الفهرس 
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Abstract
The relapse and re-hospitalization are one of the biggest problems of people suffering from schizophrenia. The cost of full relapse including the patient re-admission to the psychiatric hospital, and social burden on the patient’s family is too expensive. Added to the fact that one of the reasons of patient’s relapse is his incapacity to find a job after discharge from the hospital. Thus identification of the factors affecting re-hospitalization is important, so that early detection and abortion of such relapse will save a lot of financial, psychological and social burden on the patients, their families and the community as a whole. At the same time this will help in reducing the number of occupied psychiatric hospital’s beds and giving the chance for more problematic psychiatric cases to be treated (Faries et al, 2010 &Bowersox, 2012).
This study aimed to assess factors affecting re-hospitalization of schizophrenic patients at Benha Mental Health Hospital.
The study was conducted at the Psychiatric and Mental Health Hospital at Benha City, which is affiliated to General Secretariat. The sample included 60 schizophrenic patients. Subjects consisted of (46 males &14 females) who fulfilling the following inclusion criteria:
1- Patients who pass the acute stage and able to communicate.
2- Hospitalized twice or more.
3- Patients who stay in hospital not less than 2 months.
To collect data of this study, the following tool was used:
A structured interview questionnaire schedule was developed by the researcher based on literature review which consists of two parts:
Part one includes: socio-demographic characteristics and clinical data questionnaire to assess:
A- Socio-demographic characteristics of the schizophrenic patients such as: age, sex, marital status and level of education, occupation, position in family, and number of patient’s family members.
B- Clinical data of schizophrenic patients such as duration of illness, mode of admission to hospital, any one in family suffering from psychiatric illness and frequency of re-hospitalization.
Part two:- A structured interview questionnaire schedule concerning knowledge about factors leading to re-hospitalization of schizophrenic patients. The questionnaire contains close-ended questions and the patients were asked and responded to those questions by yes or no and multiple choice questions such as: Causes of current admission to hospital, follow up after discharge, causes of not follow up, family attitude toward patient illness, attitude of hospital staff toward patients. As well the same questionnaire contains open-ended questions such as patient’s suggestion from the medical team, family members at home and the community about how to decrease re-hospitalization rate.
Scoring system: For 24 knowledge items, the scores were summarized up and converted into qualitative variables. A patient with score less than 50 % was considered to have had poor knowledge & 50 – 65 % = had average knowledge & more than 65 % had good knowledge about factors affecting re-hospitalization.
The findings of this study can be summarized in the followings
* According to socio-demographic characteristics of studied schizophrenic patients, the findings pointed out that more than half of them were males and single (76.7 % & 61.7% respectively).
* According to occupation of studied schizophrenic patients, the findings revealed that more than half of them were unemployed and from rural areas (61.7% & 81.7% respectively), while only one third (33.3%) of them were illiterate.
* Regarding studied schizophrenic patients’ duration of illness, the results demonstrated that less than half (43.4%) of them have schizophrenia for ten years or more and their mean duration of illness was (15.40 ± 7.26) years, while more than half (55.0%) of studied patients were admitted three times to hospital.
* Concerning studied schizophrenic patients’ knowledge about factors affecting re-hospitalization, the results highlighted that more than three quarters (83.3%) of them had poor knowledge, while (11.7%) of them had good knowledge about this factors.
* Considering schizophrenic patients’ knowledge about causes leading to re-hospitalization. The results indicated that, all of them (100.0%) mentioned appearance of relapse symptoms was the major cause of current admission to hospital.
* In relation to studied schizophrenic patients’ adherence to medication, the findings revealed that, more than half of them are not adherent to medication and suffer from medication side effects (73.3% & 88.3% respectively).
* Regarding studied schizophrenic patients’ follow up after discharge. The results reported that, more than three quarters (76.7%) of them don’t follow up after discharge.
* Concerning studied schizophrenic patients’ relationship with their family members; the findings demonstrated that less than half (48.3%) of them have problems in their relation with family.
* As regards studied schizophrenic patients’ hospital environment; the results shows that, more than half of them stated that the hospital staff were physically assaultive toward them followed by they ignore their complain (61.7 % & 60.0% respectively).
* As for relationship between socio-demographic characteristics of studied schizophrenic patients and their frequency of re-hospitalization, the findings highlighted that there is a highly statistically significant difference between patient’s frequency of re-hospitalization and their age at p- value > 0.002 as old age patients admitted hospital more than young patients.
* There is a statistically significant relationship between studied schizophrenic patients’ frequency of re-hospitalization and their family number at p- value > 0.005 as patients whose family composed of 6 persons or more were admitted hospital less than patients whose family composed of (3-6) persons.
* There is a highly statistically significant relationship between studied schizophrenic patient’s frequency of re-hospitalization and their duration of illness at p- value > 0.001 as patients who were sick for a period twenty years and more were admitted more than patient who had a duration of illness of less than 20 years.
*There is a highly statistically significant relationship between studied schizophrenic patient’s frequency of re-hospitalization and their causes of not follow up at p- value > 0.05.
* There is no statistically significant relationship between studied schizophrenic patients’ frequency of re-hospitalization and their compliance to medication at p- value < 0.05.
*There is no statistically significant relationship between studied schizophrenic patients’ frequency of re-hospitalization and their medication side effects at p- value < 0.05.
* Regarding studied schizophrenic patients’ suggestions about the doctors to decrease re-hospitalization rate, more than half (53.3%) of them suggested that giving guidance to their families about disease and how to deal with schizophrenic patients.
* In relation to their suggestions about the family members at home to decrease re-hospitalization rate, more than one third (36.6%) of the studied sample suggested that their parents do not let them feel with stigma.
* Considering their suggestions about the community to decrease re-hospitalization rate, more than one third of them suggested that the community should give them the chance to socialize with friends and other people in the community followed by providing jobs for schizophrenic patients (38.3% & 28.3% respectively).
Recommendations
Based on the findings and conclusion of this study, the following recommendations are suggested:
1-Recommendations aiming at schizophrenic patients:
• Involve the patients as much as possible in their treatment plans.
• Discharged patients should be followed up by hospital staff on an ongoing basis throughout- patients’ appointments, home visits or telephone calls to reduce patients’ re-admission again.
2-Recommendations aiming at patients’ family:
• Family education about the patient’s disease and medications should be provided to enable them deal with their patients effectively.
3-Recommendations aiming at hospital staff:
• The hospital environment must be changed from a place providing custodial care only to a place providing therapeutic community services.
4-Recommendations aiming at community:
• Mass media should offer programs to the general population about mental illness and the facilities available for treatment, and the role of the community in caring for psychiatric patients.