Hospital Readmission in First-Time Admitted Patients with Schizophrenia: Smoking Patients Had Higher Hospital Readmission Rate Than Non-Smoking Patients
Restricted accessResearch articleFirst published online September, 2010
Hospital Readmission in First-Time Admitted Patients with Schizophrenia: Smoking Patients Had Higher Hospital Readmission Rate Than Non-Smoking Patients
To consider smoke-free policies for the patients with schizophrenia, the present study examined how smoking behavior is related to hospital readmission among patients with schizophrenia.
Methods:
A retrospective study was conducted in 2007 on 460 discharged patients with schizophrenia who voluntarily admitted in the participating psychiatric hospitals at first time. We reviewed smoking status, readmissions, and other variables including socio-demographic characteristics, process of care, and social functioning at discharge using the Global Assessment of Functioning scale (GAF).
Results:
The rate of cigarette smoking in this study was 42.2%. The rate of smoking was significantly higher in males (56.1%) than in females (26.2%). Mean GAF score at discharge was slightly higher in smoking patients than non-smoking patients (g = 0.18). Cox proportional hazard model revealed that hospital readmission rate was significantly higher in smoking patients than non-smoking patients after controlling for all other variables (HR = 1.78).
Conclusions:
Non-smoking patients had fewer hospital readmissions than smoking patients. This finding could be a reason to promote cessation of smoking which might provide positive influences on prognosis of schizophrenia.
DenscombeM. UK health policy and “underage” smokers: The case for smoking cessation services. Health Policy2007; 80: 69–76.
2.
U.S. Government Publishing Service. The health benefits of smoking cessation (DHHD Publication No. (CDC) 90-8416). Maryland.
3.
Ministry of Health, Labor, and Welfare: National Health and Nutrition Survey in Japan, 2006 (in Japanese). 2006.
4.
McCloughenA. The association between schizophrenia and cigarette smoking: A review of the literature and implications for mental health nursing practice. International Journal of Mental Health Nursing2003; 12: 119–129.
5.
El-GuebalyNCathcartJCurrieSBrownDGlosterS. Public health and therapeutic aspects of smoking bans in mental health and addiction settings. Psychiatric Service2002; 53: 1617–1622.
6.
LasserKBoydJWoolhandlerSHimmelsteinDMcCormickDBorD. Smoking and mental illness: A population-based prevalence study. Journal of the American Medical Association2000; 284: 2606–2610.
7.
GeorgeT. P. V. J.Nicotine addiction in psychiatric disorders. Psychiatric Times2001; 18: 39–42.
8.
McChargueDGulliverSHitsmanB. Would smokers with schizophrenia benefit from a more flexible approach to smoking treatment?Addiction2002; 97: 785–793; discussion 795–800.
9.
EastwoodR. Weeding out. Lancet1993; 341: 1316.
10.
KellyCMcCreadieR. Smoking habits, current symptoms, and premorbid characteristics of schizophrenic patients in Nithsdale, Scotland. American Journal of Psychiatry1999; 156: 1751–1757.
11.
MonnellyE. Instability before discharge and previous psychiatric admissions as predictors of early readmission. Psychiatric Service1997; 48: 1584–1586.
12.
Bezchlibnyk-ButlerK. J. J. J.Clinical handbook of psychotropic drugs (8th ed.). Hogrefe & Huber, Seattle, WA, 1998.
13.
InagakiAITFujiiY. Equivalent dose of psychotropics. Seiwa Shoten, Tokyo, 1999 (in Japanese).
14.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (3rd ed, rev.). Washington, DC, 1987.
15.
PiersmaHBoesJ. The GAF and psychiatric outcome: A descriptive report. Community Mental Health Journal1997; 33: 35–41.
16.
MoosRNicholAMoosB. Global assessment of functioning ratings and the allocation and outcomes of mental health services. Psychiatric Service2002; 53: 730–737.
17.
KlineR. Beyond significance testing: Reforming data analysis methods in behavioral research. American Psychological Association, Washington, DC, 2004.
18.
HosmerD. W. L. S.Applied survival analysis: Regression modeling of time to event data (2nd ed). Wiley-Interscience, New Jersey, 2008.
19.
R Development Core Team. A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, 2008.
20.
GoffDHendersonDAmicoE. Cigarette smoking in schizophrenia: Relationship to psychopathology and medication side effects. American Journal of Psychiatry1992; 149: 1189–1194.
21.
AkvardarYDemiralYErgorGErgorA. Substance use among medical students and physicians in a medical school in Turkey. Social Psychiatry and Psychiatric Epidemiology2004; 39: 502–506.
22.
BatelP. Addiction and schizophrenia. European Psychiatry2000; 15: 115–122.
23.
WeismanR. Quetiapine in the successful treatment of schizophrenia with comorbid alcohol and drug dependence: A case report. International Journal of Psychiatry in Medicine2003; 33: 85–89.
24.
de LeonJDadvandMCanusoCWhiteAStanillaJSimpsonG. Schizophrenia and smoking: An epidemiological survey in a state hospital. American Journal of Psychiatry1995; 152: 453–455.
25.
TangYGillespieCEpsteinMMaoPJiangFChenQCaiZMitchellP. Gender differences in 542 Chinese inpatients with schizophrenia. Schizophrenia Research2007; 97: 88–96.
26.
TangYGeorgeTMaoPCaiZChenQ. Cigarette smoking in Chinese male inpatients with schizophrenia: A cross-sectional analysis. Journal of Psychiatric Research2007; 41: 43–48.
27.
AguilarMGurpeguiMDiazFde LeonJ. Nicotine dependence and symptoms in schizophrenia: Naturalistic study of complex interactions. British Journal of Psychiatry2005; 186: 215–221.
28.
EvinsACatherCCulhaneMBirnbaumAHorowitzJHsiehEFreudenreichOHendersonDSchoenfeldDRigottiNGoffD. A 12-week double-blind, placebo-controlled study of bupropion sr added to high-dose dual nicotine replacement therapy for smoking cessation or reduction in schizophrenia. Journal of Clinical Psychopharmacology2007; 27: 380–386.
29.
de LeonJDiazFAguilarMJuradoDGurpeguiM. Does smoking reduce akathisia? Testing a narrow version of the self-medication hypothesis. Schizophrenic Research2006; 86: 256–268.
30.
OlincyAHarrisJJohnsonLPenderVKongsSAllensworthDEllisJZerbeGLeonardSStevensKStevensJMartinLAdlerLSotiFKemWFreedmanR. Proof-of-concept trial of an alpha7 nicotinic agonist in schizophrenia. Archives of General Psychiatry2006; 63: 630–638.
31.
FreedmanROlincyABuchananRHarrisJGoldJJohnsonLAllensworthDGuzman-BonillaAClementBBallMKutnickJPenderVMartinLStevensKWagnerBZerbeGSotiFKemW. Initial phase 2 trial of a nicotinic agonist in schizophrenia. American Journal of Psychiatry2008; 165: 1040–1047.
32.
GreenMHawranikP. Smoke-free policies in the psychiatric population on the ward and beyond: A discussion paper. International Journal of Nursing Studies2008; 45: 1543–1549.
