Length Of Psychiatric Hospitalization Research Articles

The impact of substance use disorders on the course of schizophrenia—A 15-year follow-up study: Dual diagnosis over 15 years

BackgroundThis follow-up study compared patients with schizophrenia with co-occurring substance use disorder to patients with schizophrenia and no substance use disorder. AimsTo investigate the prognostic significance of the effects of substance use disorders on the course of schizophrenia. MethodPatients with schizophrenia and co-occurring substance use disorder (n=107), and patients with schizophrenia only (n=119) were followed over a 15-year period through the use of national hospitalization registers, data for time and cause of death, and data for homelessness or institutionalization. ResultsThe median length of psychiatric hospitalization was 12days for a patient with dual diagnosis, and 21days for patients with schizophrenia only. Patients with dual diagnosis displayed a significantly elevated usage of all types of hospital contacts except inpatient treatment for non-psychiatric disorders. In three types of hospital contacts, patients with co-occurring substance use had approximately two to three times as many hospitalizations as did patients with schizophrenia only. Rates for homelessness and institutionalization were similar in both groups. Patients with a dual diagnosis were also significantly more at risk of dying during follow-up than were patients with schizophrenia only. ConclusionsThe findings suggest that the long-term course of schizophrenia is considerably more severe in patients who have a dual diagnosis compared to patients with schizophrenia only Substance use disorders have a substantial impact on the hospitalization rates of patients with schizophrenia, as well as on life expectancy. Patients with co-morbid substance abuse are more likely to be admitted for treatment during a given year although they have briefer contact with treatment.

The Impact of Managed Care on Psychiatric Hospitalizations and Length of Stay in Puerto Rico

The objective of this paper is to estimate the impact of managed care on psychiatric hospitalizations and length of stay of medically indigent residents in Puerto Rico. A quasi-experimental design and three waves of data from a random community sample were used. Results indicate that, after 2 years, managed care had minimal impact on the number of psychiatric hospitalizations; while the mean length of hospitalization decreased after implementation of managed care, this change was not significant. Based on the data in this study, the managed care initiative developed as part of health reform in Puerto Rico did not appear to affect rates of psychiatric hospitalization and produced only a nonsignificant reduction in the average length of psychiatric hospital stays. Additional research is needed to determine trends in mental health care provision in Puerto Rico based on more recent data.

Relation of Callous-Unemotional Traits to Length of Stay Among Youth Hospitalized at a State Psychiatric Inpatient Facility

We examined the association of callous-unemotional (C/U) traits with length of psychiatric hospitalization among two samples each with 50 participants: a group of 7-11 year-olds (39 males and 11 females) receiving services on a children's unit, and a group of 12-17 year-olds (27 males and 23 females) receiving services on an adolescent unit. Our analyses focused on the additionally predictive value of C/U traits above and beyond the influence of pre-established risk factors for length of stay, including age, gender, ethnicity, overall levels of functioning and psychopathology, and the diagnosis of a Conduct Disorder or Oppositional Defiant Disorder. In both samples, hierarchic regression analyses indicated that C/U traits were associated with longer lengths of stay, whereas none of the previously identified risk factors were significant. The discussion of these results focuses on the importance of developing non-coercive and non-confrontational therapeutic treatment regimens for youth with C/U traits receiving inpatient psychiatric services.

Changes in institutional psychiatric care and suicidal behaviour: a follow-up study of inpatient suicide attempters in Bærum, Norway

During the past decades, extensive reformatory changes in institutional psychiatric care have been implemented in Norway. The objective of the present study was to investigate whether these changes have resulted in shortened length of psychiatric hospital stays for suicide attempters. Further, to examine if length of hospital stay and time period in which the patients received treatment were related to the risk of a repeated suicide attempt and/or committing suicide. All cases of suicide attempters hospitalised between 1984 and 2006 in the municipality of Baerum, a suburb outside Oslo, were examined. The period of observation was further subdivided in two time intervals on the basis of the de-institutionalisation of psychiatric care, which started to plateau in 1996. Among 1,574 patients consecutively admitted to the local general hospital after a suicide attempt, 330 were admitted to inpatient psychiatric care. Patients admitted in the period 1996-2006 had significantly shorter hospital stays than patients in the preceding period 1984-1995 (Log Rank P < 0.001). Neither the time period of treatment variable nor the length of hospital stay variable was significantly associated with the risk of a repeated suicide attempt or suicide. Psychiatric de-institutionalisation appears as not having affected suicide attempt repetition. It is possible that reduced length of hospital stay has been compensated by improved mental health care in general and extended outpatient services in particular.

