After stopping outpatient mental health care before completion, individuals with schizophrenia may not benefit optimally from interventions and are at risk for psychiatric hospitalization (National Institute of Mental Health, 2003). Intervention adherence research has therefore proliferated in recent years, although it has been burdened by inconsistent findings (Berghofer et al., 2002). It therefore remains unclear which individuals will be linked continuously to outpatient care programs following hospital discharge (Boyer et al., 2000). Based on prior research, it was hypothesized in this study that non-adherence risk is increased by medication noncompliance, substance abuse, and involuntary hospitalization. Two new hypotheses were tested:

1. Inpatient use of substance abuse services by chemically addicted individuals can prevent outpatient care self-termination by enhancing sobriety needed for independent living. Community mental health care adherence has been linked much more extensively to specific outpatient practices than to types of inpatient interventions.

2. Arrest history may increase dropout risk. Individuals with serious mental illness are more likely than others to be arrested or incarcerated (Munetz, et. al, 2001). Persons who have been arrested may be more likely to self-terminate outpatient services because of a more general tendency to resist the authority of both mental health and criminal justice system professionals and policies established by them.

Data for this analysis were taken from the Longitudinal Patient Outcome Phase of the Rutgers Hospital and Community Survey (1994-1996). Upon psychiatric hospital discharge, 315 inpatients with schizophrenia or schizoaffective disorder completed a structured assessment that covered several domains. After three months, 264 persons were available to report extent of outpatient program adherence. Chi-square analyses and t-tests for categorical and continuous variables, respectively, identified non-adherence risk factors. Logistic regression equations then determined which factors could predict dropout after accounting for age, gender, and race influences.

After at least one appointment, forty-nine of the 264 individuals discontinued one or more outpatient programs during the three months (19%). As in prior studies, medication noncompliance, substance abuse, and involuntary hospitalization at baseline predicted non-adherence. Moreover, arrest history more than doubled dropout odds (OR=.43, p=.02, CI=.22 to .85) after accounting for influence of demographic characteristics. Inpatient use of substance abuse services decreased dropout odds by a factor of almost six (OR=5.84, p=.003, CI=1.83 to 18.66). Perhaps non-adherence risk can be assessed in the hospital using chart information and clinical interview, and once identified the more vulnerable individuals can be offered services that have been shown to enhance outpatient care participation in order to prevent costly inpatient stay.

Berghofer, G., Schmidl, F., Rudas, S., et al. (2002). Predictors of treatment discontinuity in outpatient mental health care. Social Psychiatry & Psychiatric Epidemiology, 37, 276-282.

Boyer, C.A., McAlpine, D.D., Pottick, K.J., et al. (2000). Identifying risk factors and key strategies in linkage to outpatient psychiatric care. American Journal of Psychiatry, 157, 1592-1598.

Munetz, M.R., Grande, T.P., & Chambers, M.R.. (2001). The incarceration of individuals with severe mental illness. Community Mental Health Journal, 37(4): 361-372.

National Institute of Mental Health (2003). Research on adherence to interventions for mental disorders. Online: http://grants1.nih.gov/grants/guide/pa-files/PA-03-111.html.