Stürner Lukas, Ross Thomas, Querengässer Jan, Traub Hans-Joachim
Department for Psychiatry and Psychotherapy I, Faculty of Medicine, Ulm University, Ulm, Germany.
Clinic for Forensic Psychiatry, Weissenau Psychiatric Centre, Ravensburg, Germany.
Front Psychiatry. 2024 Oct 17;15:1456363. doi: 10.3389/fpsyt.2024.1456363. eCollection 2024.
Scientific studies have focused on patient-related characteristics as predictors of length of stay in forensic psychiatry. However, little attention has been paid to the specificities of forensic psychiatric settings. This study aims to test whether differences in forensic admissions transcend individual factors by comparing length of stay between different psychiatric units, controlling for hospital characteristics and patient characteristics.
The dataset was derived from a forensic documentation system containing a wide range of information on forensic psychiatric patients. N = 594 patients with schizophrenia spectrum disorders discharged from 6 forensic hospitals in southern Germany were included in a linear mixed regression model. Linear mixed models were calculated, allowing for the simultaneous estimation of variance between patients and hospitals.
The final regression model explained 49% of the total variance. The only statistically significant patient-related predictors were age at admission, education and severity of the index offence. Hospital differences explained 41% (ICC) of the variance in length of stay without finding a significant hospital effect in the data.
Previous research has primarily analyzed predictors of length of stay in terms of individual patient characteristics. This work suggests that variables other than patient-related factors need to be considered when assessing the length of stay in forensic units. Further multi-center studies are needed to gain a better understanding of how forensic psychiatric hospitals and other institutional influences affect length of stay.
科学研究主要聚焦于患者相关特征，将其作为法医精神病学住院时长的预测因素。然而，法医精神病学环境的特殊性却很少受到关注。本研究旨在通过比较不同精神科病房的住院时长，在控制医院特征和患者特征的情况下，检验法医收治情况的差异是否超越个体因素。
数据集来源于一个法医文档系统，该系统包含了关于法医精神病患者的广泛信息。来自德国南部6家法医医院的594例精神分裂症谱系障碍患者被纳入线性混合回归模型。计算线性混合模型，以便同时估计患者和医院之间的方差。
最终回归模型解释了总方差的49%。唯一具有统计学意义的患者相关预测因素是入院年龄、教育程度和首次犯罪的严重程度。医院差异解释了住院时长方差的41%（组内相关系数），但在数据中未发现显著的医院效应。
以往的研究主要从个体患者特征方面分析住院时长的预测因素。这项研究表明，在评估法医病房的住院时长时，需要考虑患者相关因素以外的变量。需要进一步开展多中心研究，以更好地了解法医精神病医院和其他机构影响如何影响住院时长。