Substance Use Disorders as Risk Factors for Psychiatric Hospitalization in Bipolar Disorder

This study developed risk profiles of psychiatric hospitalization for veterans diagnosed as having bipolar disorder. This study included 2,963 veterans diagnosed as having bipolar disorder (types I, II, or not otherwise specified) during the 2004 fiscal year. Data were derived from the Veterans Affairs administrative database. Risk profiles for psychiatric hospitalization were generated with an iterative application of the receiver operating characteristic. In this sample 20% of the patients with bipolar disorder were hospitalized psychiatrically during the one-year study period. Patients diagnosed as having both an alcohol use disorder and polysubstance dependence and who also were separated from their spouse or partner had a 100% risk of psychiatric hospitalization; risk of psychiatric hospitalization decreased to 52% if the patients were not separated from their partner. Patients who were not diagnosed as having alcohol use disorders or polysubstance dependence and who were not separated from their partners exhibited the lowest risk of psychiatric hospitalization (12%). Among patients with a psychiatric hospitalization, 41% had longer lengths of stay (<14 days), with the strongest predictor of a longer length of stay being an age older than 77 years, which conferred a 77% risk. Alcohol use and polysubstance dependence can significantly affect the course of bipolar disorder, as evidenced by their associations with psychiatric hospitalizations. Increased focus on substance abuse among older adults with bipolar disorder may decrease length of psychiatric hospitalization. Our findings suggest that implementing substance treatment programs early in the course of bipolar disorder could reduce health service use.

Substance Use Disorders as Risk Factors for Psychiatric Hospitalization in Bipolar Disorder

This study developed risk profiles of psychiatric hospitalization for veterans diagnosed as having bipolar disorder.This study included 2,963 veterans diagnosed as having bipolar disorder (types I, II, or not otherwise specified) during the 2004 fiscal year. Data were derived from the Veterans Affairs administrative database. Risk profiles for psychiatric hospitalization were generated with an iterative application of the receiver operating characteristic.In this sample 20% of the patients with bipolar disorder were hospitalized psychiatrically during the one-year study period. Patients diagnosed as having both an alcohol use disorder and polysubstance dependence and who also were separated from their spouse or partner had a 100% risk of psychiatric hospitalization; risk of psychiatric hospitalization decreased to 52% if the patients were not separated from their partner. Patients who were not diagnosed as having alcohol use disorders or polysubstance dependence and who were not separated from their partners exhibited the lowest risk of psychiatric hospitalization (12%). Among patients with a psychiatric hospitalization, 41% had longer lengths of stay (<14 days), with the strongest predictor of a longer length of stay being an age older than 77 years, which conferred a 77% risk.Alcohol use and polysubstance dependence can significantly affect the course of bipolar disorder, as evidenced by their associations with psychiatric hospitalizations. Increased focus on substance abuse among older adults with bipolar disorder may decrease length of psychiatric hospitalization. Our findings suggest that implementing substance treatment programs early in the course of bipolar disorder could reduce health service use.

Reductions in Postdischarge Suicide After Deinstitutionalization and Decentralization: A Nationwide Register Study in Finland

Reductions in Postdischarge Suicide After Deinstitutionalization and Decentralization: A Nationwide Register Study in Finland

The Hospital as Predictor of Children's and Adolescents' Length of Stay

To predict psychiatric hospital length of stay (LOS) for a sample of Illinois Department of Children and Family Services wards across 4 fiscal years. A prospective design was implemented using the Children's Severity of Psychiatric Illness scale, a reliable and valid measure of psychiatric severity, risk factors, youth strengths, and contextual/environmental factors. Data were collected for 1,930 hospital episodes across 44 hospitals from fiscal year 1998 through fiscal year 2001. Youths were screened for admission appropriateness by the Illinois Screening, Assessment, and Supportive Services (SASS) program. The Children's Severity of Psychiatric Illness was completed by SASS workers upon conclusion of their crisis interviews. In addition to completing the Children's Severity of Psychiatric Illness, SASS workers reported on demographic information and LOS. The sample of 1,930 youths was randomly split to form development (n = 983) and validation (n = 947) samples. LOS was predicted using ordinary least squares regression. Thirty percent of the variance (F(19,666) = 16.6, p < .0001) in LOS was predicted for the development sample and 22% (F(14,657) = 14.6, p < .0001) was predicted for the confirmation sample. Hospital was the largest and most consistent predictor of LOS for both samples after controlling for clinical variables. Two hospitals accounted for approximately 10% of the variance in both samples (development beta = .273, p < .01 and beta = -.169, p < .01). Two SASS agencies also consistently predicted LOS (development beta = -.134, p < .05 and beta = .102, p < .05). No consistent changes in predictors of LOS occurred over time (FY98-FY01). These findings suggest that nonclinical variables are the primary predictors of LOS in the Illinois system of care. In addition, these variables are consistent predictors over time. Quality assurance efforts might seek to further understand potential practice pattern variations across hospitals and SASS agencies.

