Effect of social resources on readmission prevention and the influence of informal coercion in acute schizophrenia: a retrospective quasi-experimental cohort study

Abstract

Introduction

During hospitalization, social resources are introduced with or without informal coercion as means of supporting the life of people with acute schizophrenia in the community. However, neither the effect of social resources in general on preventing readmission nor that of informal coercion on clinical outcomes is known. We aimed to examine the overall effect of social resources on preventing the readmission of people with acute schizophrenia and the clinical impact of informal coercion.

Methods

The present study identified 659 participants with schizophrenia, followed them for two years, and performed survival analyses using inverse probability of treatment weighting Kaplan-Meier and Cox proportional hazards analyses. Participants were first grouped by the social resource introduction. Those who declined the introduction were further categorized into coercive introduction, elicitory introduction, or personal needs groups.

Results

Participants in the social resource introduction group had a significantly lower risk of readmission than those in the control group (hazard ratio [HR]: 0.75; 95 % confidence interval [CI]: 0.57–0.99; P = 0.041). The number needed to treat was 7.2. The coercive introduction group showed no readmission risk reduction (HR: 1.53; 95 % CI: 0.75–3.13; P = 0.24) while the elicitory introduction group had a significantly lower risk than the personal needs group (HR: 0.50; 95 % CI: 0.31–0.82; P = 0.006).

Conclusions

Introducing social resources can prevent readmission for acute schizophrenia, but coercive introduction may negate this benefit. Medical staff should avoid informal coercion and adopt strategies that elicit motivation when introducing social resources.