Discussion: Psychiatric Hospitals

Discussion: Psychiatric Hospitals ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS ON Discussion: Psychiatric Hospitals I’m studying for my Psychology class and don’t understand how to answer this. Can you help me study? Discussion: Psychiatric Hospitals In the subject line, put: “Last name, First name (Week 10).” As an example, your subject line should look like: Paul, Patrice (Week 10). Both posts are due by 11:00pm on Saturday 8/4/18. Initial Post (minimum of 5 meaningful sentences per prompt; cite something from the reading(s) with page number for one of the prompts): Discuss something you found interesting in the required readings. Describe one main challenge of working in a psychiatric hospital. Of the settings studied in this course, which one do you feel is your best fit? Why? (This is pure reflection, so no citing is required.) Response Post (minimum of 5 meaningful sentences): Respond to a classmate’s post. Discussion: Psychiatric Hospitals https://vimeo.com/43501647 Password: PSYC640 Child/Adolescent Inpatient https://vimeo.com/43562768 Password: PSYC640 doerfler__et_al.pdf drymalski__et_al_1_.pdf grubaugh__et_al.pdf Psychological Services 2010, Vol. 7, No. 4, 254 –265 © 2010 American Psychological Association 1541-1559/10/$12.00 DOI: 10.1037/a0020642 Situations Associated With Admission to an Acute Care Inpatient Psychiatric Unit Leonard A. Doerfler Peter W. Moran Assumption College and University of Massachusetts Medical School Prescott Health Care, Worcester, MA This document is copyrighted by the American Psychological Association or one of its allied publishers. This article is intended solely for the personal use of the individual user and is not to be disseminated broadly. Kristen E. Hannigan Assumption College This study examined whether stressful events occurred during the week preceding admission to an inpatient psychiatric unit in a sample of 97 adults with serious mental illness. The study also examined whether patients who had been readmitted within 30 days reported different stressful events than patients who had lived in the community for at least 6 months prior to admission. A structured interview was developed to obtain information about depressive and psychotic symptoms, stressful events, substance use, and aggressive and disruptive behaviors. Suicide risk was the most common reason for hospitalization (65%). Between 25% and 38% of patients reported interpersonal problems with family members or people outside their family, and about 50% reported financial problems immediately before hospitalization. Comparison of patients who had been readmitted within 30 days with patients who had been living in the community for at least 6 months since their last hospitalization found few differences between these groups. Discussion: Psychiatric Hospitals Results indicate that most patients were admitted to an inpatient psychiatric unit because of suicide risk, and interpersonal events seemed to precipitate hospital admission for these patients. Keywords: rehospitalization, readmission, stressful life events Psychiatric inpatient care is very expensive and consumes a major portion of mental health care resources in the United States (Mechanic, McAlpine, & Olfson, 1998). Various alternatives to hospitalization have been developed, and there is strong evidence that communitybased interventions for many individuals with Leonard A. Doerfler, Department of Psychology, Assumption College, and Department of Psychiatry, University of Massachusetts Medical School; Peter W. Moran, Prescott Health Care, Worcester, MA; Kristen E. Hannigan, Department of Psychology, Assumption College. Preparation of this article was supported by a Faculty Development Grant from Assumption College to Leonard A. Doerfler. Portions of this paper were presented at the 42nd annual meeting of the Association of Behavioral and Cognitive Therapies in Orlando, Florida, in November 2008. The authors acknowledge the helpful feedback and suggestions of Jeffrey Geller and Thomas Horn on an earlier version of this report. Correspondence concerning this article should be addressed to Leonard A. Doerfler, Department of Psychology, Assumption College, 500 Salisbury Street, Worcester, MA 01609-1296. E-mail: [email protected] serious mental illness are more effective and less costly than inpatient treatment (Kiesler & Sibulkin, 1987). Discussion: Psychiatric Hospitals As the average length of inpatient stay decreased, it was noted that rehospitalization is a significant problem because many individuals with serious mental illness do not remain in the community for extended periods of time (Durbin, Lin, Layna, & Teed, 2007; Klinkenberg & Calsyn, 1996; Talbott, 1974). A significant number of individuals are readmitted within a year of discharge (Durbin et al., 2007; Klinkenberg & Calsyn, 1996), and there is evidence that in some settings rehospitalization is more common than first-time admissions (Bachrach, 1983). Over the past several decades a considerable body of research on predictors of psychiatric hospitalization has accrued (Durbin et al., 2007; Klinkenberg & Calsyn, 1996; Pfeiffer, O’Malley, & Shott, 1996; Rosenblatt & Mayer, 1974). Rehospitalization has been associated with a wide range of clinical, demographic, and social factors, including history