Use of psychiatric hospitals and social integration of patients with psychiatric disorders: a prospective cohort study i
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ORIGINAL PAPER
Use of psychiatric hospitals and social integration of patients with psychiatric disorders: a prospective cohort study in five European countries Pierre Smith1 · Pablo Nicaise1 · Domenico Giacco2 · Victoria jane Bird2 · Michael Bauer3 · Mirella Ruggeri4 · Marta Welbel7 · Andrea Pfennig3 · Antonio Lasalvia5,6 · Jacek Moskalewicz7 · Stefan Priebe2 · Vincent Lorant1 Received: 25 September 2019 / Accepted: 2 May 2020 © The Author(s) 2020
Abstract Purpose Long lengths of stay (LoS) in psychiatric hospitals or repeated admission may affect the social integration of patients with psychiatric disorders. So far, however, studies have been inconclusive. This study aimed to analyse whether long LoS or repeated admissions in psychiatric wards were associated in different ways with changes in the social integration of patients. Methods Within a prospective cohort study, data were collected on 2181 patients with a main ICD-10 diagnosis of psychotic, affective, or anxiety disorder, hospitalised in the UK, Italy, Germany, Poland, and Belgium in 2015. Social integration was measured at baseline and 1 year after admission using the SIX index, which includes four dimensions: employment, housing, family situation, and friendship. Regression models were performed to test the association between LoS, the number of admissions, and the change in social integration over the study period, controlling for patients’ characteristics (trial registration ISRCTN40256812). Results A longer LoS was significantly associated with a decrease in social integration (β = − 0.23, 95%CI − 0.32 to − 0.14, p = 0.03), particularly regarding employment (OR = 2.21, 95%CI 1.18–3.24, p = 0.02), housing (OR = 3.45, 95%CI 1.74–5.16, p 162 days, OR = 0.38, p = 0.008) than patients with a main diagnosis of psychotic disorder who had the same LoS. Patients who had a low level of
Discussion Main findings Having a long length of stay in a psychiatric ward was more strongly associated with a decrease in the social integration of psychiatric patients after 1 year than experiencing repeated admissions. The dimensions of social integration that were more strongly and negatively associated with longer lengths of stay were the patients’ housing, employment, and household living situation. Psychiatric patients who experienced a total of more than 76 days of psychiatric hospitalisation in 1 year had a significantly higher
Table 3 Socio-demographic and clinical moderators of the association between length of stay, number of admissions in psychiatric wards, and changes in patients’ social integration outcomes over the follow-up period Change in social integration over a year
Decrease in employment status over a year
Main effect Β (p value)
Main effect OR (p value)
Interaction β (p value) Length of stay (days) c
Diagnosis ICD-10a Mood disorders Neurotic disorders Educational statusb Primary Secondary Length of stay (days)c > 162 76–162 22–75 Number of admissions
22–75
76–162
> 162
− 0.17 (0.25) − 0.05 (0.81)
− 0.21 (0.65) − 0.03 (0.54)
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