Factors affecting hospital stay in psychiatric patients: the role of active comorbidity

Abstract

BackgroundResearch on length of stay (LOS) of psychiatric inpatients is an under-investigated issue. In this naturalistic study factors which affect LOS of two groups of patients were investigated, focusing on the impact on LOS of medical comorbidity severe enough to require referral.MethodsActive medical comorbidity was quantified using referral as the criterion. The study sample consisted of 200 inpatients with the diagnosis of schizophrenia and 228 inpatients suffering from bipolar disorder (type I or II). Jonckheere and Mann–Whitney tests were used to estimate the influence of referrals on LOS, and regression analyses isolated variables associated with LOS separately for each group.ResultsHalf of the patients needed one or more referrals for a non-psychiatric problem. The most common medical condition of patients with bipolar disorder was arterial hypertension. Inpatients with schizophrenia suffered mostly from an endocrine/metabolic disease - 12% of referrals were for Hashimoto’s thyroiditis. A positive linear trend was found between LOS and number of referrals; the effect was greater for schizophrenia patients. The effect of referrals on LOS was verified by regression in both groups. Overall, referred patients showed greater improvement in GAF compared to controls.ConclusionsTo our knowledge this was the first study to investigate physical comorbidity in psychiatric inpatients using the criterion of referral to medical subspecialties. Comorbidity severe enough to warrant referral is a significant determinant of hospital stay. This insight may prove useful in health care planning. The results show lack of effective community care in the case of schizophrenia and negative symptoms may be the cause of this. Our findings call for more attention to be paid to the general medical needs of inpatients with severe mental health and concurrent severe medical comorbidity.

Correlates of Length of Admission among Patients Discharged in a Mono-specialist Neuropsychiatric Hospital in Nigeria

“…However, we found that the diagnosis of bipolar affective disorder was associated with shorter duration of hospital stay. This finding is in contrast with previous studies [4,12,16]. While the explanation for this finding may not be known in the immediate, we theorized that time of onset of overt manic symptoms to presentation and admission in the hospital may be of shorter duration compared to Schizophrenia and Substance use disorders.…”

“…Nowadays, longer hospital stay may imply poor mental health care and support in the community. Reduction of length of admission has been associated with less expenditure and successful treatment in the community [4].…”

“…Prolonged admission poses greater financial and economic burden on careers, continuously isolates the patient from their social network and may initiate maladaptive behavioural patterns in patients [4]. Factors influencing length of admission for psychiatric patients include variables like clinical diagnoses, co-morbidities, treatment modalities and socio-demographic factors as age, level of social support and global functioning [3,[5][6][7].…”

Psychiatric inpatient care: where do we go from here?

“…The implications of Douzenis et al's (2012) study are interesting and highlight the importance of addressing physical health problems in people with severe mental illness. It is important to note that the study was based on an inpatient sample in Greece where the provision of comprehensive community-based mental health care may not have been available.…”

“…One study focused on the impact of medical comorbidity on length of stay (Douzenis et al 2012). Two of the hypotheses tested aimed to examine whether severe comorbidity requiring referral in patients with schizophrenia and bipolar disorder would affect length of stay and what factors were associated with it.…”