of prior hospitalization (e.g., Bobo et al., 2004; Yamanda, 254 This document is copyrighted by the American Psychological Association or one of its allied publishers. This article is intended solely for the personal use of the individual user and is not to be disseminated broadly. ADMISSION TO AN ACUTE CARE INPATIENT UNIT Korman, & Hughes, 2000), comorbid substance abuse (e.g., Haywood et al., 1995; Sullivan, Wells, Morgenstern, & Leake, 1995; Yamada et al., 2000), demographic characteristics (e.g., Klinkenberg & Calsyn, 1998; Serban & Gidynski, 1974), noncompliance with psychiatric medications (e.g., Haywood et al., 1995; Sullivan et al., 1995; Yamada et al., 2000), and negative relations with family members (e.g., Postrado & Lehman, 1995; Sullivan et al., 1995). Discussion: Psychiatric Hospitals Although there is an extensive body of research on this topic, findings regarding most variables that have been examined have been inconsistent. Reviews of this research by Durbin et al. (2007) and Klinkenberg and Calsyn (1996) conclude that only history of psychiatric hospital admission and poor medication compliance consistently predict rehospitalization. The findings for many studies are difficult to compare, however, because they differ widely in length of hospitalization, patient population, treatment setting, and length of follow-up evaluation. Methodological limitations of this research are important to consider (Pfeiffer, 1990), but another limitation is that this research generally has been atheoretical. When studies presented a model to predict rehospitalization, a clinical model was cited most often. This model hypothesizes that severity of mental illness (using indicators like psychiatric diagnosis, ratings of symptom severity) is associated with increased risk of hospitalization. However, very few clinical variables consistently predict rehospitalization, suggesting that concentrating on diagnostic or other psychopathological factors results in too narrow of a focus. Sullivan, Young, and Morgenstern (1997) suggested that a more fruitful approach is to use a vulnerability-stress model to investigate risk factors associated with rehospitalization. It is widely acknowledged that stressful life events are important in the development of a wide range of psychological disorders (Brown & Harris, 1989; Dohrenwend, 1998), and this model may offer insights into some environmental influences on rehospitalization. According to this model, psychological symptoms or difficulties emerge whenever stressful events or challenges exceed an individual’s vulnerability level (Zubin & Spring, 1977). 255 To date, the most consistent finding from research on risk factors for rehospitalization is that individuals with a history of repeated admissions are most vulnerable to being rehospitalized (Durbin et al., 2007; Klinkenberg & Calsyn, 1996).Discussion: Psychiatric Hospitals Although the nature of this vulnerability is uncertain, a vulnerability-stress model proposes that this vulnerability, when activated by stress, puts an individual at risk of readmission. Most research on stressful life events has focused on major life events (e.g., death of a loved one, divorce, losing one’s job), but accumulating evidence indicates that individuals with a serious mental illness are very sensitive to the small stresses of daily life (Dienes, Hammen, Henry, Cohen, & Daley, 2006; Hammen, Henry, & Daley, 2000; MyinGermeys & van Os, 2007). For individuals who have had multiple psychiatric hospitalizations, even minor events may be capable of precipitating recurrence of serious symptoms (Monroe & Harkness, 2005). Another issue that has received considerable attention in the research on rehospitalization is the “revolving door” phenomenon (e.g., Haywood et al., 1995; Talbott, 1974). Many times, patients are readmitted within 30 days of discharge (Durbin et al., 2007). Readmission within such a short time period following discharge raises questions as to whether the length or intensity of inpatient treatment was adequate, but in their review, Durbin et al. (2007) found that length of inpatient stay was not a consistent predictor of readmission. However, Durbin et al. (2007, p ? .143) did conclude “that the period immediately after discharge is one of high vulnerability to readmission” because a significant proportion of patients are rehospitalized within 30 days of discharge. The present study explored various stressful events or situations that occurred in the week prior to admission to an inpatient psychiatry unit in a sample of individuals with serious mental illness. Domains examined in this study included (1) occurrence of stressful events involving negative interactions with family members or other people outside the family, or other events like financial or legal problems, (2) severity of depressive and psychotic symptoms and the occurrence of aggressive or threatening behaviors, and (3) alcohol or drug use in the week prior to hospitalization. Discussion: Psychiatric Hospitals This study was primarily exploratory in nature, but it was hy- This document is copyrighted by the American Psychological Association or one of its allied publishers. This article is intended solely for the personal use of the individual user and is not to be disseminated broadly. 