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Meta-Analysis
. 2014 Jan 30;2014(1):CD000384.
doi: 10.1002/14651858.CD000384.pub3.

Length of hospitalisation for people with severe mental illness

Olufemi Babalola  1 , Vahdet Gormez, Nisreen A Alwan, Paul Johnstone, Stephanie Sampson
Affiliations
Meta-Analysis

Length of hospitalisation for people with severe mental illness

Olufemi Babalola et al. Cochrane Database Syst Rev. .

Abstract

Background: In high-income countries, over the last three decades, the length of hospital stays for people with serious mental illness has reduced drastically although considerable variation remains. In lower-income countries this variation may be greater. Some argue that reduction in hospital stay leads to 'revolving door admissions' and worsening mental health outcomes despite apparent cost savings, whilst others suggest longer stays may be more harmful by institutionalising people to hospital care.

Objectives: To evaluate the effect of short stay/brief admission hospital care with long stay/standard in-patient care in people with serious mental illness.

Search methods: We searched the Cochrane Schizophrenia Group's register of trials, July 2007 and updated this search in May 2012.

Selection criteria: We included all randomised controlled trials comparing planned short/brief with long/standard hospital stays for people with serious mental illnesses.

Data collection and analysis: We extracted data independently. For dichotomous data we calculated risk ratios (RR) and their 95% confidence intervals (CI) on an intention-to-treat basis based using a fixed-effect model. For continuous data, had we identified such data, we planned to calculate fixed-effect mean differences (MD). We assessed risk of bias for included studies and rated quality of evidence using GRADE.

Main results: We included six relevant trials undertaken between 1969 and 1980. We found no significant difference in death (n = 175, 1 RCT, RR in the longer term 0.42, CI 0.10 to 1.83, very low quality evidence). In the long term, there was no difference in improvement of mental state (n = 61, 1 RCT, RR 3.39, CI 0.76 to 15.02, very low quality evidence). There was no difference in readmission to hospital (n = 651, 4 RCTs, RR by the long term 1.26, CI 1.00 to 1.57, low quality evidence). Data for leaving the study prematurely by the longer term showed no difference (n = 229, 2 RCTs, (RR 0.77, CI 0.34 to 1.77, low quality evidence). There was a significant difference favouring short stay (P = 0.01) in numbers of participants with delayed discharge from hospital exceeding the time planned in study (n = 404, 3 RCTs, RR in the longer term 0.54, CI 0.33 to 0.88, low quality evidence). There was no difference in numbers of participants lost to follow-up (n = 404, 3 RCTs, RR by the longer term 1.07, CI 0.70 to 1.62, low quality evidence). Finally, there was a significant difference favouring short-stay hospitalisation for social functioning, including unemployment, unable to housekeep, or unknown employment status (n = 330, 2 RCTs, RR by longer term 0.61, CI 0.50 to 0.76, very low quality evidence).

Authors' conclusions: The effects of hospital care and the length of stay is important for mental health policy. We found limited low and very low quality data which were all over 30 years old. Outcomes from these studies do suggest that a planned short-stay policy does not encourage a 'revolving door' pattern of admission and disjointed care for people with serious mental illness. More large, well-designed and reported trials are justified especially where a short-stay policy is not routine care.

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Conflict of interest statement

None known.

Figures

1
1
Study flow diagram (for 2012 update search).
2
2
'Risk of bias' graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
3
3
'Risk of bias' summary: review authors' judgements about each risk of bias item for each included study.
1.1
1.1. Analysis
Comparison 1 SHORT versus LONG HOSPITAL STAY, Outcome 1 Death ‐ 2 years follow‐up.
1.2
1.2. Analysis
Comparison 1 SHORT versus LONG HOSPITAL STAY, Outcome 2 Mental state: Not improved.
1.3
1.3. Analysis
Comparison 1 SHORT versus LONG HOSPITAL STAY, Outcome 3 Service outcomes: 1a. Readmission to hospital (homogeneous studies).
1.4
1.4. Analysis
Comparison 1 SHORT versus LONG HOSPITAL STAY, Outcome 4 Service outcomes: 1b. Readmission to hospital ‐ Burhan 1969 only.
1.5
1.5. Analysis
Comparison 1 SHORT versus LONG HOSPITAL STAY, Outcome 5 Service outcomes: 1c. Readmission to hospital ‐ due to parasuicide.
1.7
1.7. Analysis
Comparison 1 SHORT versus LONG HOSPITAL STAY, Outcome 7 Service outcomes: 3. Leaving hospital prematurely ‐ by 2 years.
1.8
1.8. Analysis
Comparison 1 SHORT versus LONG HOSPITAL STAY, Outcome 8 Service outcomes: 4. Discharge delayed beyond the time planned in study ‐ 2‐year data.
1.9
1.9. Analysis
Comparison 1 SHORT versus LONG HOSPITAL STAY, Outcome 9 Service outcomes: 5. Day care ‐ by 1 year.
1.10
1.10. Analysis
Comparison 1 SHORT versus LONG HOSPITAL STAY, Outcome 10 Behaviour: violent incidents to self.
1.11
1.11. Analysis
Comparison 1 SHORT versus LONG HOSPITAL STAY, Outcome 11 Leaving the study early.
1.12
1.12. Analysis
Comparison 1 SHORT versus LONG HOSPITAL STAY, Outcome 12 General functioning: 1. Unemployed, unable to housekeep or unknown employment status ‐ by 2 years.
1.13
1.13. Analysis
Comparison 1 SHORT versus LONG HOSPITAL STAY, Outcome 13 General functioning: 2. Work attendance (high = better).
See this image and copyright information in PMC

