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Am J Psychiatry 1993; 150:72-76
Copyright © 1993 by American Psychiatric Association
Length of stay and recidivism in schizophrenia: a study of public psychiatric hospital patients
L Appleby, PN Desai, DJ Luchins, RD Gibbons and DR Hedeker
Illinois Department of Mental Health and Developmental Disabilities, University of Illinois College of Medicine, Chicago.
OBJECTIVE: Psychiatric beds in public hospitals have decreased 80% since
1955, but admissions have risen correspondingly, largely because of high
recidivism rates. Decreases in numbers of beds have been partly achieved by
shortening the length of stay, which lessened by half between 1970 and
1980. This study was undertaken to determine whether duration of hospital
treatment affects the rate and rapidity of relapse among schizophrenic
patients. METHOD: Data on 1,500 patients from 10 state hospitals were
gathered for 18 months after initial discharge. Predictor variables
included age, sex, marital status, race, number of previous admissions,
location of the facility, and length of stay. Data were analyzed by
survival analysis with a Cox regression model for two times to initial
relapse: 30 days and 18 months (outcome). RESULTS: Length of stay was
significantly related to each time to relapse after the effects of number
of previous admissions and age were partialed out. Facility location was
not predictive, but intrahospital effects were tested by examining the data
on the largest facility; again, length of stay significantly predicted
relapse. CONCLUSIONS: Although the magnitude of the effect was small, the
clinical significance of the findings is the greater likelihood that
brief-stay patients will be rehospitalized within 30 days after discharge
than will patients treated for longer periods. Brief hospitalization seems
generally applicable to psychiatric populations, but there may be a small
but important group of seriously mentally ill patients for whom other
alternatives are possibly more appropriate and should be explored.
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