256 DOERFLER, MORAN, AND HANNIGAN pothesized that many individuals would report conflicts or negative interactions with family members or other people (e.g., coworkers) in the week prior to hospitalization. To examine the “revolving door” phenomenon, two subgroups of patients were recruited for this study. One group was comprised of patients who had a prior psychiatric hospitalization and then were readmitted to the same inpatient psychiatry unit within 30 days of discharge (revolving door patients). The second group was comprised of patients who were admitted to an inpatient psychiatry unit, but had lived in the community for at least 6 months without psychiatric hospitalization prior to the current admission. It was predicted that patients readmitted within 30 days would differ from the patients who had lived in the community for at least 6 months prior to admission on some of these stressful events or situations. It was also predicted that patients readmitted within 30 days of discharge would experience a greater number of stressful events than patients who had lived in the community for at least 6 months. Method Participants Participants were 97 adults (61 women, 36 men) who were admitted to the inpatient psychiatry unit of a teaching hospital affiliated with a teaching hospital affiliated with a University located in a large urban community in the Northeast United States. This hospital is located in a large urban community in central Massachusetts. No participants in this study had been admitted on an involuntary basis and all had had at least one prior psychiatric hospitalization. Of the 97 patients, 42 had been readmitted within 30 days of prior psychiatric hospitalization; the remaining 55 patients had been living in the community at least 6 months.Discussion: Psychiatric Hospitals For the entire sample, the mean length of current hospitalization was 7.21 days (SD ? 5.94) and the mean number of psychiatric hospitalizations in the past 12 months was 2.41 (SD ? 2.11). The mean age for this sample was 45.1-yearold (SD ? 14.40). With regard to ethnicity, 91% were Caucasian, 6% were African American, 1% was Hispanic, 1% was Asian American, and 1% reported other ethnic background. In terms of education, 35% had a high school diploma and another 43% had completed some college. Most participants (55%) were unable to work, but 18% worked part-time, 14% worked fulltime, 11% were retired, and 3% were homemakers. The mean number of people living in a patient’s household was 2.74 (SD ? 2.96). Patients were diagnosed by the attending psychiatrist. The primary Axis I diagnosis was mood disorder (64% major depression, 15% bipolar disorder). For the remaining patients, the primary diagnosis was schizoaffective disorder (7%), posttraumatic stress disorder (5%), substance abuse (4%), and schizophrenia (2%). Measures A structured interview was developed to obtain information about (1) severity of depressive and psychotic symptoms and the occurrence of aggressive or threatening behaviors in the week prior to hospitalization, (2) occurrence of various stressful events in the week prior to hospitalization, and (3) self-reported alcohol or drug use in the week prior to hospitalization. Questions were adapted from research that studied predictors of rehospitalization or suicidal behavior. The interview also included questions about participants’ demographic background, reasons for hospitalization, and the person who decided that the patient should enter the hospital.1 Demographic and background information. Patients were asked to provide information about the following areas: age, ethnic background, education, employment status, living arrangements, and the number of psychiatric hospitalizations in the past year. Patients also were asked about the main reason for their admission (suicide/self-harm, homicide/harm to another, inability to care for self in the community, hallucinations or other psychotic symptoms), and who made the decision to enter the hospital (self, family member, mental health professional, other person). Discussion: Psychiatric Hospitals When a mental health professional decided that hospitalization was indicated, patients followed this recommendation and voluntarily went to the emergency room for evaluation and admission. 1 A copy of the interview can be obtained from the first author. This document is copyrighted by the American Psychological Association or one of its allied publishers. This article is intended solely for the personal use of the individual user and is not to be disseminated broadly. ADMISSION TO AN ACUTE CARE INPATIENT UNIT Depressive and psychotic symptoms and aggressive or threatening behavior. Ten questions that assessed the severity of depressive and psychotic symptoms in the week prior to hospitalization were taken directly from the Hospital Questionnaire Patient Interview (Sullivan, 1988; Sullivan et al., 1995, 1997, 1997). For these questions, patients used a 5-point Likert scale (1 ? almost never, 5 ? almost always) to rate how much they were bothered by each depressive or psychotic symptom. Patients were also asked about the occurrence of aggressive and disruptive behaviors during the week prior to hospitalization. These questions, which were adapted from Sullivan et al.’s (1997) study, related to the patient’s actions or words that may have been threatening or