Natural history after discharge from a hospital psychosomatic treatment - Results of a one-year follow-up

Abstract

The effectiveness of the inpatient psychosomatic treatment has been documented in various settings. The question of the sustainability of the improvement achieved as well as the prognostic factors is of interest for public health.Primary outcome variables reflect the stability or change in the clinical status of patients one year after the discharge from the inpatient psychosomatic treatment. Secondary outcome variables reflect differences in utilization of medical services between the year before and after admission.One-year naturalistic follow-up of a sample consisting of patients treated in a psychosomatic hospital service by means of 9 clinical and 3 variables for measurement of utilization of medical services. Four measuring points were considered: agreeing at admission (N = 262), discharge (N = 249), 6 months (N = 148) and 12 months (N = 114) after discharge. Differences and associations were assessed by means of t tests and multivariate linear as well as logistic regressions.The subsample with adherence to the study is representative for the whole sample since hardly any differences to the drop-out group were found. A year after discharge, all clinical variables showed significant differences (p < 0.001) compared with clinical status at admission and no significant differences compared with status at discharge (p > 0.05). Three quarters of sample reported a subjective improvement one year after discharge, contrary to results of clinical scales. Medical aftercare was ensured principally by psychotherapists (78 %), followed by general practitioners (63 %), and psychiatrists (44 %). Relevant associations were found between psychotherapy appointments and clinical variables in follow-up.The clinical improvement attained through the psychosomatic hospitalization remain on average stable a year after discharge. Subjective global assessment of health status shows an improvement for the majority of the sample, contrary to results of clinical scales; that is the reason why both assessment approaches have to be considered. Psychotherapy in aftercare could play a prominent role for health preservation.