Background:
Research on length of stay (LOS) of psychiatric inpatients is an under-investigated issue. Inthis naturalistic study we investigated factors which affect LOS in two groups of patientsfocusing particularly on the impact on LOS of medical comorbidity severe enough to requirereferral.
Methods:
Active medical comorbidity was quantified using referral as the criterion. The study samplecomprised of with 200 inpatients with the diagnosis of schizophrenia and 228 inpatientssuffering from bipolar disorder (type I or II). Jonckheere and Mann-Whitney tests were usedto estimate the influence of referrals on LOS, and regression analyses isolated variablesassociated with LOS separately for each group.
Results:
Half of the patients needed one or more referrals for a non-psychiatric problem. The mostcommon medical condition of patients with bipolar disorder was arterial hypertension.Inpatients with schizophrenia suffered mostly from an endocrine/metabolic disease – 12% ofreferrals were for Hashimoto’s thyroiditis. A positive linear trend was found between LOSand number of referrals in both groups, the effect was greater for schizophrenia patients. Theeffect of referrals on LOS was verified by regression in both groups. Overall, referredpatients showed greater improvement in GAF compared to controls.
Conclusions:
To our knowledge this is the first study to investigate physical comorbidity in psychiatricinpatients using the criteria of referral to medical subspecialties. Comorbidity severe enoughto warrant referral is a significant determinant of hospital stay. This insight may prove usefulin health care planning. The results show lack of effective community care in the case ofschizophrenia and negative symptoms may be the cause of this. Our findings call for moreattention to be paid to the general medical needs of inpatients with severe mental health andconcurrent severe medical comorbidity.