distressing to other people. Using a 5-point scale (1 ? almost never, 5 ? almost always), patients were asked (1) how often they had a temper tantrum, and (2) how often they verbally attacked or threatened other people, or actually tried to hit or harm someone. When patients reported either form of aggressive behavior, they were asked to rate how distressing their aggressive behavior was (1 ? not at all, 5 ? very much). Patients also were asked about suicidal behavior in the week prior to admission. Using a 5-point scale (1 ? almost never, 5 ? almost always), patients were asked (1) how often they talked about harming or killing themselves and (2) how often they tried to harm or kill themselves. When patients acknowledged talking about their suicidal thoughts or acting on these thoughts, they were asked to rate how distressing these behaviors were (1 ? not at all, 5 ? very much). Stressful events. Discussion: Psychiatric Hospitals The interview included 10 questions about stressful interpersonal events and four questions about other noninterpersonal events that occurred the week before admission. These questions were adapted from the study by Bancroft and colleagues who interviewed individuals shortly after an incident involving deliberate self-injury or self-poisoning (Bancroft, Skrimshire, Casson, Harvard-Watts, & Reynolds, 1977). When patients reported one of these events, they were asked to rate how distressing the event was (1 ? not at all, 5 ? very much). Patients were asked about six possible events or problems involving their family or partner that occurred the week before admission. The questions covered the following areas: quarrel 257 with a family member, family member broke off relationship with patient, rejection by a family member, a stressful event that happened to a family member, partner’s infidelity, or patient’s infidelity. Patients were asked about four other events with people outside their family. These questions covered the following topics: quarrel with other people, friend broke off relationship with patient, a stressful event happened to a friend, or any physical or sexual threats (from a family member or other person). Patients also were asked if they experienced any of four different stressful events in the week prior to admission. These events included financial, housing, legal, or work problems. Self-reported alcohol or drug use. Patients were asked about their alcohol or drug use during the week prior to hospitalization. These questions were adapted from the Addiction Severity Index (McLellan, Luborsky, Woody, & O’Brien, 1980). All substance use questions were answered yes/no. Patients were asked whether they used the following drugs: alcohol (use), alcohol (to intoxication), amphetamine, marijuana, barbiturates, cocaine, heroin, codeine, and psychodelics. Patients used a 5-point scale (1 ? not at all, 5 ? very much) to rate whether they had a problem with alcohol abuse at the time of admission. When patients acknowledged a problem with alcohol abuse they were asked to rate how distressing this problem was (1 ? not at all, 5 ? very much). Patients also used a 5-point scale (1 ? not at all, 5 ? very much) to rate whether they had a problem with drug abuse at the time of admission. When patients acknowledged a problem with drug abuse, they were asked to rate how distressing this problem was (1 ? not at all, 5 ? very much).Discussion: Psychiatric Hospitals Procedure This study was approved by the teaching hospital’s institutional review board. Patients were eligible to participate in the study if they had been admitted to the unit twice within the past 30 days, or if they reported that they had lived in the community for at least 6 months without psychiatric hospitalization prior to the current admission. Potential participants were identified by the head nurse on the inpatient psychiatry unit, and the patient’s attending psychiatrist or clinical psychologist granted per- This document is copyrighted by the American Psychological Association or one of its allied publishers. This article is intended solely for the personal use of the individual user and is not to be disseminated broadly. 258 DOERFLER, MORAN, AND HANNIGAN mission to interview the patient. The head nurse selected patients to be interviewed based on clinical factors about whether an individual was able to participate in the interview. Patients were not interviewed during the first 2 days of hospitalization because several staff members (psychiatrist, psychologist, social worker) routinely interviewed patients as part of the unit’s admission procedure. Patients who had received electroconvulsive therapy within the past three days were not interviewed because of confusion or memory problems. Furthermore, patients were not interviewed if they were agitated, confused, or actively psychotic. A small number of patients who were invited to participate in the study declined, but records were not kept on the number of patients who declined, or the reasons for not participating. Participants were interviewed individually by one of four interviewers (one doctoral-level clinical psychologist and three graduate students enrolled in a Master’s-level counseling psychology program). Interviewers explai … Get a 10 % discount on an order above $ 100 Use the following coupon code : NURSING10

