The revolving door phenomenon in severe psychiatric disorders: A systematic review

Background: The treatment of psychiatric patients has suffered a major change over the last decades, with long-term hospitalizations being replaced by short-term stays and appropriate aftercare in outpatient services. Some chronically ill patients exhibit a pattern of multiple hospitalizations, designated as the Revolving Door (RD) phenomenon. Aims: This review aims to analyse the existing literature regarding sociodemographic, clinical and other factors associated with multiple hospitalizations in psychiatric facilities. Method: The search performed in the PubMed database for the terms revolving[Title] AND (psyc*[Title] OR schizo*[Title] OR mental[Title]) presented 30 citations, 8 of which met the eligibility criteria. Four other studies found in references of these articles were also included in the review. Results: Albeit the use of different criteria to define the RD phenomenon, it is more likely to be associated with patients who are younger, single, with low educational level, unemployed, diagnosed with a psychotic disorder, particularly schizophrenia, and with alcohol and/or substance use. It is also associated with a younger age on disease onset, suicidality, noncompliance and voluntary type of admission. Conclusion: Recognizing patients with a RD pattern of admissions and prediction of rehospitalization can help the development of preventive intervention strategies and identify potential limitations in existing health care delivery systems.