{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T09:10:00Z","timestamp":1790327400672,"version":"4.1.0"},"reference-count":38,"publisher":"MDPI AG","issue":"19","license":[{"start":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T00:00:00Z","timestamp":1790294400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>Background\/Objectives: Psychiatric readmissions are an important indicator for assessing disease progression and the effectiveness of healthcare services. The aim of this study was to explore factors associated with one-year readmission and to evaluate the performance of machine learning models using clinical information extracted from discharge summaries of patients receiving inpatient treatment in a psychiatric ward. Methods: This retrospective study included 622 patients hospitalized in the psychiatry department of a university hospital between 2020 and 2024. Clinical variables were extracted from discharge summaries using a theme-based structured coding approach. Factors associated with 1-year readmission were evaluated using univariate and multivariable logistic regression analyses, while length of hospital stay was analyzed using log-transformed linear regression. The predictive performance of logistic regression, Random Forest, HistGradientBoosting, and BERTurk-based machine learning models was also compared. Results: The 1-year psychiatric readmission rate was 17.0%. In univariate analyses, previous psychiatric hospitalization, longer index length of stay, and manic symptoms were associated with readmission. In multivariable analysis, only previous psychiatric hospitalization remained an independent predictor of readmission (adjusted OR = 2.14, 95% CI: 1.34\u20133.42; p = 0.001). Previous psychiatric hospitalization, unemployment, and depressive symptoms were independently associated with longer hospital stay. Among the machine learning models, logistic regression using structured clinical variables and theme-based features achieved the best performance (AUC = 0.602). Conclusions: Previous psychiatric hospitalization was the strongest independent factor associated with 1-year psychiatric readmission. These findings suggest that routinely collected clinical records may contain potentially useful information for understanding psychiatric readmission risk and support further investigation in larger, multicenter studies.<\/jats:p>","DOI":"10.3390\/jcm15197457","type":"journal-article","created":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T08:09:02Z","timestamp":1790323742000},"page":"7457","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Predicting One-Year Psychiatric Rehospitalization Using Natural Language Processing and Machine Learning Methods Based on Clinical Texts"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5081-5983","authenticated-orcid":false,"given":"Sare","family":"Ayd\u0131n","sequence":"first","affiliation":[{"name":"Department of Psychiatry, School of Medicine, Tokat Gaziosmanpa\u015fa University, 60250 Tokat, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"validation","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"project-administration","vocabulary":"credit"}]},{"given":"Sena","family":"Karaca","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Tokat State Hospital, 60100 Tokat, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"validation","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"}]},{"given":"Esma","family":"Akp\u0131nar Aslan","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, School of Medicine, Tokat Gaziosmanpa\u015fa University, 60250 Tokat, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"investigation","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"resources","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4777-4524","authenticated-orcid":false,"given":"\u0130lker","family":"G\u00fcneysu","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, School of Medicine, Tokat Gaziosmanpa\u015fa University, 60250 Tokat, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"investigation","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"resources","vocabulary":"credit"}]},{"given":"Figen","family":"\u00dcnal Demir","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, School of Medicine, Tokat Gaziosmanpa\u015fa University, 60250 Tokat, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5198-8827","authenticated-orcid":false,"given":"Filiz","family":"\u00d6zsoy","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, School of Medicine, Tokat Gaziosmanpa\u015fa University, 60250 Tokat, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Burcu","family":"Eser","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, School of Medicine, Tokat Gaziosmanpa\u015fa University, 60250 Tokat, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,25]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1111\/inm.13042","article-title":"Risk factors associated with 30-day unplanned hospital readmission for patients with mental illness","volume":"32","author":"Zhou","year":"2023","journal-title":"Int. J. Ment. Health Nurs."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"240","DOI":"10.1007\/s10488-026-01492-z","article-title":"Sex Difference in Risk and Protective Factors of State Psychiatric Hospital Readmissions among Non-forensic Psychiatric Patients in the United States in 2020\u20132023: Discrete-Time Hazard Models Applied to the National Mental Health Client-Level Data","volume":"53","author":"Ishida","year":"2026","journal-title":"Adm. Policy Ment. Health Ment. Health Serv. Res."