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Discussion: Psychiatric Hospitals

Discussion: Psychiatric Hospitals ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS ON Discussion: Psychiatric Hospitals I’m studying for my Psychology class and don’t understand how to answer this. Can you help me study? Discussion: Psychiatric Hospitals In the subject line, put: “Last name, First name (Week 10).” As an example, your subject line should look like: Paul, Patrice (Week 10). Both posts are due by 11:00pm on Saturday 8/4/18. Initial Post (minimum of 5 meaningful sentences per prompt; cite something from the reading(s) with page number for one of the prompts): Discuss something you found interesting in the required readings. Describe one main challenge of working in a psychiatric hospital. Of the settings studied in this course, which one do you feel is your best fit? Why? (This is pure reflection, so no citing is required.) Response Post (minimum of 5 meaningful sentences): Respond to a classmate’s post. Discussion: Psychiatric Hospitals https://vimeo.com/43501647 Password: PSYC640 Child/Adolescent Inpatient https://vimeo.com/43562768 Password: PSYC640 doerfler__et_al.pdf drymalski__et_al_1_.pdf grubaugh__et_al.pdf Psychological Services 2010, Vol. 7, No. 4, 254 –265 © 2010 American Psychological Association 1541-1559/10/$12.00 DOI: 10.1037/a0020642 Situations Associated With Admission to an Acute Care Inpatient Psychiatric Unit Leonard A. Doerfler Peter W. Moran Assumption College and University of Massachusetts Medical School Prescott Health Care, Worcester, MA This document is copyrighted by the American Psychological Association or one of its allied publishers. This article is intended solely for the personal use of the individual user and is not to be disseminated broadly. Kristen E. Hannigan Assumption College This study examined whether stressful events occurred during the week preceding admission to an inpatient psychiatric unit in a sample of 97 adults with serious mental illness. The study also examined whether patients who had been readmitted within 30 days reported different stressful events than patients who had lived in the community for at least 6 months prior to admission. A structured interview was developed to obtain information about depressive and psychotic symptoms, stressful events, substance use, and aggressive and disruptive behaviors. Suicide risk was the most common reason for hospitalization (65%). Between 25% and 38% of patients reported interpersonal problems with family members or people outside their family, and about 50% reported financial problems immediately before hospitalization. Comparison of patients who had been readmitted within 30 days with patients who had been living in the community for at least 6 months since their last hospitalization found few differences between these groups. Discussion: Psychiatric Hospitals Results indicate that most patients were admitted to an inpatient psychiatric unit because of suicide risk, and interpersonal events seemed to precipitate hospital admission for these patients. Keywords: rehospitalization, readmission, stressful life events Psychiatric inpatient care is very expensive and consumes a major portion of mental health care resources in the United States (Mechanic, McAlpine, & Olfson, 1998). Various alternatives to hospitalization have been developed, and there is strong evidence that communitybased interventions for many individuals with Leonard A. Doerfler, Department of Psychology, Assumption College, and Department of Psychiatry, University of Massachusetts Medical School; Peter W. Moran, Prescott Health Care, Worcester, MA; Kristen E. Hannigan, Department of Psychology, Assumption College. Preparation of this article was supported by a Faculty Development Grant from Assumption College to Leonard A. Doerfler. Portions of this paper were presented at the 42nd annual meeting of the Association of Behavioral and Cognitive Therapies in Orlando, Florida, in November 2008. The authors acknowledge the helpful feedback and suggestions of Jeffrey Geller and Thomas Horn on an earlier version of this report. Correspondence concerning this article should be addressed to Leonard A. Doerfler, Department of Psychology, Assumption College, 500 Salisbury Street, Worcester, MA 01609-1296. E-mail: [email protected] serious mental illness are more effective and less costly than inpatient treatment (Kiesler & Sibulkin, 1987). Discussion: Psychiatric Hospitals As the average length of inpatient stay decreased, it was noted that rehospitalization is a significant problem because many individuals with serious mental illness do not remain in the community for extended periods of time (Durbin, Lin, Layna, & Teed, 2007; Klinkenberg & Calsyn, 1996; Talbott, 1974). A significant number of individuals are readmitted within a year of discharge (Durbin et al., 2007; Klinkenberg & Calsyn, 1996), and there is evidence that in some settings rehospitalization is more common than first-time admissions (Bachrach, 1983). Over the past several decades a considerable body of research on predictors of psychiatric hospitalization has accrued (Durbin et al., 2007; Klinkenberg & Calsyn, 1996; Pfeiffer, O’Malley, & Shott, 1996; Rosenblatt & Mayer, 1974). Rehospitalization has been associated with a wide range of