Relationship Between Time of Admission, Help-Seeking Behavior, and Psychiatric Outcomes: “From Dusk Till Dawn”

Abstract

IntroductionDay and time of admission influence treatment outcomes and prognosis in several medical specialties; this seems related to resources' ability. It is largely unknown whether this also applies to mental health services. We investigate the relationship between time of admission, patients' demographic and clinical profile, and treatment outcomes.MethodsDemographic and clinical profiles of admitted and discharged patients to a general psychiatric ward between January 1st, 2013 and December 31st, 2020, were analyzed. In addition, we used the last year (i.e., 2020) to monitor rehospitalization. Time of admission was defined as weekdays (working day, weekend) and dayshifts (daytime, dusk, and dawn).ResultsDuring the study period, 12,449 patient admissions occurred. The mean age of the sample was 48.05 ± 20.90 years, with 49.32% (n = 6,140) females. Most admissions (n = 10,542, 84%) occurred on working days. Two-fifths of admissions (39.7%, n = 4,950) were compulsory, with a higher rate outside daytime hours. Patients had slight differences in the clinical profile, resulting from evaluating the different items of the Health of Nation Outcome Scale (HoNOS). Patients admitted on night shifts, weekends, and holidays showed a shorter length of stay; patients compulsorily admitted during daytime (disregarding the day of the week) had a longer length of stay. All patient groups achieved a robust clinical improvement (i.e., an HoNOS score reduction of around 50%), with similar readmission rates.DiscussionThe main finding of our study is the relationship between “daytime hours” and fewer compulsory admissions, a result of the interplay between demographics, clinical characteristics, and out-of-clinic service availability (such as ambulatory psychiatric- psychological praxis; day-clinic; home-treatment). The differing clinical profile, in turn, determines differences in treatment selection, with patients admitted after office hours experiencing a higher rate of coercive measures. The shorter length of stay for out-of-office admissions might result from the hospitalization as an intervention. These results should encourage the implementation of outpatient crisis-intervention services, available from dusk till dawn.

Evaluating the effectiveness of concurrent sessions and counselors’ attention allocation in online counseling.

“…Client profiles and behaviors could also vary throughout the day, which could lead to different outcomes. In a study of psychiatric patients, patients admitted on night shifts have more acute symptoms and are given a shorter length of stay and higher rates of coercive measures (Knorr et al, 2022). In order to account for the potential effects of visiting hours, we categorized the clients’ visiting hours into three 8-hr shifts: late night shift (1 a.m. to 8 a.m.), day shift (9 a.m. to 4 p.m.), and evening shift (5 p.m. to midnight).…”

Beyond Patient Characteristics: A Narrative Review of Contextual Factors Influencing Involuntary Admissions in Mental Health Care

“…A multi-center investigation of twenty acute psychiatric units in Norway found that IA happened more often during evenings and nights and by physicians who did not know the PMHC [45]. Two separate Swiss studies reported that involuntary admissions occurred more often at night time and during the weekends [46,47]. The link between "daytime hours" and fewer IAs was attributed to a combination of demographics, clinical features, and out-of-clinic service availability (such as ambulatory psychiatric-psychological praxis; day-clinic; and home treatment) [46].…”

“…Two separate Swiss studies reported that involuntary admissions occurred more often at night time and during the weekends [46,47]. The link between "daytime hours" and fewer IAs was attributed to a combination of demographics, clinical features, and out-of-clinic service availability (such as ambulatory psychiatric-psychological praxis; day-clinic; and home treatment) [46]. A German study likewise discovered that cases admitted unwillingly were admitted more frequently at night or on weekends [36].…”