Update of

References

References to studies included in this review

Burhan 1969 {published data only}
    1. Burhan AS. Short term hospital treatment: a study. Hospital and Community Psychiatry 1969;20:369‐70. - PubMed
Glick 1975 {published data only}
    1. Glick ID, Hargreaves WA, Drues JMA, Showstack JA. Short versus long hospitalization: a prospective controlled study. IV. One‐year follow‐up results for schizophrenic patients. American Journal of Psychiatry 1976;133:509‐14. - PubMed
    1. Glick ID, Hargreaves WA, Goldfield MD. Short versus long hospitalization. Archives of General Psychiatry 1974;30:363‐9. - PubMed
    1. Glick ID, Hargreaves WA, Raskin M, Kutner SJ. Short versus long hospitalization. II. Results for schizophrenia in‐patients. American Journal of Psychiatry 1975;123:385‐90. - PubMed
    1. Hargreaves WA, Glick ID, Drues J, Showstack JA, Feigenbaum E. Short versus long hospitalization: a prospective controlled study. VI. Two‐year follow‐up results for schizophrenics. Archives of General Psychiatry 1977;34:305‐11. - PubMed
    1. Young RC, Gould E, Glick ID. Personality inventory correlates of outcome in a follow‐up study of psychiatric hospitalization. Psychological Reports 1980;46:903‐6. - PubMed
Glick 1976 {published data only}
    1. Glick ID, Hargreaves WA, Drues JA, Showstack JA, Katzow JJ. Short versus long hospitalization: a prospective controlled study. VII. Two‐year follow‐up results for non‐schizophrenics. Archives of General Psychiatry 1977;34:314‐7. - PubMed
    1. Glick ID, Hargreaves WA, Drues JMA, Showstack JA. Short versus long hospitalization: a controlled study. III. Inpatient results for nonschizophrenics. Archives of General Psychiatry 1976;33:78‐83. - PubMed
    1. Glick ID, Hargreaves WA, Drues JMA, Showstack JA. Short versus long hospitalization: a prospective controlled study. V. One‐year follow up for non‐schizophrenics. American Journal of Psychiatry 1976;133:515‐7. - PubMed
Herz 1975 {published data only}
    1. Endicott J, Cohen J, Nee J, Fleiss JL, Herz MI. Brief vs standard hospitalization. For whom?. Archives of General Psychiatry 1979;36:706‐12. - PubMed
    1. Herz MI, Endicott J, Gibbon M. Brief hospitalization: two‐year follow‐up. Archives of General Psychiatry 1979;36:701‐5. - PubMed
    1. Herz MI, Endicott J, Spitzer RL. Brief hospitalization of patients with families: initial results. American Journal of Psychiatry 1975;132:413‐8. - PubMed
    1. Herz MI, Endicott J, Spitzer RL. Brief hospitalization: a two‐year follow‐up. American Journal of Psychiatry 1977;134:502‐7. - PubMed
    1. Herz ML, Endicott J, Spitzer RL. Brief versus standard hospitalization: the families. American Journal of Psychiatry 1976;133:795‐801. - PubMed
Hirsch 1979* {published data only}
    1. Hirsch SR, Platt S, Knights A, Weyman A. Shortening hospital stay for psychiatric care: effect on patients and their families. British Medical Journal 1979;1:442‐6. - PMC - PubMed
    1. Knights A, Hirsch SR, Platt SD. Clinical change as a function of brief admission to hospital in a controlled study using the present state examination. British Journal of Psychiatry 1980;137:170‐80. - PubMed
    1. Platt S, Hirsch S. The effects of brief hospitalization upon the psychiatric patient's household. Acta Psychiatrica Scandinavica 1981;64:199‐216. - PubMed
    1. Platt SD, Hirsch SR, Knights AC. Effects of brief hospitalization on psychiatric patients' behaviour and social functioning. Acta Psychiatrica Scandinavica 1981;63:117‐28. - PubMed
Kennedy 1980 {published data only}
    1. Kennedy P, Hird F. Description and evaluation of a short‐stay admission ward. British Journal of Psychiatry 1980;136:205‐15. - PubMed