clinical, demographic, and social factors, including history of prior hospitalization (e.g., Bobo et al., 2004; Yamanda, 254 This document is copyrighted by the American Psychological Association or one of its allied publishers. This article is intended solely for the personal use of the individual user and is not to be disseminated broadly. ADMISSION TO AN ACUTE CARE INPATIENT UNIT Korman, & Hughes, 2000), comorbid substance abuse (e.g., Haywood et al., 1995; Sullivan, Wells, Morgenstern, & Leake, 1995; Yamada et al., 2000), demographic characteristics (e.g., Klinkenberg & Calsyn, 1998; Serban & Gidynski, 1974), noncompliance with psychiatric medications (e.g., Haywood et al., 1995; Sullivan et al., 1995; Yamada et al., 2000), and negative relations with family members (e.g., Postrado & Lehman, 1995; Sullivan et al., 1995). Discussion: Psychiatric Hospitals Although there is an extensive body of research on this topic, findings regarding most variables that have been examined have been inconsistent. Reviews of this research by Durbin et al. (2007) and Klinkenberg and Calsyn (1996) conclude that only history of psychiatric hospital admission and poor medication compliance consistently predict rehospitalization. The findings for many studies are difficult to compare, however, because they differ widely in length of hospitalization, patient population, treatment setting, and length of follow-up evaluation. Methodological limitations of this research are important to consider (Pfeiffer, 1990), but another limitation is that this research generally has been atheoretical. When studies presented a model to predict rehospitalization, a clinical model was cited most often. This model hypothesizes that severity of mental illness (using indicators like psychiatric diagnosis, ratings of symptom severity) is associated with increased risk of hospitalization. However, very few clinical variables consistently predict rehospitalization, suggesting that concentrating on diagnostic or other psychopathological factors results in too narrow of a focus. Sullivan, Young, and Morgenstern (1997) suggested that a more fruitful approach is to use a vulnerability-stress model to investigate risk factors associated with rehospitalization. It is widely acknowledged that stressful life events are important in the development of a wide range of psychological disorders (Brown & Harris, 1989; Dohrenwend, 1998), and this model may offer insights into some environmental influences on rehospitalization. According to this model, psychological symptoms or difficulties emerge whenever stressful events or challenges exceed an individual’s vulnerability level (Zubin & Spring, 1977). 255 To date, the most consistent finding from research on risk factors for rehospitalization is that individuals with a history of repeated admissions are most vulnerable to being rehospitalized (Durbin et al., 2007; Klinkenberg & Calsyn, 1996).Discussion: Psychiatric Hospitals Although the nature of this vulnerability is uncertain, a vulnerability-stress model proposes that this vulnerability, when activated by stress, puts an individual at risk of readmission. Most research on stressful life events has focused on major life events (e.g., death of a loved one, divorce, losing one’s job), but accumulating evidence indicates that individuals with a serious mental illness are very sensitive to the small stresses of daily life (Dienes, Hammen, Henry, Cohen, & Daley, 2006; Hammen, Henry, & Daley, 2000; MyinGermeys & van Os, 2007). For individuals who have had multiple psychiatric hospitalizations, even minor events may be capable of precipitating recurrence of serious symptoms (Monroe & Harkness, 2005). Another issue that has received considerable attention in the research on rehospitalization is the “revolving door” phenomenon (e.g., Haywood et al., 1995; Talbott, 1974). Many times, patients are readmitted within 30 days of discharge (Durbin et al., 2007). Readmission within such a short time period following discharge raises questions as to whether the length or intensity of inpatient treatment was adequate, but in their review, Durbin et al. (2007) found that length of inpatient stay was not a consistent predictor of readmission. However, Durbin et al. (2007, p ? .143) did conclude “that the period immediately after discharge is one of high vulnerability to readmission” because a significant proportion of patients are rehospitalized within 30 days of discharge. The present study explored various stressful events or situations that occurred in the week prior to admission to an inpatient psychiatry unit in a sample of individuals with serious mental illness. Domains examined in this study included (1) occurrence of stressful events involving negative interactions with family members or other people outside the family, or other events like financial or legal problems, (2) severity of depressive and psychotic symptoms and the occurrence of aggressive or threatening behaviors, and (3) alcohol or drug use in the week prior to hospitalization. Discussion: Psychiatric Hospitals This study was primarily exploratory in nature, but it was hy- This document is copyrighted by the American Psychological Association or one of its allied publishers. This article is intended solely for the personal use of the individual user and is not to be disseminated broadly. 