Hand preference and length of psychiatric hospital stay by month of admission.

Length of psychiatric hospital stay is higher for patients admitted in the months of April and May. This effect was strongly associated with handedness and was greatest for left-handers. The duration of hospitalization of left-handed subjects admitted in April and May was, on average, 88.5% longer than for left-handed subjects admitted during any other period. In contrast, length of stay for right-handed patients differed by no more than 16% between any months compared.

HAND PREFERENCE AND LENGTH OF PSYCHIATRIC HOSPITAL STAY BY MONTH OF ADMISSION

Length of psychiatric hospital stay is higher for patients admitted in the months of April and May. This effect was strongly associated with handedness and was greatest for left-handers. The duration of hospitalization of left-handed subjects admitted in April and May was, on average, 88.5% longer than for left-handed subjects admitted during any other period. In contrast, length of stay for right-handed patients differed by no more than 16% between any months compared.

Does physical illness influence length of psychiatric hospitalization?

Does physical illness influence length of psychiatric hospitalization?

Factors related to length of psychiatric hospital stay of children and adolescents: A nationwide register study

Hospital discharge register information was collected on length of stay (LOS) of all those children and adolescents less than 18 years old in psychiatric inpatient treatment in 1990 (n=818) and 1993 (n=958) in Finland. The predictors for LOS > 60 days included previous psychiatric inpatient treatment, involuntary treatment, and treatment in adolescent psychiatric unit. No psychiatric diagnosis was associated with shorter LOS. Girls and the under-school-age group had significantly shorter LOS. There were only rather minor differences in LOS between different diagnostic groups.

Predictors of Length of Stay Among Youths Hospitalized in State Hospitals in Illinois

Using data from the Integrated Database on Children and Family Services in Illinois, we examined factors associated with the length of psychiatric hospitalization of youths in state hospitals between July 1, 1987 and June 30, 1992. Univariate analysis indicated that those diagnosed with attention deficit, psychotic, and conduct disorder experienced longer hospitalizations. In contrast, youths diagnosed with depressive disorders, drug and alcohol disorders, and adjustment disorders had shorter hospitalizations. Youths receiving services from multiple sectors of the human service delivery system experienced longer hospitalizations. Youths living in communities with state hospital linked community-based mental health services had shorter hospitalizations. Males experienced longer hospitalizations than females and African American youths experienced longer hospitalizations than White youths. Hispanic youths experienced shorter stays than either White or African American youths. The proportional hazards model indicated that being female, a history of previous admissions, multiservice use, and dangerousness were all associated with the decreased likelihood of discharge. Psychotic, attention deficit, and bipolar disorders were also associated with a decreased likelihood of hospital discharge. Youths with depressive disorders and African Americans with psychotic disorders had an increased likelihood of discharge. Increased age was also associated with the increased likelihood of discharge.

A review of inpatient group therapy for borderline personality disorder.

Because the average length of psychiatric hospitalization is decreasing, effective short-term treatments for patients with borderline personality disorder (BPD) are in greater demand. Of particular interest are group therapies, which have traditionally been a treatment of choice on inpatient units. We review empirical research and clinical descriptions of group psychotherapy for inpatients with personality disorders, especially BPD. Based on the existing literature on inpatient groups, supplemented by the most recent literature on outpatient groups for patients with BPD, we propose a framework within which an effective short-term group treatment may be developed for inpatients with this disorder. In particular, we discuss the advantages and disadvantages of adapting Linehan's Dialectical Behavior Therapy for short-term inpatient use.

The impact of preadmission approval and continued stay review on hospital stay and outcome among children and adolescents.

Managed care has emerged as the centerpiece of the health care industry's efforts to control costs and ensure appropriate use of hospital services. This study assesses the impact of managed care by preadmission approval and/or continued stay review on length of psychiatric hospitalization and clinical outcome of children and adolescents. The sample included 277 cases hospitalized in nine psychiatric specialty hospitals in 1990. Demographic and clinical characteristics, hospital ownership type, and preadmission approval or continued stay review were used as independent variables in a multiple regression model to predict length of stay and clinical outcome. Results indicate that the model accounted for 27% of the variance in length of stay. Previous psychiatric hospitalization and for-profit hospital status predicted longer hospitalization. Clinical outcome was not significantly predicted by the model. Managed care did not predict either length of stay or clinical outcome. Implications for health care reform are discussed.