References to studies excluded from this review

Appleby 1993 {published data only}
    1. Appleby L, Prakash ND, Luchins DJ, Gibbons RD, Hedeker DR. Length of stay and recidivism in schizophrenia: a study of public psychiatric hospital patients. American Journal of Psychiatry 1993;150:72‐6. - PubMed
Caffey 1968 {published data only}
    1. Caffey EM, Galbrecht CR, Klett CJ. Brief hospitalization and aftercare in the treatment of schizophrenia. Archives of General Psychiatry 1971;24:81‐6. - PubMed
    1. Caffey EM, Jones RD, Diamond LS, Burton E, Bowen WT. Brief hospital treatment of schizophrenia: early results of a multiple hospital study. Hospital and Community Psychiatry 1968;19:282‐7. - PubMed
Hafner 1986 {published data only}
    1. Hafner H, an der Heiden W, Buchholz W, Bardens R, Klug J, Krumm B. Organisation, Wirksamkeit und Wirkschaftlichkeit komplementarer Versorgung schizophrener. Nervenartz 1986;57:214‐26. - PubMed
Lehrman 1961 {published data only}
    1. Lehrman NS. Follow‐up of brief versus prolonged psychiatric hospitalization. Comprehensive Psychiatry 1961;2:227‐40. - PubMed
May 1968 {published data only}
    1. May PRA. Treatment of Schizophrenia: a Comparative Study of Five Treatment Methods. New York: Science House, 1968.
    1. May PRA, Tuma AH, Yale C, Potepan P, Dixon WJ. Schizophrenia ‐ a follow‐up study of results of treatment. II. Hospital stay over two to five years. Archives of General Psychiatry 1976;33:481‐6. - PubMed
Mendel 1966 {published data only}
    1. Mendel WM. Effect of length of hospitalization on rate and quality of remission from acute psychotic episodes. Journal of Nervous and Mental Disease 1966;143:226‐33. - PubMed
Olfson 1990 {published data only}
    1. Olfson M, Plotke GS, Harding CM, Jones J, Mayfield VW. A controlled evaluation of inpatient crisis treatment for acute schizophrenia episodes. Psychiatric Quarterly 1990;61:143‐54. - PubMed
Rosen 1976 {published data only}
    1. Mattes JA, Klein DF, Millan D, Rosen B. Comparison of the clinical effectiveness of 'short' versus 'long' stay psychiatric hospitalization. Journal of Nervous and Mental Disease 1979;167:175‐81. - PubMed
    1. Mattes JA, Rosen B, Klein DF. Comparison of the clinical effectiveness of short versus long stay intensive psychiatric hospitalization. II. Results of a 3‐year post‐hospital follow‐up. Journal of Nervous and Mental Diseases 1977;165:387‐94. - PubMed
    1. Rosen B, Katzoff A, Carillo C, Klein DF. Clinical effectiveness of short versus long psychiatric hospitalisation. I. Inpatient results. Archives of General Psychiatry 1976;33:1316‐22. - PubMed
Singer 1975 {published data only}
    1. Singer JE, Grob MC. Short term versus long term hospitalization in a private psychiatric facility. A follow‐up study. Hospital and Community Psychiatry 1975;26:745‐6. - PubMed