256 DOERFLER, MORAN, AND HANNIGAN pothesized that many individuals would report conflicts or negative interactions with family members or other people (e.g., coworkers) in the week prior to hospitalization. To examine the “revolving door” phenomenon, two subgroups of patients were recruited for this study. One group was comprised of patients who had a prior psychiatric hospitalization and then were readmitted to the same inpatient psychiatry unit within 30 days of discharge (revolving door patients). The second group was comprised of patients who were admitted to an inpatient psychiatry unit, but had lived in the community for at least 6 months without psychiatric hospitalization prior to the current admission. It was predicted that patients readmitted within 30 days would differ from the patients who had lived in the community for at least 6 months prior to admission on some of these stressful events or situations. It was also predicted that patients readmitted within 30 days of discharge would experience a greater number of stressful events than patients who had lived in the community for at least 6 months. Method Participants Participants were 97 adults (61 women, 36 men) who were admitted to the inpatient psychiatry unit of a teaching hospital affiliated with a teaching hospital affiliated with a University located in a large urban community in the Northeast United States. This hospital is located in a large urban community in central Massachusetts. No participants in this study had been admitted on an involuntary basis and all had had at least one prior psychiatric hospitalization. Of the 97 patients, 42 had been readmitted within 30 days of prior psychiatric hospitalization; the remaining 55 patients had been living in the community at least 6 months.Discussion: Psychiatric Hospitals For the entire sample, the mean length of current hospitalization was 7.21 days (SD ? 5.94) and the mean number of psychiatric hospitalizations in the past 12 months was 2.41 (SD ? 2.11). The mean age for this sample was 45.1-yearold (SD ? 14.40). With regard to ethnicity, 91% were Caucasian, 6% were African American, 1% was Hispanic, 1% was Asian American, and 1% reported other ethnic background. In terms of education, 35% had a high school diploma and another 43% had completed some college. Most participants (55%) were unable to work, but 18% worked part-time, 14% worked fulltime, 11% were retired, and 3% were homemakers. The mean number of people living in a patient’s household was 2.74 (SD ? 2.96). Patients were diagnosed by the attending psychiatrist. The primary Axis I diagnosis was mood disorder (64% major depression, 15% bipolar disorder). For the remaining patients, the primary diagnosis was schizoaffective disorder (7%), posttraumatic stress disorder (5%), substance abuse (4%), and schizophrenia (2%). Measures A structured interview was developed to obtain information about (1) severity of depressive and psychotic symptoms and the occurrence of aggressive or threatening behaviors in the week prior to hospitalization, (2) occurrence of various stressful events in the week prior to hospitalization, and (3) self-reported alcohol or drug use in the week prior to hospitalization. Questions were adapted from research that studied predictors of rehospitalization or suicidal behavior. The interview also included questions about participants’ demographic background, reasons for hospitalization, and the person who decided that the patient should enter the hospital.1 Demographic and background information. Patients were asked to provide information about the following areas: age, ethnic background, education, employment status, living arrangements, and the number of psychiatric hospitalizations in the past year. Patients also were asked about the main reason for their admission (suicide/self-harm, homicide/harm to another, inability to care for self in the community, hallucinations or other psychotic symptoms), and who made the decision to enter the hospital (self, family member, mental health professional, other person). Discussion: Psychiatric Hospitals When a mental health professional decided that hospitalization was indicated, patients followed this recommendation and voluntarily went to the emergency room for evaluation and admission. 1 A copy of the interview can be obtained from the first author. This document is copyrighted by the American Psychological Association or one of its allied publishers. This article is intended solely for the personal use of the individual user and is not to be disseminated broadly. ADMISSION TO AN ACUTE CARE INPATIENT UNIT Depressive and psychotic symptoms and aggressive or threatening behavior. Ten questions that assessed the severity of depressive and psychotic symptoms in the week prior to hospitalization were taken directly from the Hospital Questionnaire Patient Interview (Sullivan, 1988; Sullivan et al., 1995, 1997, 1997). For these questions, patients used a 5-point Likert scale (1 ? almost never, 5 ? almost always) to rate how much they were bothered by each depressive or psychotic symptom. Patients were also asked about the occurrence of aggressive and disruptive behaviors during the week prior to hospitalization. These questions, which were adapted from Sullivan et al.’s (1997) study, related to the patient’s