A community ability scale for chronically mentally ill consumers: Part I. Reliability and validity.

The authors describe the development, reliability testing, and validation of a 17-item instrument that measures the level of functioning of chronically mentally ill persons living in the community. The Multnomah Community Ability Scale is designed to be completed by case managers. The instrument provides a measure of the consumer's severity of disability which can, in turn, be used to: (a) describe an agency's "case mix" of clients; (b) measure consumer progress; (c) assign clients to different levels of service; and (d) assist payors in determining reimbursement. The Multnomah Community Ability Scale is aimed specifically at persons with chronic mental illness, is sensitive to differences among individuals within this special population, and is quick and easy to complete. The scale's reliability and validity have been examined in detail. Inter-rater and test-retest reliability are good. Criterion variables such as length of psychiatric hospitalization and clinicians' global ratings correlated highly with scale scores. Finally, the instrument predicts subsequent state and local hospital admissions.

Private Psychiatric Hospitalization of Children: Predictors of Length of Stay

To quantitatively identify predictors and determinants of length of psychiatric hospital stay for children. Forty-seven demographic, psychosocial stressor, psychopathology, and disposition variables were statistically reviewed as correlates of length of stay in 100 consecutive discharges from a child psychiatry inpatient service (age range 4-12) in a private hospital. Those with strong statistical significance were then analyzed by multiple regression. Greater severity of psychopathology (measured by the Children's Global Assessment Scale), greater severity of psychosocial stressors (by Axis IV scale), diagnosis of post-traumatic stress disorder, special educational and out-of-home dispositions, and severe tantrums in hospital all strongly predicted longer hospital stay. Diagnosis of adjustment disorder predicted shorter stay. Together these variables explained 57% of the total variance in length of stay. The most powerful of these predictor variables could potentially be measured at the time of admission, thus permitting accurate prediction of length of stay. A set of models was generated for this purpose.

The Rorschach test for predicting suicide among depressed adolescent inpatients.

With the decreasing length of psychiatric hospitalizations, identification of test indicators of suicide risk becomes critically important. This Rorschach study was designed to model a clinical decision-making scenario concerning adolescent suicide risk. Using Psychiatric Evaluation Form (PEF) scores, we selected a sample of 25 severely depressed and suicidal adolescents; 26 severely depressed, not suicidal adolescents; and 28 not suicidal, not depressed adolescent inpatients at The Sheppard and Enoch Pratt Hospital. A Rorschach Index using the Exner (1986) Comprehensive System for scoring was developed to predict group membership. Four of six of the features on this index selected 64% of suicidal subjects. This constellation included traditional affective variables (vista responses, color-shading blends, color dominated responses, and morbid content) as well as measures of cognitive distortion (inaccurately perceived human movement responses [M-] and special scores). We discuss the implications of these findings for the diagnosis and treatment of the suicidal adolescent.

Conservatorship for gravely disabled psychiatric patients: a four-year follow-up study

The authors examined the conservatorship process in California by studying a group of psychiatric patients for whom conservatorship was sought; their goal was to determine its effectiveness both during and after the period of conservatorship. The subjects were 60 county psychiatric hospital inpatients 18-60 years old for whom temporary (30-day) conservatorships were obtained and who were followed for 4 years. The patients' courses over the 4 years were assessed in terms of whether 1-year conservatorships were obtained, stability (number and length of psychiatric hospitalizations, arrests, serious physical violence, and homelessness), and presence or absence of family support. The patients proved to be a severely mentally ill and disabled group. Thirty-five (58%) were granted a 1-year conservatorship sometime during the 4-year study period, and 25 (42%) were not. Both family support and conservatorship appeared to be related to the patients' stability. When one or both were present, there was a significantly greater likelihood of stability. The authors believe that for a considerable number of chronically and severely mentally ill individuals, conservatorship would play an important role in their clinical management and treatment by helping to eliminate their chaotic life styles, their cycle of admission and discharge from hospitals and jails, and/or their living on the streets, particularly when family support is absent.

Variables associated with length of psychiatric hospitalization of children during the 1980s.

Variables associated with length of psychiatric hospitalization of children during the 1980s.