Soc Psychiatry Psychiatr Epidemiol (1995) 30:65-72 9 Springer-Verlag 1995 J. Rabinowitz 9 M. Mark 9 M: Popper. M. Slyuzberg H. Munitz Predicting revolving-door patients in a 9-year national sample Accepted: 17 August 1994 Abstract We attempted to predict revolving door (RD) patterns of admission (four or more admissions with less than 2.5 years between consecutive admissions) in a ran- dom sample of 10 % of all first admissions to psychiatric hospitals and psychiatric wards of general hospitals in Israel from 1983 to 1990 with follow-up into 1993. This included 4570 hospitalizations of 2220 patients. Data were extracted from the National Psychiatric Case Reg- istry of the Ministry of Health. Almost 59 % of the sam- ple had only one admission, 41% had two or more, 23 % had three or more, and 14 % had four or more admis- sions. Patients with four or more admissions were all RD patients. ~hey had an average of 200 days between admissions. The average number of admissions for RD patients was 6.17, and the average number of years be- tween the first admission and the last admission was 3.28 years. Using discriminant analysis we correctly pre- dicted 73.9 % of the non-RD group (about chance level since 80 % of the cases were non-RD) and 71.2 % of the RD group (considerably better than chance, only 12.0 % of the sample were RD). The main predictors of RD in descending order were not being married at the time of first hospitalization, unemployment and more severe initial diagnosis. The minor predictors were old- er age, more education and longer first admission. Sub- stance abuse, patients ability to care for their affairs, voluntary status of first admission and suicide attempts did not predict RD. The predictors of RD were almost the same as predictors of more than one admission. We were not able to identify a variable that clearly differen- tiated between the two or more, three or more and four or more admissions groups. Variability between hospi- tals is also presented. J. Rabinowitz ( ~ ) . M. Slyuzberg School of Social Work, Bar Ilan University, Ramat-Gan, Israel M. Mark - M. Popper Mental Health Services, Ministry of Health, R O. Box 1176, Jerusalem, Israel H. Munitz Gehah Psychiatric Hospital, Petah Tigra, Israel Introduction The "revolving-door" (RD) patient is one of the most problematic patients to treat and most expensive for the mental health care system. In some places they com- prise half of all psychiatric admissions (Joyce et al. 1981). However, there is still no consensus even in the definition of who is an RD patient. There is also no clear demarcation between chronic and RD patients. Some prefer not to define RD and to use an intuitive conception (Joyce et al. 1981). Others suggest a more precise definition. Rose et al. (1977), for example, de- fine RD as a "pattern of short hospitalizations and dis- charge followed by repeated admission". "Short" and "repeated" leave this definitign wanting. Woogh (1986) suggests that RD is four or more admissions. Others combine the number of admissions with other factors. For example, Lerner et at. (1989) use the term chronic and define it as patients who spend at: least a quarter of their follow-up time in hospital and accumulate their long-stay status during several hospitalizations. Using that definition they found that 29 % of their population was chronic. Kastrup (Kastrup 1987a, b, c) defines RD as four or more admissions during two and a half years after the date of first admissions or four or more admis- sions for any period and neither admission nor dis- charge period lasting for more than two and a half years. The common denominator of these definitions is four or more admissions. We attempted to identify predictors of RD from vari- ables available at the first admission. Research in this area has not reached conclusive results and much re- mains to be learned about the antecedents of RD. The literature offers some correlates of RD. In a review of studies (Rosenblatt and Mayer 1974), the only variable that consistently predicted readmission was the num- ber of previous admissions; diagnosis, demographic fac- tors and outpatient treatment are not consistent predic- tors of RD. Since then studies have found some addi- tional correlates. The more severe the diagnosis, specifi- cally psychotic ones, the more likely the patient is to be