actions or words that may have been threatening or distressing to other people. Using a 5-point scale (1 ? almost never, 5 ? almost always), patients were asked (1) how often they had a temper tantrum, and (2) how often they verbally attacked or threatened other people, or actually tried to hit or harm someone. When patients reported either form of aggressive behavior, they were asked to rate how distressing their aggressive behavior was (1 ? not at all, 5 ? very much). Patients also were asked about suicidal behavior in the week prior to admission. Using a 5-point scale (1 ? almost never, 5 ? almost always), patients were asked (1) how often they talked about harming or killing themselves and (2) how often they tried to harm or kill themselves. When patients acknowledged talking about their suicidal thoughts or acting on these thoughts, they were asked to rate how distressing these behaviors were (1 ? not at all, 5 ? very much). Stressful events. Discussion: Psychiatric Hospitals The interview included 10 questions about stressful interpersonal events and four questions about other noninterpersonal events that occurred the week before admission. These questions were adapted from the study by Bancroft and colleagues who interviewed individuals shortly after an incident involving deliberate self-injury or self-poisoning (Bancroft, Skrimshire, Casson, Harvard-Watts, & Reynolds, 1977). When patients reported one of these events, they were asked to rate how distressing the event was (1 ? not at all, 5 ? very much). Patients were asked about six possible events or problems involving their family or partner that occurred the week before admission. The questions covered the following areas: quarrel 257 with a family member, family member broke off relationship with patient, rejection by a family member, a stressful event that happened to a family member, partner’s infidelity, or patient’s infidelity. Patients were asked about four other events with people outside their family. These questions covered the following topics: quarrel with other people, friend broke off relationship with patient, a stressful event happened to a friend, or any physical or sexual threats (from a family member or other person). Patients also were asked if they experienced any of four different stressful events in the week prior to admission. These events included financial, housing, legal, or work problems. Self-reported alcohol or drug use. Patients were asked about their alcohol or drug use during the week prior to hospitalization. These questions were adapted from the Addiction Severity Index (McLellan, Luborsky, Woody, & O’Brien, 1980). All substance use questions were answered yes/no. Patients were asked whether they used the following drugs: alcohol (use), alcohol (to intoxication), amphetamine, marijuana, barbiturates, cocaine, heroin, codeine, and psychodelics. Patients used a 5-point scale (1 ? not at all, 5 ? very much) to rate whether they had a problem with alcohol abuse at the time of admission. When patients acknowledged a problem with alcohol abuse they were asked to rate how distressing this problem was (1 ? not at all, 5 ? very much). Patients also used a 5-point scale (1 ? not at all, 5 ? very much) to rate whether they had a problem with drug abuse at the time of admission. When patients acknowledged a problem with drug abuse, they were asked to rate how distressing this problem was (1 ? not at all, 5 ? very much).Discussion: Psychiatric Hospitals Procedure This study was approved by the teaching hospital’s institutional review board. Patients were eligible to participate in the study if they had been admitted to the unit twice within the past 30 days, or if they reported that they had lived in the community for at least 6 months without psychiatric hospitalization prior to the current admission. Potential participants were identified by the head nurse on the inpatient psychiatry unit, and the patient’s attending psychiatrist or clinical psychologist granted per- This document is copyrighted by the American Psychological Association or one of its allied publishers. This article is intended solely for the personal use of the individual user and is not to be disseminated broadly. 258 DOERFLER, MORAN, AND HANNIGAN mission to interview the patient. The head nurse selected patients to be interviewed based on clinical factors about whether an individual was able to participate in the interview. Patients were not interviewed during the first 2 days of hospitalization because several staff members (psychiatrist, psychologist, social worker) routinely interviewed patients as part of the unit’s admission procedure. Patients who had received electroconvulsive therapy within the past three days were not interviewed because of confusion or memory problems. Furthermore, patients were not interviewed if they were agitated, confused, or actively psychotic. A small number of patients who were invited to participate in the study declined, but records were not kept on the number of patients who declined, or the reasons for not participating. Participants were interviewed individually by one of four interviewers (one doctoral-level clinical psychologist and three graduate students enrolled in a Master’s-level counseling psychology program). 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