Do patients improve after short psychiatric admission? A cohort study in Italy

Abstract

Background: Information on outcomes of acute inpatient care in routine psychiatric practice is scant. In particular, it is uncertain to what extent short hospitalization can produce clinically meaningful changes. Aim: Our aim was to estimate the symptomatic outcome in a representative sample of patients admitted for short treatment to general hospital psychiatric units in Italy. Methods: Patients were assessed at admission and discharge using 24-item Brief Psychiatric Rating Scale (BPRS). Reliable change index was calculated to estimate the proportion of change attributable to measurement error and a cut-off score of 38 was adopted to identify the patients who showed clinically significant change. Results: Average length of stay was 5.7 days. Mean BPRS score dropped from 53.2 on admission to 41.5 at discharge, showing statistically significant improvement with an effect size of 0.80. However, reliable change was achieved by 24.7% of patients and clinically meaningful change by 13.6%. Conclusions: Reliance on statistical significance and effect size overestimates treatment effects, whereas reliable and clinically significant change index provides a conservative way to assess outcome. Few patients showed relevant improvement after a brief admission.

• Acute psychiatric inpatient care
• Brief Psychiatric Rating Scale
• Clinical significance
• Mental health services research
• Outcome evaluation

Acknowledgements

This research was supported by a grant from the Ministry of Health of Italian Republic.

The PROGRES-Acute group includes—National and Regional Coordinators, and scientific consultants: F. Amaddeo, A. Barbato, G. Borgherini, G. Borsetti, R. Bracco, R. Canosa, M. Casacchia, I. Casula, P. Ciliberti, A. Colotto, A. D'Aloise, G. de Girolamo, G. Dell'Acqua, M. De Palma, W. Di Munzio, A. Gaddini, G. Grassi, N. Longhin, M. Miceli, R. Miglio, P. Morosini, M. Nicotera, M. Percudani, B. Norcio, A. Picardi, R. Potzolu, E. Rossi, P. Rucci, G. Santone, S. Schiaffino, F. Scotti, R. Tomasi, G. Turrini, E. Zanalda.

Researchers: G. Agostani, F. Basile, F. Basilico, R.N. Battino, L. Bavero, G. Bazzacco, L. Biscaglia, R. Borio, S. Buttacavoli, B. Caporali, F. Cappelletti, L. Caserta, L. Cifarelli, P. Congia, M. Dazzi, L. Elia, E. Fantini, A. Galli, R. Gangi, P. Ghirardo, L. Giordano, S. Goldoni, A. Guidoni, S. Marchegiani, G. Morelli, M. Nassisi, E. Paltrinieri, K. Pesaresi, A. Pettolino, L. Pinciaroli, G. Pitzalis, M. Severini, C. Sighinolfi, G. Spinetti, A. Trequattrini, U. Unterfrauner, K. Wolf, L. Zecca.

This article is dedicated to the memory of Professor Pierluigi Morosini, who was the Director of the National Mental Health Project, and initiated and tirelessly supported the PROGRES-Acute project since its start. He passed away on 9 September 2008.

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.