Population-based examination of the relationship between type of first admission for schizophrenia and outcomes

Objective: This study examined the relationship between legal status at the time of the first psychiatric hospitalization and hospitalization outcomes in a population-based cohort. Methods: All first and subsequent admissions for schizophrenia were extracted from the complete Israeli national registry of psychiatric admissions for the years 1978 to 1992, and the cohort (N=12,071) was followed through 1996 for additional admissions or death. Admissions were categorized as being voluntary, involuntary, or forensic. Multivariate analysis of covariance and binary logistic regression were conducted to predict hospitalization outcomes, controlling for age at first hospitalization and sex. Results: Among males and females, a forensic first admission predicted a higher average number of days hospitalized per year and a longer length of first stay in a hospital. And among males, but not females, a forensic first admission predicted more admissions per illness year. Conclusions: Findings suggest that a forensic first admission is a risk factor for a more severe course of illness; this measure thus appears to have prognostic value aside from age of onset.