Additional references

Altman 1996
    1. Altman DG, Bland JM. Detecting skewness from summary information. BMJ 1996;313:1200. [LH020600] - PMC - PubMed
Anonymous 1996
    1. Anonymous. British Medical Journal Headlines. BMJ 1996;313:8.
Appleby 1991
    1. Appleby L, Araya R (eds). Mental Health and the Global Village. Royal College of Psychiatrists. London: Gaskell, 1991.
Begg 1996
    1. Begg C, Cho M, Eastwood S, Horton R, Mower D, Alkin I, et al. Improving quality of reporting of randomized controlled trials. The CONSORT statement. JAMA 1996;276:637‐9. - PubMed
Bland 1997
    1. Bland JM. Statistics notes. Trials randomised in clusters. BMJ 1997;315:600. - PMC - PubMed
Boissel 1999
    1. Boissel JP, Cucherat M, Li W, Chatellier G, Gueyffier F, Buyse M, et al. The problem of therapeutic efficacy indices. 3. Comparison of the indices and their use. Therapie 1999;54(4):405‐11. - PubMed
Connolly 1856
    1. Connolly J. The Treatment of the Insane without Mechanical Restraints. London: Elger & Company, 1856.
Cooper 1972
    1. Cooper JE, Kendell RE, Gurland BJ, Sharpe L, Copeland JRM, Simon R. Psychiatric Diagnosis in New York and London. Vol. 20, Oxford: Oxford University Press, 1972.
Deeks 2000
    1. Deeks J. Issues in the selection for meta‐analyses of binary data. Abstracts of 8th International Cochrane Colloquium; 2000 Oct 25‐28th; Cape Town, South Africa. 2000.
Divine 1992
    1. Divine GW, Brown JT, Frazier LM. The unit of analysis error in studies about physicians' patient care behavior. Journal of General Internal Medicine 1992;7(6):623‐9. - PubMed
DoH 1994
    1. Department of Health, England, Wales. Report of the Inquiry into the Care and Treatment of Christopher Clunis. London: HMSO, 1994.
DOH 1999
    1. Department of Health, England, Wales. National Service Framework for Mental Health. London: HMSO, 1999.
Donner 2002
    1. Donner A, Klar N. Issues in the meta‐analysis of cluster randomized trials. Statistics in Medicine 2002;21:2971‐80. - PubMed
Egger 1997
    1. Egger M, Davey Smith G, Schneider M, Minder C. Bias in meta‐analysis detected by a simple, graphical test. BMJ 1997;315:629‐34. - PMC - PubMed
Elbourne 2002
    1. Elbourne D, Altman DG, Higgins JPT, Curtina F, Worthingtond HV, Vaile A. Meta‐analyses involving cross‐over trials: methodological issues. International Journal of Epidemiology 2002;31(1):140‐9. - PubMed
Endicott 1972
    1. Endicott J, Spitzer RL. What! Another rating scale? The Psychiatric Evaluation Form. Journal of Nervous and Mental Disease 1972;154(2):88‐104. - PubMed
Furukawa 2006
    1. Furukawa TA, Barbui C, Cipriani A, Brambilla P, Watanabe N. Imputing missing standard deviations in meta‐analyses can provide accurate results. Journal of Clinical Epidemiology 2006;59(7):7‐10. - PubMed
Glick 1974
    1. Glick ID, Hargreaves WA, Goldfield MD. Short versus long hospitalization. Archives of General Psychiatry 1974;30:363‐9. - PubMed
Goffman 1961
    1. Goffman E. Asylums: Essays on the Social Situation of Mental Patients and Other Inmates. New York: Doubleday, 1961.
Gulliford 1999
    1. Gulliford MC. Components of variance and intraclass correlations for the design of community‐based surveys and intervention studies: data from the Health Survey for England 1994. American Journal of Epidemiology 1999;149:876‐83. - PubMed
Hafner 1987
    1. Hafner H. Do we still need beds for psychiatric patients? An analysis of changing patterns of mental health care. Acta Psychiatrica Scandinavica 1987;75:113‐26. - PubMed
Higgins 2003
    1. Higgins JPT, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta‐analyses. BMJ 2003;327:557‐60. - PMC - PubMed
Higgins 2006
    1. Higgins JPT. Cochrane Handbook for Systematic Reviews of Interventions 4.2.6 [updated September 2006]. In: Higgins JPT, Green S editor(s). The Cochrane Library. Chichester, UK: John Wiley & Sons, Ltd., 2006.
Higgins 2011
    1. Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.2 [updated September 2011]. The Cochrane Collaboration, 2011. Available from www.cochrane‐handbook.org..
Jones 1985
    1. Jones K, Poletti A. Understanding the Italian experience. British Journal of Psychiatry 1985;146:341. - PubMed
Kay 1986
