The determinants and outcomes of long-stay psychiatric admissions: a case-control study.
BACKGROUND
Acute psychiatric admissions lasting over 6 months (long-stays) continue to occur in England. Previous studies have suggested an association between long-stay and both schizophrenia and challenging behaviour, as well as rehousing or placement difficulties, but no UK study to date has compared such cases with control admissions.


METHODS
We performed a case-control study. All long-stay patients present on acute general psychiatric wards serving the London Boroughs of Croydon, Lambeth, Lewisham and Southwark on November 1st 2004 were compared with a group of 'next admitted' controls. We followed up long-stay cases 1 year later to determine whether they were still in hospital, and, if not, where they were living.


RESULTS
In unadjusted comparisons long stay was associated with schizophrenia, non-white ethnicity, admission not due to suicidality, violence, severe illness and need for rehousing. A logistic regression was used to adjust for associations among exposures and only violence, severity of illness and need for rehousing remained associated with long-stay. After 1 year, two-thirds of cases were living out of hospital.


CONCLUSIONS
Case-control studies may usefully contribute to the study of the complex social phenomenon of long-stay. Further research should address how the combination of individual and socially-determined effects that we found operate together over the course of admission to generate long-stays.
Tulloch
Alex D
AD
Division of Psychological Medicine and Psychiatry, Institute of Psychiatry, King's College London, De Crespigny Park, London, SE5 8AF, UK.
Fearon
Paul
P
David
Anthony S
AS
D000293:Adolescent; D000328:Adult; D016022:Case-Control Studies; D015897:Comorbidity; D035061:Control Groups; D005006:Ethnicity / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D016015:Logistic Models; D008131:London / Q000453:epidemiology; D008134:Long-Term Care / Q000706:statistics & numerical data; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology / Q000628:therapy*; D011567:Psychiatric Department, Hospital / Q000706:statistics & numerical data*; D012307:Risk Factors; D012559:Schizophrenia / Q000453:epidemiology / Q000628:therapy; D012720:Severity of Illness Index; D016896:Treatment Outcome; D006113:United Kingdom / Q000453:epidemiology; D014754:Violence / Q000523:psychology / Q000706:statistics & numerical data