Are day hospitals effective for acutely ill psychiatric patients? A European multicenter randomized controlled trial.
OBJECTIVE
Acute psychiatric day care has been proposed as an alternative to conventional inpatient care, yet the evidence of its effectiveness is inconsistent and based only on single-site studies in 3 countries. The aim of this multicenter randomized controlled trial was to establish the effectiveness of acute day hospital care in a large sample across a range of mental health care systems.


METHODS
The trial was conducted from December 2000 to September 2003 in 5 European countries, with a sample of 1117 voluntarily admitted patients. Immediately before or very shortly after admission to the participating psychiatric facilities, patients were randomly allocated to treatment in a day hospital or an inpatient ward. Psychopathology, treatment satisfaction, subjective quality of life, and social disabilities were assessed at admission, at discharge, and 3 and 12 months after discharge. An intention-to-treat analysis was conducted using fixed-effects linear models with structured error covariance matrices and covariates.


RESULTS
Day hospital care was as effective as conventional inpatient care with respect to psychopathologic symptoms, treatment satisfaction, and quality of life. It was more effective on social functioning at discharge and at the 3- and 12-month follow-up assessments.


CONCLUSIONS
This study, which has more than doubled the existing evidence base, has shown that day hospital care is as effective on clinical outcomes as conventional inpatient care and more effective on social outcomes.


BACKGROUND
ClinicalTrials.gov identifier NCT00153959.
Kallert
Thomas W
TW
Department of Psychiatry and Psychotherapy, University Hospital. thomas.kallert@mailbox.tu-dresden.de
Priebe
Stefan
S
McCabe
Rosemarie
R
Kiejna
Andrzej
A
Rymaszewska
Joanna
J
Nawka
Pĕtr
P
Ocvár
Ladislav
L
Raboch
Jirí
J
Stárková-Kalisová
Lucie
L
Koch
Rainer
R
Schützwohl
Matthias
M
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D003631:Day Care, Medical; D005060:Europe; D005260:Female; D006801:Humans; D007297:Inpatients; D008297:Male; D001523:Mental Disorders / Q000628:therapy*; D008875:Middle Aged; D017060:Patient Satisfaction; D011788:Quality of Life