Impact of the interaction of depression and physical illness on a psychiatric unit's length of stay

doi:10.1016/0163-8343(95)00065-Y

General Hospital Psychiatry

Volume 17, Issue 5, September 1995, Pages 326-334

https://doi.org/10.1016/0163-8343(95)00065-Y Get rights and content

Abstract

Prior literature suggests that length of stay (LOS) on medical inpatient units is increased by the coexistence of depression and physical illness. The present study examined 532 psychiatric inpatient admissions to determine if physical illness increased LOS for patients grouped by diagnostic categories of psychosis, depression, personality disorder, anxiety disorder, adjustment disorder, bipolar disorder (not depressed), and other psychiatric disorders. LOS for depressed patients was significantly longer for those with any physical final diagnosis (mean = 20.08 days) than for depressed patients with no physical diagnosis (mean = 11.48 days). LOS was also longer for all patients with physical diagnoses (mean = 19.31 days) than all patients with no physical diagnosis (mean = 13.13 days). No other specific diagnostic group (psychosis, personality disorder, and so forth) showed significant differences in LOS for any associated physical illness vs no physical illness. The study results tend to indicate that physical illness is associated with increased LOS for depressed psychiatric patients but not for other specific diagnostic groups. Depressed patients may 1) mask physical illness by depression-generated physical complaints; 2) prioritize mood symptoms over physical symptoms; and/or 3) may suffer from feelings of hopelessness or be pessimistic that their physical symptoms will be effectively treated and, therefore, not report their physical symptoms.

