Páv Marek, Vaníček Ondřej, Závora Jiří, Pekara Jaroslav, Zahrádka-Kȍhlerová Michaela, Papežová Simona, Anders Martin
Bohnice Psychiatric Hospital, Department of Psychiatry, Ústavní 91, Prague 8, 181 02, Czech Republic.
Department of Psychiatry, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Ke Karlovu 11, Prague, Prague 2, 128 08, Czech Republic.
Int J Ment Health Syst. 2025 Jun 14;19(1):19. doi: 10.1186/s13033-025-00675-9.
Length of stay (LoS) is a critical parameter of inpatient forensic treatment functioning. Inpatient forensic LoS in Czechia varies across hospitals with the number of patients per 100,000 inhabitants and the treatment duration. We aimed to analyse these inter-hospital differences and provide relevant sociodemographic and treatment-related data.
We collected descriptive parameters from 841 forensic inpatients from 13 hospitals in Czechia, with follow-up data collection after 6 months (N = 800). Data from eight hospitals with > 50 patients (N = 765) were entered into linear regression analyses with subsequent resampling to identify differences in LoS associated with index offence, diagnosis, and treatment type, thereby highlighting interhospital variations.
The cohort comprised predominantly males (mean age, 41.84 years; standard deviation [SD] 3.63) with extended mental health histories; the mean main diagnosis length was 13.2 years (SD 12.18). Most inmates committed violent offences, with psychotic, substance use, or paraphilic disorders predominating. Family contact remained common despite the patients' poor socioeconomic status. The mean LoS was 1,327.58 (SD 1642.41) days. We observed significant differences in LoS among patients from the same diagnostic group. Within the whole system, patients with substance abuse disorders, psychotic disorders, and intellectual disabilities stayed for 760, 1490, and 2441 days, respectively. Violent index offences increased LoS in most hospitals, as did sexual offences, but "other" minor criminal offences (non-violent, non-sexual) were associated with increased LoS only in some hospitals. Sex offender treatment significantly affected LoS in some hospitals, while enrolment into substance use programmes shortened it.
Our study revealed significant inter-hospital variations in LoS associated with index offences, diagnoses, or treatment programs, which could be related to previously unrecognised institutional factors. Regular evaluation of treatment outcomes and implementation of standardised guidelines across the entire system is necessary to balance these differences. The insights provided into inpatient treatment in Czechia can be used to guide policy and practice improvements, enhancing the quality of forensic psychiatric care and ensuring the rights and well-being of the patients. The study addressed the knowledge gap existing in the available literature regarding previously unrecognised factors influencing the LoS at the system "mezzo" level.
住院时间（LoS）是住院法医治疗功能的一个关键参数。捷克共和国住院法医治疗的住院时间因医院而异，与每10万居民中的患者数量和治疗持续时间有关。我们旨在分析这些医院间的差异，并提供相关的社会人口学和治疗相关数据。
我们收集了来自捷克共和国13家医院的841名法医住院患者的描述性参数，并在6个月后收集随访数据（N = 800）。将来自8家患者人数超过50人的医院的数据（N = 765）进行线性回归分析，随后进行重新抽样，以确定与索引犯罪、诊断和治疗类型相关的住院时间差异，从而突出医院间的差异。
该队列主要由男性组成（平均年龄41.84岁；标准差[SD] 3.63），有较长的心理健康史；平均主要诊断时长为13.2年（SD 12.18）。大多数囚犯犯有暴力罪行，以精神病、物质使用或性偏好障碍为主。尽管患者社会经济地位低下，但家庭联系仍然很常见。平均住院时间为1327.58天（SD 1642.41）。我们观察到同一诊断组患者的住院时间存在显著差异。在整个系统中，物质滥用障碍、精神障碍和智力残疾患者的住院时间分别为760天、1490天和2441天。暴力索引犯罪在大多数医院增加了住院时间，性犯罪也是如此，但“其他”轻微刑事犯罪（非暴力、非性犯罪）仅在一些医院与住院时间增加有关。性犯罪者治疗在一些医院显著影响住院时间，而参加物质使用项目则缩短了住院时间。
我们的研究揭示了与索引犯罪、诊断或治疗项目相关的住院时间在医院间存在显著差异，这可能与以前未被认识到的机构因素有关。有必要对治疗结果进行定期评估，并在整个系统中实施标准化指南，以平衡这些差异。对捷克共和国住院治疗的见解可用于指导政策和实践改进，提高法医精神病护理质量，确保患者的权利和福祉。该研究解决了现有文献中关于系统“中间”层面影响住院时间的以前未被认识到的因素存在的知识空白。
