Retrospective Analysis of Factors Associated with Long-Stay Hospitalizations in an Acute Psychiatric Ward

Figures & data

Table 1 Demographic Variables Related to Hospitalizations in SPDT from 1/1/2010 to 31/12/2015, Divided by the Duration

Demographic Variables	≤36 Days Hospitalizations N=3,254 (97.57%)	>36 Days Hospitalizations N=81 (2.43%)	Total Hospitalizations N=3,335 (100%)	Statistical Test Probability
Age (m± SD)
Years	42.28±15.68	41.02±16.34	43.51±16.38	t=0.71 p=0.476
Gender, n (%)
Males	1,845 (57%)	40 (49%)	1,885 (55%)	Pearson Chi^Citation2=1.72 p=0.189
Females	1,409 (43%)	41 (51%)	1,450 (45%)
Nationality, n (%)
Italian	2,681 (82%)	64 (79%)	2,745 (82%)	Pearson Chi^Citation2=0.62 p=0.431
Non-Italian	573 (18%)	17 (21%)	590 (18%)
Place of Residence, n (%)
Catchment area	2,764 (85%)	69 (85%)	2,833 (82%)	Pearson Chi^Citation2=6.39 p=0.094
Italy (outside the catchment area)	284 (10%)	3 (4%)	287 (12%)
Non-Italian residence	134 (4%)	7 (10%)	141 (5%)
Homeless	24 (1%)	1 (1%)	25 (1%)

Table 2 Clinical Variables Related to Hospitalizations in SPDT from 1/1/2010 to 31/12/2015, Divided into Two Groups by the Duration

Clinical Variables		≤36 Days Hospitalizations N=3,254 (97.57%)	>36 Days Hospitalizations N=81 (2.43%)	Total Hospitalizations N=3,335 (100%)	Statistical Test Probability
Psychiatric Activities, n (%)
Clinical interview with patient alone		1,433 (45%)	20 (25%)	1,453 (44%)	Pearson Chi^Citation2=12.26 p=0.002
Clinical interview with patient +caregivers		1,424 (45%)	51 (63%)	1,475 (46%)
Clinical interview with patient +caregivers + other professionals		337 (10%)	10 (12%)	347 (10%)
Organic Comorbidity, n (%)
Present		669 (21%)	14 (17%)	683 (20%)	Pearson Chi^Citation2=0.52 p=0.471
Absent		2,585 (79%)	67 (83%)	2,652 (80%)
Rehabilitation Programs, n (%)
Absent		2,006 (61%)	32 (40%)	2,038 (61%)	Pearson Chi^Citation2=37.05 p=0.000
In the ward		125 (4%)	13 (16%)	138 (4%)
With other services		1,123 (35%)	36 (44%)	1,159 (35%)
Extra-Psychiatric Clinical Activities, n (%)
Present		1,481 (46%)	35 (43%)	1,516 (45%)	Pearson Chi^Citation2=0.17 p=0.681
Absent		1,773 (54%)	46 (57%)	1,819 (55%)
Psycho-Pharmacotherapy, n (%)*
No psycho-pharmacotherapy		27 (1%)	0 (0%)	27 (1%)	Pearson Chi^Citation2=6.40 p=0.041
Monotherapy		561 (17%)	6 (7%)	567 (17%)
Politherapy		2,564 (79%)	73 (90%)	2,637 (79%)
Routes of Drug Administration, n (%)*
Oral		2,362 (73%)	46 (57%)	2,408 (72%)	Pearson Chi^Citation2=12.91 p=0.000
Parenteral/more than one route		806 (25%)	35 (43%)	841 (25%)
State of Admission, n (%)
Voluntary		2,389 (73%)	48 (59%)	2,437 (73%)	Pearson Chi^Citation2=8.05 p=0.005
Compulsory		865 (27%)	33 (41%)	898 (27%)
Aggressiveness, n (%)**
Absent		2,300 (71%)	39 (48%)	2,339 (70%)	Pearson Chi^Citation2=29 p=0.000
Moderate		653 (20%)	24 (30%)	677 (20%)
Severe (with need for restraints and/or interventions of hospital security guards)		254 (8%)	18 (22%)	272 (8%)

Notes: *3% data not available; **2% data not available.

