BACKGROUND: Incarcerated subjects with schizophrenia are at high risk for re-incarceration or schizophrenia-related hospitalization following release.
OBJECTIVE: To assess the effect of subject characteristics and utilization of healthcare services on risk of re-incarceration or schizophrenia-related hospitalization.
METHODS: Using a merged Medicaid/Department of Corrections database for South Carolina, adult subjects (18-62 years) with diagnosed schizophrenia (ICD9-CM=295.xx) and Medicaid eligibility at release from incarceration were selected between 1/1/2006 to 9/30/2011. Independent variables included age, race, gender, marital status, reason for incarceration, diagnosed drug dependence, and healthcare service utilization. Four separate Cox Regression models were used to evaluate the risk for re-incarceration and schizophrenia-related hospitalization over one and three year time periods.
RESULTS: Of the 413 subjects, 25.4% were white, 68.3% male, average age was 39.4 years, 83.1% were unmarried, and 12.7% were incarcerated for substance abuse. One year post-release, 57 (13.8%) were re-incarcerated and 54 (13.1%) were hospitalized. Three years post-release, 97 (23.5%) were re-incarcerated and 95 (23.0%) were hospitalized. None of the examined variables in the one year re-incarceration model were significant; however, drug dependence was significant (HR=3.825, 95% CI=1.386, 10.560) in the three-year re-incarceration model. For the hospitalization models, number of mental health-related outpatient visits was a significant predictor of hospitalization (HR=1.020, 95% CI =1.012, 1.027).
CONCLUSIONS: Drug dependence was a major risk factor for re-incarceration in this population of previously incarcerated Medicaid subjects with schizophrenia. Presence of mental-health related outpatient visits may be a predictor of increased risk of hospitalization.