73 - 92 .

Thompson EE, Neighbors HW, Munday C, Trierweiler S. Length of stay, referral to aftercare, and rehospitalization among psychiatric inpatients. Psychiatr Serv 2003; 54: 1271 - 6 .

Spiegel D, Wissler T. Family environment as a predictor of psychiatric rehospitalization. Am J Psychiatry 1986; 143: 56-60.

Tavallaii SA, Assari SH, Karimi Zarchi AA. Descriptive Study of Psychiatric Readmissions in Baqiyatallah and Noorafshar Hospitals, 2000-2001. Mil Med 2005; 7: 161-6.

Woo BK, Golshan S, Allen EC, Daly JW, Jeste DV, Sewell DD. Factors associated with frequent admissions to an acute geriatric psychiatric inpatient unit. J Geriatr Psychiatry Neurol 2006;19 : 226- 30 .

Goldstein JM. Gender differences in the course of schizophrenia. Am J Psychiatry 1988; 145: 684 -9 .

Kent S, Yellowlees P. Psychiatric and social reasons for frequent rehospitalization. Hosp Comm Psychiatry 1994; 45: 347–50.

Roick C, Heider D, Kilian R, Matschinger H, Toumi M, Angermeyer MC. Factors contributing to frequent use of psychiatric inpatient services by schizophrenia patients. Soc Psychiatry Psychiatr Epidemiol 2004; 39: 744-51.

Kent S, Yellowlees P. The relationship between social factors and frequent use of psychiatric services. Aust N Z J Psychiatry 1995; 29: 403–8.

Fetter MS, Lowery BJ. Psychiatric rehospitalization of the severely mentally ill: patient and staff perspectives. Nurs Res 1992; 41: 301-5.

Olfson M, Mechanic D, Boyer CA, Hansell S, Walkup J, Weiden PJ. Assessing clinical predictions of early rehospitalization in schizophrenia. J Nerv Ment Dis 1999; 187: 721-9.

How to Cite
Omranifard V, Yazdani M, Yaghoubi M, Namdari M. Family Stressors as the Cause of Rehospitalization in Psychotic Disorders. J Fam Reprod Health. 2(3):147-152.
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