Table 3 Clinical Variables Related to the Discharges from SPDT from 1/1/2010 to 31/12/2015, Divided by the Duration

Clinical Variables	≤36 Days Hospitalizations N=3,254 (97.57%)	>36 Days Hospitalizations N=81 (2.43%)	Total Hospitalizations N=3,335 (100%)	Statistical Test Probability
Psychiatric Diagnosis (ICD-9-CM) at Discharge, n (%)*
Schizophrenia and other psychotic disorders	1,139 (35%)	42 (52%)	1,181 (35%)	Pearson Chi^Citation2=17.24 p=0.045
Bipolar disorder	570 (18%)	14 (17%)	584 (18%)
Anxiety disorders	249 (8%)	1 (1%)	250 (7%)
Mental retardation	120 (4%)	3 (4%)	123 (4%)
Dementia and organic psychosis	160 (5%)	2 (2%)	162 (5%)
Personality disorders	438 (13%)	11 (14%)	449 (13%)
Substance, drugs and alcohol abuse	240 (7%)	4 (5%)	244 (7%)
Adjustment disorders	142 (4%)	0 (0%)	142 (4%)
Other disorders	94 (3%)	4 (5%)	126 (4%)
No psychiatric diagnosis	28 (1%)	0 (0%)	28 (1%)
Destination at Discharge, n (%)**
General practitioner	230 (7%)	8 (10%)	238 (7%)	Pearson Chi^Citation2=13.02 p=0.023
Community outpatient service	1,572 (48%)	40 (49%)	1,612 (48%)
Transfer to other psychiatric wards	827 (25%)	10 (12%)	837 (25%)
Transfer to non-psychiatric wards	42 (1%)	2 (2%)	44 (1%)
Protected facilities	213 (7%)	11 (14%)	224 (7%)
More than one outpatient community service	275 (8%)	7 (9%)	282 (8%)
Therapeutic and Rehabilitative Programs at Discharge, n (%)
With practitioner	910 (28%)	7 (9%)	917 (27%)	Pearson Chi^Citation2=29.89 p=0.000
With one community outpatient service	1,450 (45%)	31 (38%)	1,481 (44%)
With more than one community outpatient service	894 (27%)	43 (53%)	937 (28%)

Notes: *2% data not available; **4% data not available.

Table 4 Variables Statistically Significantly Related to Dependent Variable, Length of Hospitalization (Stepwise Multiple Linear Regression)

Variables	Coeff.	Standard Error	p-value	Confidence Interval 95%
Age	0.06	0.013	0.000	0.03; 0.08
Modality of Admission (Voluntary)*
Compulsory	2.29	0.42	0.000	1.46; 3.13
Psychiatric Activities (Clinical Interview with Patient Alone)*
Clinical interview with patient+caregivers	4.32	0.40	0.000	3.52; 5.11
Clinical interview with patient+ caregivers +other professionals	2.52	0.75	0.001	0.88; 3.79
Rehabilitation Programs During the Hospitalization (Absent)*
With staff of ward	7.08	0.91	0.000	5.29; 8.86
With staff of other services	2.11	0.42	0.000	1.29; 2.94
Aggressiveness During the Hospitalization (Absent)*
Moderate	1.08	0.51	0.035	0.07; 2.09
Severe (with need for restraints and/or interventions of hospital security guards)	4	0.7	0.000	2.63; 5.37
Psycho-Pharmacotherapy (Monotherapy)*
Polytherapy	2.4	0.49	0.000	1.44; 3.36
Routes of Drug Administration (Oral)*
Parenteral/more than one route	2.41	0.44	0.000	1.55; 3.27
Destination at Discharge (General Practitioner)*
Transfer to other psychiatric wards	−2.99	0.77	0.000	−4.51; −1.46
Therapeutic and Rehabilitative Programs at Discharge (With Practitioner)*
With one community outpatient service	2.28	0.49	0.000	1.32; 3.23
With more than one community outpatient service	4.81	0.55	0.000	3.72; 5.89

Note: * Reference category.

Table 5 Variables Statistically Significantly Related to the Longest Hospitalizations (Stepwise Multiple Logistic Regression)

Variables	Coeff.	Standard Error	p-value	Confidence Interval 95%
Rehabilitation Programs During the Hospitalization (Absent)*
With ward staff	1.81	0.45	0.016	1.12; 2.95
Aggressiveness During the Hospitalization (Absent)*
Moderate	2.33	0.58	0.005	1.25; 3.63
Severe (with need of restraints and/or interventions of hospital security guards)	3.44	1.05	0.000	1.88; 6.26
Routes of Drug Administration (Oral)*
Parenteral/more than one route	1.95	0.46	0.005	1.22; 3.11
Therapeutic and Rehabilitative Programs at Discharge (With Practitioner)*
With more than one community outpatient service	5.3	2.61	0.001	2.01; 13.93

Note: * Reference category.

Preti A, Rucci P, Gigantesco A, for PROGRES-Acute Group, et al. Patterns of care in patients discharged from acute psychiatric inpatient facilities: a national survey in Italy. Soc Psychiatry Psychiatr Epidemiol. 2009;44(9):767–776. doi:10.1007/s00127-009-0498-2.19212696

 PubMed Web of Science ®Google Scholar