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Rachmawaty, R., Hariyati, R.T.S., Niswar, M., Wahyudin, E., Bukhari, A., Mardatillah, R., and Kim, H. (2026). Quality of mental health care among insured patients in an Indonesian psychiatric hospital. BMC Health Serv. Res., 26.","DOI":"10.1186\/s12913-026-14805-7"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1007\/s11414-007-9055-5","article-title":"Is readmission a valid indicator of the quality of inpatient psychiatric care?","volume":"34","author":"Durbin","year":"2007","journal-title":"J. Behav. Health Serv. Res."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1192\/bjp.bp.112.115030","article-title":"Transitional interventions to reduce early psychiatric readmissions in adults: Systematic review","volume":"202","author":"Vigod","year":"2013","journal-title":"Br. J. Psychiatry"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"e2814","DOI":"10.1590\/1982-4327e2814","article-title":"Factors associated with psychiatric readmissions: A systematic review","volume":"28","author":"Zanardo","year":"2018","journal-title":"Paid\u00e9ia"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1176\/appi.ps.201900234","article-title":"Psychiatric readmission of children and adolescents: A systematic review and meta-analysis","volume":"71","author":"Edgcomb","year":"2020","journal-title":"Psychiatr. Serv."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Donisi, V., Tedeschi, F., Wahlbeck, K., Haaramo, P., and Amaddeo, F. (2016). Pre-discharge factors predicting readmissions of psychiatric patients: A systematic review of the literature. BMC Psychiatry, 16.","DOI":"10.1186\/s12888-016-1114-0"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"137","DOI":"10.2147\/PRBM.S35061","article-title":"Discharged from a mental health admission ward: Is it safe to go home? A review on the negative outcomes of psychiatric hospitalization","volume":"7","author":"Loch","year":"2014","journal-title":"Psychol. Res. Behav. Manag."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1177\/0300060520977382","article-title":"Sociodemographic and clinical characteristics of patients with recurrent psychiatric readmissions in Qatar","volume":"48","author":"Elhassan","year":"2020","journal-title":"J. Int. Med. Res."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1039","DOI":"10.1016\/S2215-0366(19)30406-7","article-title":"Clinical and social factors associated with increased risk for involuntary psychiatric hospitalisation: A systematic review, meta-analysis, and narrative synthesis","volume":"6","author":"Walker","year":"2019","journal-title":"Lancet Psychiatry"},{"key":"ref_12","first-page":"e42490","article-title":"Independent predictors of 30-day readmission to acute psychiatric wards in patients with mental disorders: A systematic review and meta-analysis","volume":"15","author":"Muhammad","year":"2023","journal-title":"Cureus"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1007\/s10488-010-0310-3","article-title":"Length of stay of general psychiatric inpatients in the United States: Systematic review","volume":"38","author":"Tulloch","year":"2011","journal-title":"Adm. Policy Ment. Health Ment. Health Serv. Res."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1590\/1516-4446-2016-2155","article-title":"Predictors of length of stay in an acute psychiatric inpatient facility in a general hospital: A prospective study","volume":"40","author":"Baeza","year":"2018","journal-title":"Rev. Bras. Psiquiatr."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1016\/j.eurpsy.2017.11.001","article-title":"Predictors of length of stay in psychiatric inpatient units: Does their effect vary across countries?","volume":"48","author":"Dimitri","year":"2018","journal-title":"Eur. Psychiatry"},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Elbattah, M., Arnaud, \u00c9., Gignon, M., and Dequen, G. (2021, January 11\u201313). The Role of Text Analytics in Healthcare: A Review of Recent Developments and Applications. Proceedings of the 14th International Joint Conference on Biomedical Engineering Systems and Technologies, Online.","DOI":"10.5220\/0010414508250832"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"e23898","DOI":"10.2196\/23898","article-title":"Health natural language processing: Methodology development and applications","volume":"9","author":"Hao","year":"2021","journal-title":"JMIR Med. Inform."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1038\/s41398-020-01104-w","article-title":"Hard for humans, hard for machines: Predicting readmission after psychiatric hospitalization using narrative notes","volume":"11","author":"Boag","year":"2021","journal-title":"Transl. Psychiatry"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"e71630","DOI":"10.2196\/71630","article-title":"Cross-site predictions of readmission after psychiatric hospitalization with mood or psychotic disorders: Retrospective study","volume":"12","author":"Ren","year":"2025","journal-title":"JMIR Ment. Health"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1426","DOI":"10.1017\/S0033291719000151","article-title":"Machine learning in mental health: A scoping review of methods and applications","volume":"49","author":"Shatte","year":"2019","journal-title":"Psychol. Med."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1186\/1751-0473-3-17","article-title":"Purposeful selection of variables in logistic regression","volume":"3","author":"Bursac","year":"2008","journal-title":"Source Code Biol. Med."