Giorgia Dimitri1, Domenico Giacco2, Michael Bauer3, Victoria Jane Bird4, Lauren Greenberg5, Antonio Lasalvia6, Vincent Lorant7, Jacek Moskalewicz8, Pablo Nicaise7, Andrea Pfennig3, Mirella Ruggeri1, Marta Welbel8, Stefan Priebe4. 1. Section of Psychiatry, Department of Public Health and Community Medicine, University of Verona, Verona, Italy. 2. Unit for Social and Community Psychiatry (World Health Organisation Collaborating Centre for Mental Health Services Development), Queen Mary University of London, London, UK. Electronic address: d.giacco@qmul.ac.uk. 3. Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany. 4. Unit for Social and Community Psychiatry (World Health Organisation Collaborating Centre for Mental Health Services Development), Queen Mary University of London, London, UK. 5. Queen Mary University of London, Pragmatic Clinical Trials Unit, London, UK. 6. UOC Psichiatria, Azienda Ospedaliera Universitaria Integrata (AOUI) di Verona, Verona, Italy. 7. Institute of Health and Society IRSS, Université Catholique de Louvain, Bruxelles, Belgium. 8. Institute of Psychiatry and Neurology, Warsaw, Poland.
Abstract
BACKGROUND: Previous studies in individual countries have identified inconsistent predictors of length of stay (LoS) in psychiatric inpatient units. This may reflect methodological inconsistencies across studies or true differences of predictors. In this study we assessed predictors of LoS in five European countries and explored whether their effect varies across countries. METHODS: Prospective cohort study. All patients admitted over 14 months to 57 psychiatric inpatient units in Belgium, Germany, Italy, Poland and United Kingdom were screened. Putative predictors were collected from medical records and in face-to-face interviews and tested for their association with LoS. RESULTS: Average LoS varied from 17.9days in Italy to 55.1days in Belgium. In the overall sample being homeless, receiving benefits, social isolation, diagnosis of psychosis, greater symptom severity, substance use, history of previous admission and being involuntarily admitted predicted longer LoS. Several predictors showed significant interaction effects with countries in predicting LoS. One variable, homelessness, predicted a different LoS even in opposite directions, whilst for other predictors the direction of the association was the same, but the strength of the association with LoS varied across countries. CONCLUSIONS: The same patient characteristics have a different impact on LoS in different contexts. Thus, although some predictor variables related to clinical severity and social dysfunction appear of generalisable relevance, national studies on LoS are required to understand the complex influence of different patient characteristics on clinical practice in the given contexts.
BACKGROUND: Previous studies in individual countries have identified inconsistent predictors of length of stay (LoS) in psychiatric inpatient units. This may reflect methodological inconsistencies across studies or true differences of predictors. In this study we assessed predictors of LoS in five European countries and explored whether their effect varies across countries. METHODS: Prospective cohort study. All patients admitted over 14 months to 57 psychiatric inpatient units in Belgium, Germany, Italy, Poland and United Kingdom were screened. Putative predictors were collected from medical records and in face-to-face interviews and tested for their association with LoS. RESULTS: Average LoS varied from 17.9days in Italy to 55.1days in Belgium. In the overall sample being homeless, receiving benefits, social isolation, diagnosis of psychosis, greater symptom severity, substance use, history of previous admission and being involuntarily admitted predicted longer LoS. Several predictors showed significant interaction effects with countries in predicting LoS. One variable, homelessness, predicted a different LoS even in opposite directions, whilst for other predictors the direction of the association was the same, but the strength of the association with LoS varied across countries. CONCLUSIONS: The same patient characteristics have a different impact on LoS in different contexts. Thus, although some predictor variables related to clinical severity and social dysfunction appear of generalisable relevance, national studies on LoS are required to understand the complex influence of different patient characteristics on clinical practice in the given contexts.
Authors: D Giacco; V J Bird; T Ahmad; M Bauer; A Lasalvia; V Lorant; E Miglietta; J Moskalewicz; P Nicaise; A Pfennig; M Welbel; S Priebe Journal: Epidemiol Psychiatr Sci Date: 2018-12-18 Impact factor: 6.892
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