Outcome Quality of Open General Psychiatric Inpatient Treatment at the MesoLevel - an Observational Study in an Urban German General Hospital

Abstract

Inpatient treatment (meso level) in psychiatric hospitals is commonly assumed to be effective. However, there is very little evidence-based data on this issue. First evaluation of the outcome quality of an inpatient general psychiatric treatment in a German general hospital using multifaceted quality indicators (symptom severity, wellbeing, self-efficacy, depressive avoidance, patients' satisfaction with the treatment) was carried out. Patients with a wide range of psychiatric diagnoses (ICD-10 F2-F6) were randomly assigned to this naturalistic single-group pre-post study. For ethical and methodological reasons, only adult inpatients treated in open general psychiatric wards were enrolled. The sample (n = 110, 58.2 % females) had a mean age of 47.2 (SD 15.9) years. 67 (60.9 %) and 29 (26.4 %) patients had at least one or two additional psychiatric diagnoses, respectively. 84 (76.4 %) and 62 (56.4 %) patients had a minimum of one or two additional somatic diagnoses, respectively. The treatment lasted 38 (SD 36; median 28.5) days. Significant positive treatment effects for all quality indicators were found at regular hospital discharge. The effect sizes varied between Cohen's d = 0.17 - 0.62 ("intention-to-treat" population, n = 110) and d = 0.28 - 0.99 ("completer" population, n = 70). This study provides direct evidence for the effectiveness of an open inpatient general psychiatric hospital treatment at the meso level. The results, however, are not representative for all German general psychiatric wards because of major differences between hospitals in personnel resources and framework conditions.