Impact of community mental health center follow-up on psychiatric hospitalization burden in schizophrenia spectrum disorders: a retrospective mirror-image study

BACKGROUND: Community-based psychiatric rehabilitation services are increasingly used to reduce recurrent hospitalization and improve continuity of care among individuals with schizophrenia spectrum disorders. However, long-term real-world longitudinal data evaluating hospitalization outcomes following community mental health center follow-up remain limited. This study aimed to evaluate the impact of community mental health center (Toplum Ruh Sağlığı Merkezi [CMHC]) follow-up on psychiatric hospitalization burden among individuals with schizophrenia spectrum disorders using a retrospective mirror-image design. METHODS: This retrospective longitudinal mirror-image study included 652 individuals with schizophrenia spectrum disorders followed at a community mental health center in Türkiye between 2015 and 2025. Annualized psychiatric hospitalization rates before and after CMHC enrollment were calculated for each participant. Hospitalization reduction scores were defined as the difference between pre-CMHC and post-CMHC annual hospitalization rates. Sociodemographic and clinical variables associated with hospitalization reduction were evaluated using nonparametric analyses, correlation analyses, and multivariable linear regression models. RESULTS: Psychiatric hospitalization burden significantly decreased following CMHC enrollment. Mean annual hospitalization rates declined from 0.179 ± 0.204 admissions/year before CMHC follow-up to 0.061 ± 0.159 admissions/year after enrollment (p < 0.001). The mean hospitalization reduction score was 0.118 ± 0.218, corresponding to a large effect size. In multivariable regression analyses, higher pre-CMHC annual hospitalization rates independently predicted higher post-CMHC hospitalization rates (β = 0.315, p < 0.001), whereas longer CMHC follow-up duration was independently associated with lower post-CMHC hospitalization rates (β = -0.119, p = 0.004). Hospitalization reduction scores were positively correlated with both CMHC follow-up duration (r = 0.308, p < 0.001) and total number of psychiatric hospitalizations (r = 0.386, p < 0.001). Most sociodemographic and clinical variables were not significantly associated with differential hospitalization reduction outcomes. CONCLUSIONS: Long-term follow-up within a community mental health center was associated with significant reductions in psychiatric hospitalization burden among individuals with schizophrenia spectrum disorders. Sustained rehabilitation follow-up and continuity of care may contribute to improved long-term clinical stabilization and reduced inpatient psychiatric service utilization. These findings suggest that sustained CMHC follow-up may be associated with reduced psychiatric hospitalization burden in routine clinical practice. CLINICAL TRIAL REGISTRATION: Non applicable.