Department of Biostatistics & Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, University of London, London, UK.
Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, University College London, London, UK.
Psychol Med. 2020 Apr;50(6):991-1001. doi: 10.1017/S0033291719000904. Epub 2019 May 6.
Reducing hospitalisation and length of stay (LOS) in hospital following first episode psychosis (FEP) is important, yet reliable measures of these outcomes and their moderators are lacking. We conducted a systematic review and meta-analysis to investigate the proportion of FEP cases who were hospitalised after their first contact with services and the LOS in a hospital during follow-up.
Studies were identified from a systematic search across major electronic databases from inception to October 2017. Random effects meta-analyses and meta-regression analyses were conducted.
81 longitudinal studies encompassing data for 23 280 FEP patients with an average follow-up length of 7 years were included. 55% (95% CI 50.3-60.5%) of FEP cases were hospitalised at least once during follow-up with the pooled average LOS of 116.7 days (95% CI 95.1-138.3). Older age of illness onset and being in a stable relationship were associated with a lower proportion of people who were hospitalised. While the proportion of hospitalised patients has not decreased over time, LOS has, with the sharpest reduction in the latest time period. The proportion of patients hospitalised during follow-up was highest in Australia and New Zealand (78.4%) compared to Europe (58.1%) and North America (48.0%); and lowest in Asia (32.5%). Black ethnicity and longer duration of untreated psychosis were associated with longer LOS; while less severe psychotic symptoms at baseline were associated with shorter LOS.
One in two FEP cases required hospitalisation at least once during a 7-year follow-up with an average length of hospitalisation of 4 months during this period. LOS has declined over time, particularly in those countries in which it was previously longest.
减少首发精神病（FEP）患者的住院次数和住院时间（LOS）非常重要，但目前缺乏可靠的评估这些结局的指标及其调节因素。本研究旨在对首发精神病患者的首次就诊后住院情况及其在随访期间的 LOS 进行系统评价和 meta 分析。
通过对从开始到 2017 年 10 月期间各大电子数据库的系统检索，确定了研究对象。采用随机效应 meta 分析和 meta 回归分析。
共纳入 81 项纵向研究，涵盖了 23280 例首发精神病患者的数据，平均随访时间为 7 年。在随访期间，55%（95%CI 50.3-60.5%）的 FEP 患者至少住院一次，平均 LOS 为 116.7 天（95%CI 95.1-138.3）。发病年龄较大和处于稳定关系与较低的住院比例相关。尽管住院患者的比例没有随时间的推移而减少，但 LOS 却有所减少，最近的时间段降幅最大。在澳大利亚和新西兰，随访期间住院的患者比例最高（78.4%），欧洲为 58.1%，北美为 48.0%；亚洲的最低（32.5%）。黑种人种族和未治疗精神病的持续时间较长与 LOS 较长有关；而基线时较轻的精神病症状与较短的 LOS 相关。
在 7 年的随访期间，每两个 FEP 患者中就有一个至少需要住院一次，在此期间的平均住院时间为 4 个月。LOS 随时间的推移而下降，尤其是在 LOS 之前较长的国家。