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Effects of temporary psychiatric holds on length of stay and readmission risk among persons admitted for psychotic disorders
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Citation Excerpt :
Models for our outcome variables were developed using independent variables that had previously been associated with LOS or readmission risk and which were available in our dataset. LOS among psychiatric inpatients has been linked to multiple factors including age (Citrome, Green, & Fost, 1994; Huntley, Cho, Christman, & Csernansky, 1998; McCrone & Phelan, 2009), family support (Creed, Tomenson, Anthony, & Tramner, 1997; Draper & Luscombe, 1998; Fortney, Booth, & Smith, 1996; Suh, 2002; Zhang, Harvey, & Andrew, 2011), gender (Chung et al., 2010; Compton, Craw, & Rudisch, 2006; Suh, 2002), access to housing (Hwang, Weaver, Aubry, & Hoch, 2011; Stoskopf & Horn, 1992; Suh, 2002; Zhang et al., 2011), diagnosis (Brock & Brown, 1993; Fortney et al., 1996; Frick, Rehm, Krischker, & Cording, 1999; Herr, Abraham, & Anderson, 1991; Huntley et al., 1998; Kiesler, Simpkins, & Morton, 1990; McCrone & Phelan, 2009; Schubert, Yokley, Sloan, & Gottesman, 1995; Suh, 2002), insurance type (Chung et al., 2010; Kiesler et al., 1990; Stoskopf & Horn, 1992; Suh, 2002), and having a substance use disorder (Citrome et al., 1994; Compton et al., 2006; Frick, Rehm, Krischker, & Cording, 1999; Huntley et al., 1998; Zhang et al., 2011), among others. Likewise, readmission risk has been associated with age (Bernardo & Forchuk, 2001; Byrne, Hooke, & Page, 2010; Mellesdal, Mehlum, Wentzel-Larsen, Kroken, & Jørgensen, 2010; Monnelly, 1997; Mortensen & Eaton, 2009; Thornicroft, Gooch, & Dayson, 1992; Vigod et al., 2015), employment (Barros, de Azevedo Marques, Santos, Zuardi, & Del-Ben, 2016; Bernardo & Forchuk, 2001; Callaly, Hyland, Trauer, Dodd, & Berk, 2010; Filipcic et al., 2017; Kent & Yellowlees, 1994), family support (Bernardo & Forchuk, 2001; Bowersox, Saunders, & Berger, 2012; Byrne et al., 2010; Hamilton et al., 2015; Kent & Yellowlees, 1994; Lyons et al., 1997), gender (Bernardo & Forchuk, 2001; Hamilton et al., 2015; Mellesdal et al., 2010; Mortensen & Eaton, 2009; Rylander et al., 2016; Schoenbaum, Cookson, & Stelovich, 1995; Thornicroft et al., 1992), access to housing (Hamilton, Passos, et al., 2015; Lorine et al., 2015; Rylander et al., 2016; Schmutte, Dunn, & Sledge, 2009; Thornicroft et al., 1992; Vijayaraghavan, Messer, Xu, Sarkin, & Gilmer, 2015; Walker, Minor-Schork, Bloch, & Esinhart, 1996), number of previous admissions (Bernardo & Forchuk, 2001; Grinshpoon, Lerner, Hornik-Lurie, Zilber, & Ponizovsky, 2011; Kim, Pfeiffer, Ganoczy, & Valenstein, 2011; Mellesdal et al., 2010; Monnelly, 1997; Thompson, Neighbors, Munday, & Trierweiler, 2003; Thornicroft et al., 1992; Vigod et al., 2015; Vijayaraghavan et al., 2015; Wong & Chung, 2006), diagnosis (Bernardo & Forchuk, 2001; Manu et al., 2014; Mark et al., 2013; Rylander et al., 2016; Thompson et al., 2003; Thornicroft et al., 1992; Vigod et al., 2015; Zhang et al., 2011), outpatient medication adherence (Beadles et al., 2015; Goodpastor & Hare, 1991; Rittmannsberger, Pachinger, Keppelmuller, & Wancata, 2004; Scott & Pope, 2002), and having a substance use disorder (Hodgson, Lewis, & Boardman, 2001; Kent & Yellowlees, 1994; Lin et al., 2010; Lorine et al., 2015; Mark et al., 2013; Mellesdal et al., 2010; Vijayaraghavan et al., 2015; Wheeler, Moyle, Jansen, Robinson, & Vanderpyl, 2011; Zhang et al., 2011), among other factors.
The practice of involuntary psychiatric commitment is central to the acute treatment of persons with severe mental illness and others in psychiatric crisis. Deciding whether a patient should be admitted involuntarily requires weighing respect for autonomy against beneficence, considering the clinical needs of the patient, and navigating ambiguous legal standards. The relative dearth of information about the impact of involuntary commitment on objective patient outcomes complicates matters ethically, legally, and clinically. To address this gap in the literature, we sought to determine the association between temporary psychiatric holds and length of stay and readmission rates among a retrospective sample of adult patients admitted to a large psychiatric hospital with diagnoses of schizophrenia, schizoaffective disorder, mania, and other psychotic disorders. In total, we identified 460 patients and 559 unique encounters meeting our inclusion criteria; 90 of the encounters were voluntary (involving a temporary psychiatric hold) and 469 were involuntary. Univariable and multivariable analyses suggested that temporary psychiatric holds were not significantly associated with either length of stay or readmission rate. These findings are relevant to clinicians who must decide whether to admit a patient involuntarily, as they suggest that making a patient involuntary is not associated with differences in length of stay or readmission risk.
Determinants of length of stay for psychiatric inpatients: Analysis of a national database covering the entire Korean elderly population
2010, Health Policy
In a rapidly aging society, inappropriately long geropsychiatric inpatient hospitalization is a challenging concern for mental health policy-makers and researchers. This study aimed to investigate patient and institutional factors affecting geropsychiatric inpatient length of stay (LOS), providing an overview of current geropsychiatric health care system in South Korea.
This retrospective, population-based, cross-sectional study analysed nationwide reimbursement claim databases covering the entire elderly population of Korea between January 2005 and June 2006. Given the nested structure of the data, a multivariate multilevel regression analysis was performed.
The average LOS was 128 days. Males, patients with schizophrenia, and those enrolled in a National Medical Care Aid program tended to have longer hospital stays. Patient age was negatively related to LOS. Institutional variables related to longer hospitalizations included a psychiatric hospital, a higher number of beds, fewer human resource employees, a higher proportion of male, oldest old, and patients with dementia.
Our results suggest that policies targeting geropsychiatric patients diagnosed with schizophrenia, enrolled in National Medical Care Aid programs, and admitted to psychiatric hospitals could reduce LOS. Additionally, the impact of the patient composition of a medical institution on LOS needs to be closely investigated.
Impact of depression on disablement in late middle aged and older persons: Results from the Longitudinal Aging Study Amsterdam
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The main pathway of the disablement process consists of four consecutive phases: Pathology (presence of disease/injury), Impairments (dysfunctions/structural abnormalities), Functional Limitations (restrictions in basic physical/mental actions), and Disability (difficulty doing activities of daily life, ADL). This study determines the presence of the main pathway of disablement in a cohort aged 55 years and older and examines whether progression of the main pathway of disablement is accelerated in the presence of depression. Based on baseline (T1) and two three-year follow-up interviews (T2 and T3) from the Longitudinal Aging Study Amsterdam (LASA) in a population-based cohort of 1110 Dutch persons, we first analysed the intermediate effect of the different consecutive phases of the disablement process by means of multiple regression, adjusted for covariates. Then, depression was used as interaction term in multiple regression analyses linking the consecutive phases of the disablement process. We found that Impairments mediated the association between Pathology and Functional Limitations, and that Functional Limitations mediated the association between Impairments and Disability. Depression significantly modified the associations between Pathology and subsequent Impairments, and between Functional Limitations and subsequent Disability. In sum, the main pathway of the disablement process was identified in our sample. In addition, we found an accelerating effect of depression, particularly in the early and late stages of the model. Reduction of depression may help slow down the process of disablement for persons who find themselves in those stages of the model.
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Impact of the interaction of depression and physical illness on a psychiatric unit's length of stay

Abstract

Psychosomatics

Gen Hosp Psychiatry

Lancet

Morbidity and rate of undiagnosed physical illness in a psychiatric clinic population

Arch Gen Psychiatry

Physical illness presenting a psychiatric disease

Arch Gen Psychiatry

Brucellosis III. Psychologic aspects of delayed convalescence

Arch Int Med

Convalescence from influenza

Arch Intern Med

Psychosomatic factors in the rate of recovery from tuberculosis

Psychosom Med

Survival and healthcare utilization in elderly medical inpatients with major depression

J Am Geriatr Soc

Psychiatric comorbidities and patients with head and spinal cord trauma