    1. Kay SR, Opler LA, Fiszbein A. Positive and Negative Syndrome Scale (PANSS) Manual. North Tonawanda, NY: Multi‐Health Systems, 1986.
Leucht 2005
    1. Leucht S, Kane JM, Kissling W, Hamann J, Etschel E, Engel RR. What does the PANSS mean?. Schizophrenia Research 2005;79(2‐3):231‐8. [PUBMED: 15982856] - PubMed
Leucht 2005a
    1. Leucht S, Kane JM, Kissling W, Hamann J, Etschel E, Engel R. Clinical implications of brief psychiatric rating scale scores. British Journal of Psychiatry 2005;187:366‐71. [PUBMED: 16199797] - PubMed
Leucht 2007
    1. Leucht S, Engel RR, Bauml J, Davis JM. Is the superior efficacy of new generation antipsychotics an artifact of LOCF?. Schizophrenia Bulletin 2007;33(1):183‐91. [PUBMED: 16905632] - PMC - PubMed
Luborsky 1962
    1. Luborsky L. Clinicians' judgments of mental health: a proposed scale. Archives of General Psychiatry 1962;7(6):407‐17. - PubMed
Marshall 1999
    1. Marshall M, Gray A, Lockwood A, Green R. Case management for people with severe mental disorders. Cochrane Database of Systematic Reviews 1999, Issue 3. [DOI: 10.1002/14651858.CD000050.pub2] - DOI - PubMed
Marshall 2000
    1. Marshall M, Lockwood A, Bradley C, Adams C, Joy C, Fenton M. Unpublished rating scales: a major source of bias in randomised controlled trials of treatments for schizophrenia. British Journal of Psychiatry 2000;176:249‐52. - PubMed
Moher 1998
    1. Moher D, Pham B, Jones A, Cook DJ, Jadad AR, Moher M, Tugwell P, Klassen TP. Does quality of reports of randomised trials affect estimates of intervention efficacy reported in meta‐analyses?. Lancet 1998;352:609‐13. - PubMed
Moher 2001
    1. Moher D, Schulz KF, Altman D, CONSORT Group. The CONSORT statement: Revised recommendations for improving the quality of reports of parallel‐group randomized trials. JAMA 2001;285:1987‐91. - PubMed
Overall 1962
    1. Overall JE, Gorham DR. The brief psychiatric rating scale. Psychological Reports 1962;10:799‐812.
Pinel 1806
    1. Pinel P (translated Davis DD). A Treatise on Insanity. Sheffield: Caddell & Davils, 1806.
Rust 1989
    1. Rust J, Golombok S. Modern Psychometrics. London: Routledge, 1989.
Schulz 1995
    1. Schulz KF, Chalmers I, Hayes RJ, Altman DG. Empirical evidence of bias: dimensions of methodological quality associated with estimates of treatment effects in controlled trials. JAMA 1995;273:408‐12. - PubMed
Schünemann 2008
    1. Schünemann HJ, Oxman AD, Vist GE, Higgins JPT, Deeks JJ, Glasziou P, et al. Chapter 12: Interpreting results and drawing conclusions. In: Higgins JPT, Green S editor(s). Cochrane Handbook for Systematic Reviews of Interventions. The Cochrane Collaboration, 2008:359‐83.
Todd 1976
    1. Todd NA, Bennie EH, Carlisle JM. Some features of new long‐stay male schizophrenic. British Journal of Psychiatry 1976;129:424‐7. - PubMed
Tuke 1813
    1. Tuke S. A Description of the Retreat. York: Alexander & Webb, 1813.
Ukoumunne 1999
    1. Ukoumunne OC, Gulliford MC, Chinn S, Sterne JAC, Burney PGJ. Methods for evaluating area‐wide and organisation‐based intervention in health and health care: a systematic review. Health Technology Assessment 1999;3(5):1‐75. - PubMed
WHO 1973
    1. World Health Organization. Report of the International Pilot Study of Schizophrenia. Vol. 1, Geneva: World Health Organization, 1973.
Wing 1970
    1. Wing JK, Brown GW. Institutionalism and Schizophrenia: A Comparative Study of Three Mental Hospitals, 1960‐1968. Cambridge: Cambridge University Press, 1970.
Xia 2009
    1. Xia J, Adams CE, Bhagat N, Bhagat V, Bhoopathi P, El‐Sayeh H, et al. Loss to outcomes stakeholder survey: the LOSS study. Psychiatric Bulletin 2009;33(7):254‐7.

References to other published versions of this review

Alwan 2008
    1. Alwan N, Johnstone P, Zolese G. Length of hospitalisation for people with severe mental illness. Cochrane Database of Systematic Reviews 2008, Issue 1. [DOI: 10.1002/14651858.CD000384.pub2] - DOI - PMC - PubMed
Johnstone 1999
    1. Johnstone P, Zolese G. Length of hospitalisation for people with severe mental illness. Cochrane Database of Systematic Reviews 1999, Issue 2. [DOI: 10.1002/14651858.CD000384] - DOI - PubMed

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