Section of Psychiatry, Department of Public Health and Community Medicine, University of Verona, Verona, Italy.
Unit for Social and Community Psychiatry (World Health Organisation Collaborating Centre for Mental Health Services Development), Queen Mary University of London, London, UK.
Eur Psychiatry. 2018 Feb;48:6-12. doi: 10.1016/j.eurpsy.2017.11.001. Epub 2018 Jan 10.
Previous studies in individual countries have identified inconsistent predictors of length of stay (LoS) in psychiatric inpatient units. This may reflect methodological inconsistencies across studies or true differences of predictors. In this study we assessed predictors of LoS in five European countries and explored whether their effect varies across countries.
Prospective cohort study. All patients admitted over 14 months to 57 psychiatric inpatient units in Belgium, Germany, Italy, Poland and United Kingdom were screened. Putative predictors were collected from medical records and in face-to-face interviews and tested for their association with LoS.
Average LoS varied from 17.9days in Italy to 55.1days in Belgium. In the overall sample being homeless, receiving benefits, social isolation, diagnosis of psychosis, greater symptom severity, substance use, history of previous admission and being involuntarily admitted predicted longer LoS. Several predictors showed significant interaction effects with countries in predicting LoS. One variable, homelessness, predicted a different LoS even in opposite directions, whilst for other predictors the direction of the association was the same, but the strength of the association with LoS varied across countries.
The same patient characteristics have a different impact on LoS in different contexts. Thus, although some predictor variables related to clinical severity and social dysfunction appear of generalisable relevance, national studies on LoS are required to understand the complex influence of different patient characteristics on clinical practice in the given contexts.
先前在个别国家进行的研究已经确定了精神科住院患者住院时间（LoS）的不一致预测因素。这可能反映了研究之间方法学的不一致，也可能反映了预测因素的真实差异。在这项研究中，我们评估了五个欧洲国家的 LoS 预测因素，并探讨了它们在各国之间的影响是否存在差异。
前瞻性队列研究。在 14 个月的时间里，从比利时、德国、意大利、波兰和英国的 57 个精神科住院病房筛选出所有入院的患者。从病历和面对面访谈中收集潜在的预测因素，并测试其与 LoS 的相关性。
平均 LoS 从意大利的 17.9 天到比利时的 55.1 天不等。在整个样本中，无家可归、领取福利、社会孤立、精神分裂症诊断、更严重的症状严重程度、物质使用、既往住院史和非自愿住院与 LoS 延长有关。几个预测因素与国家在预测 LoS 方面存在显著的交互作用。一个变量，无家可归，即使在相反的方向上也预测了不同的 LoS，而对于其他预测因素，关联的方向是相同的，但与 LoS 的关联强度在各国之间有所不同。
相同的患者特征在不同的环境中对 LoS 有不同的影响。因此，尽管一些与临床严重程度和社会功能障碍相关的预测变量具有普遍相关性，但需要进行关于 LoS 的国家研究，以了解不同患者特征对特定背景下临床实践的复杂影响。