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Han, X., Jiang, F., Tang, Y., Needleman, J., Guo, M., Chen, Y., Zhou, H., and Liu, Y. (2020). Factors associated with 30-day and 1-year readmission among psychiatric inpatients in Beijing China: A retrospective, medical record-based analysis. BMC Psychiatry, 20.","DOI":"10.1186\/s12888-020-02515-1"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1028","DOI":"10.1016\/j.healthpol.2019.07.006","article-title":"Using national electronic health care registries for comparing the risk of psychiatric re-hospitalisation in six European countries: Opportunities and limitations","volume":"123","author":"Katschnig","year":"2019","journal-title":"Health Policy"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"282","DOI":"10.1071\/AH08721","article-title":"Readmission to an acute psychiatric unit within 28 days of discharge: Identifying those at risk","volume":"34","author":"Callaly","year":"2010","journal-title":"Aust. Health Rev."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1053\/apnu.2002.30494","article-title":"Understanding those who seek frequent psychiatric hospitalizations","volume":"16","author":"Montgomery","year":"2002","journal-title":"Arch. Psychiatr. Nurs."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"994","DOI":"10.1176\/appi.ps.54.7.994","article-title":"Rates and predictors of rehospitalization among formerly hospitalized adolescents","volume":"54","author":"Arnold","year":"2003","journal-title":"Psychiatr. Serv."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1037\/a0012557","article-title":"The influence of clinical, treatment, and healthcare system characteristics on psychiatric readmission of adolescents","volume":"78","author":"Fontanella","year":"2008","journal-title":"Am. J. Orthopsychiatr."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"685625","DOI":"10.1155\/2013\/685625","article-title":"Factors associated with readmission of patients at a university hospital psychiatric ward in Iran","volume":"2013","author":"Barekatain","year":"2013","journal-title":"Psychiatry J."},{"key":"ref_29","first-page":"57","article-title":"Rehospitalizations among psychiatric patients whose first admission was involuntary: A 10-year follow-up","volume":"43","author":"Rosca","year":"2006","journal-title":"Isr. J. Psychiatry Relat. Sci."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1489","DOI":"10.1176\/ps.2007.58.11.1489","article-title":"Factors associated with a six-month return to emergency services among child and adolescent psychiatric patients","volume":"58","author":"Goldstein","year":"2007","journal-title":"Psychiatr. Serv."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1097\/QMH.0000000000000077","article-title":"Risk Factors for Readmission on an Adult Inpatient Psychiatric Unit","volume":"25","author":"Rylander","year":"2016","journal-title":"Qual. Manag. Health Care"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"982","DOI":"10.1111\/sltb.13103","article-title":"Examining the predictive utility of suicidal ideation characteristics in relation to real-time monitoring of suicidal ideation and suicide attempts at follow-up","volume":"54","author":"Rogers","year":"2024","journal-title":"Suicide Life-Threat. Behav."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1425","DOI":"10.1007\/s00127-020-01881-1","article-title":"Use of psychiatric hospitals and social integration of patients with psychiatric disorders: A prospective cohort study in five European countries","volume":"55","author":"Smith","year":"2020","journal-title":"Soc. Psychiatry Psychiatr. Epidemiol."},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Gokhale, S., Taylor, D., Gill, J., Hu, Y., Zeps, N., Lequertier, V., Prado, L., Teede, H., and Enticott, J. (2023). Hospital length of stay prediction tools for all hospital admissions and general medicine populations: Systematic review and meta-analysis. Front. Med., 10.","DOI":"10.3389\/fmed.2023.1192969"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1979","DOI":"10.1177\/00207640231183916","article-title":"Predictors of long-stay in a tertiary care psychiatry hospital in India","volume":"69","author":"Vranda","year":"2023","journal-title":"Int. J. Soc. Psychiatry"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"681","DOI":"10.1016\/j.comppsych.2013.11.004","article-title":"Factors associated with length of psychiatric hospitalization","volume":"55","author":"Masters","year":"2014","journal-title":"Compr. Psychiatry"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1007\/s11126-017-9498-7","article-title":"Factors Associated with Length of Stay in Psychiatric Inpatient Services in London, UK","volume":"89","author":"Newman","year":"2017","journal-title":"Psychiatr. Q."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"603","DOI":"10.1007\/s00127-009-0091-8","article-title":"Outcome and length of stay in psychiatric hospitalization, the experience of the University Clinic of Turin","volume":"45","author":"Rocca","year":"2009","journal-title":"Soc. Psychiatry Psychiatr. Epidemiol."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/19\/7457\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T08:33:52Z","timestamp":1790325232000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/19\/7457"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,25]]},"references-count":38,"journal-issue":{"issue":"19","published-online":{"date-parts":[[2026,10]]}},"alternative-id":["jcm15197457"],"URL":"https:\/\/doi.org\/10.3390\/jcm15197457","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,25]]}}}