December 01, 2004

Transition from Hospital a Stressful Time

Although returning home from a hospitalization is clearly a stressful experience, very little research exists about what specific stressors might be prevalent during this period, and how they might be avoided. Given the strong link between stress and exacerbation of schizophrenia symptoms, being aware of these transitional stressors could be an important way to reduce future episodes, further hospitalizations, and possible suicide attempts.

A letter to the editor of Psychiatric Services (Dec 2004) suggests that although major life stressors have been a focus in the onset of schizophrenia symptoms, chronic everyday stress may be a better indicator.

The letter then cites a specific study, evaluating the stressors identified by 110 schizophrenia patients within a week of a hospital discharge. Respondants indicated that the most prevalent stressor was psychotic symptoms (identified by 31% of patients). Re-adjusting to residential settings (28%), finding/maintaining employment (33%), various interpersonal stressors such as social activities, relationships with family/friends, and loneliness (43% overall), and health-related concerns (i.e. the possibility of future hospitalization, 31%) were also mentioned as significant stressors.

The researchers conclude their study with the hope that identifying these key stressors shortly following hospital discharge will lead to specific stress management and coping techniques becoming integrated into the discharge treatment and follow-up plan.

Family members who are aware of these potential stresses can also help to create a low-stress living environment for a loved one returning home after a hospital stay. See the following resources for helping to manage life stress:

1) Overcoming stress in the workplace. (
2) Lower levels of family stress to reduce risk of schizophrenia (or relapse): (
3) Research on how family stress environment can negatively impact schizophrenia symptoms: (Pubmed abstract: "Family Intervention for Schizophrenia")

Research shows that one of the most risky periods for suicide attempts are in the months after someone has begun medication treatment and is "thinking more clearly." Since many people recieve medication treatment for the first time following a hospitalization, family members and caregivers must be especially vigilant in identifying depression and suicidal tendencies immediately following discharge, and encourage the depressed member to find help. See the following pages for more information on how to manage depression and prevent suicide:

1) Preventing suicide in people with schizophrenia. (
2) Overcoming Depression. (

Original Article Source: "Identifying Life Stressors of Patients With Schizophrenia at Hospital Discharge." Psychiatric Services ("Letters" section), Dec 2004. Available at


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