Background
Determinants of length of stay for patients with serious mental illness
Methods
Study population
Variable | Pooled (N = 89,510) (1) | Schizophrenia (N = 38,216) (2) | Psychotic and schizoaffective disorder (N = 21,415) (3) | Manic and bipolar disorder (N = 29,879) (4) | ||||
---|---|---|---|---|---|---|---|---|
Main diagnosis (n, %) | ||||||||
Schizophrenia (F20) | 38,216 | (42.7) | 38,216 | (100.0) | ||||
Schizotypal disorder (F21) | 229 | (0.3) | 229 | (1.1) | ||||
Persistent delusional disorder (F22) | 3,605 | (4.0) | 3,605 | (16.8) | ||||
Acute and transient psychotic disorder (F23) | 6,446 | (7.2) | 6,446 | (30.1) | ||||
Induced delusional disorder (F24) | 66 | (0.1) | 66 | (0.3) | ||||
Schizoaffective disorders (F25) | 8,200 | (9.2) | 8,200 | (38.3) | ||||
Other nonorganic psychotic disorders (F28) | 268 | (0.3) | 268 | (1.3) | ||||
Unspecified nonorganic psychosis (F29) | 2,601 | (2.9) | 2,601 | (12.1) | ||||
Manic episode (F30) | 2,777 | (3.1) | 2,777 | (9.3) | ||||
Bipolar affective disorder (F31) | 27,102 | (30.3) | 27,102 | (90.7) | ||||
Age (n, %) | ||||||||
Age up to 25 | 8,224 | (9.2) | 3,893 | (10.2) | 2,795 | (13.1) | 1,536 | (5.1) |
Age 25-34 | 17,951 | (20.1) | 9,213 | (24.1) | 4,623 | (21.6) | 4,115 | (13.8) |
Age 35-44 | 22,116 | (24.7) | 10,308 | (27.0) | 5,094 | (23.8) | 6,714 | (22.5) |
Age 45-54 | 17,997 | (20.1) | 7,298 | (19.1) | 3,824 | (17.9) | 6,875 | (23.0) |
Age 55-64 | 11,652 | (13.0) | 4,194 | (11.0) | 2,281 | (10.7) | 5,177 | (17.3) |
Age 65-74 | 7,110 | (7.9) | 2,203 | (5.8) | 1,402 | (6.5) | 3,505 | (11.7) |
Age 75 and over | 4,460 | (5.0) | 1,107 | (2.9) | 1,396 | (6.5) | 1,957 | (6.5) |
Gender (n, %) | ||||||||
Female | 42,589 | (47.6) | 13,217 | (34.6) | 11,292 | (52.7) | 18,080 | (60.5) |
Male | 46,921 | (52.4) | 24,999 | (65.4) | 10,123 | (47.3) | 11,799 | (39.5) |
Detention status (n, %) | ||||||||
Not detained | 72,273 | (80.7) | 30,554 | (80.0) | 17,039 | (79.6) | 24,680 | (82.6) |
Detained | 17,237 | (19.3) | 7,662 | (20.0) | 4,376 | (20.4) | 5,199 | (17.4) |
Ethnicity (n, %) | ||||||||
White | 67,980 | (75.9) | 27,330 | (71.5) | 15,841 | (74.0) | 24,809 | (83.0) |
Mixed | 1,822 | (2.0) | 948 | (2.5) | 443 | (2.1) | 431 | (1.4) |
Asian | 6,728 | (7.5) | 3,290 | (8.6) | 1,684 | (7.9) | 1,754 | (5.9) |
Black | 8,898 | (9.9) | 5,051 | (13.2) | 2,172 | (10.1) | 1,675 | (5.6) |
Unknown or missing | 4,082 | (4.6) | 1,597 | (4.2) | 1,275 | (6.0) | 1,210 | (4.0) |
Patient has a carer (n, %) | ||||||||
No | 83,426 | (93.2) | 35,647 | (93.3) | 19,958 | (93.2) | 27,821 | (93.1) |
Yes | 6,084 | (6.8) | 2,569 | (6.7) | 1,457 | (6.8) | 2,058 | (6.9) |
Patient was previously treated for mental health issues (n, %) | ||||||||
No | 48,126 | (53.8) | 19,377 | (50.7) | 12,803 | (59.8) | 15,946 | (53.4) |
Yes | 41,384 | (46.2) | 18,839 | (49.3) | 8,612 | (40.2) | 13,933 | (46.6) |
Alcohol and substance misuse (n, %) | ||||||||
No | 84,786 | (94.7) | 35,797 | (93.7) | 20,304 | (94.8) | 28,685 | (96.0) |
Yes | 4,724 | (5.3) | 2,419 | (6.3) | 1,111 | (5.2) | 1,194 | (4.0) |
Co-morbid personality disorder (n, %) | ||||||||
No | 88,329 | (98.7) | 37,800 | (98.9) | 21,077 | (98.4) | 29,452 | (98.6) |
Yes | 1,181 | (1.3) | 416 | (1.1) | 338 | (1.6) | 427 | (1.4) |
Number of comorbidities (mean, sd) | 0.43 | (1.0) | 0.39 | (1.0) | 0.47 | (1.1) | 0.45 | (1.1) |
Discharge type (n, %) | ||||||||
Discharged by consultant | 87,063 | (97.3) | 37,148 | (97.2) | 20,790 | (97.1) | 29,125 | (97.5) |
Self-discharged | 2,017 | (2.3) | 902 | (2.4) | 525 | (2.5) | 590 | (2.0) |
Died in hospital | 430 | (0.5) | 166 | (0.4) | 100 | (0.5) | 164 | (0.5) |
Resident in urban area (n, %) | ||||||||
No | 8,959 | (10.0) | 2,782 | (7.3) | 2,251 | (10.5) | 3,926 | (13.1) |
Yes | 80,551 | (90.0) | 35,434 | (92.7) | 19,164 | (89.5) | 25,953 | (86.9) |
Percentage mental health benefit claimants in local community (mean, sd) | 2 | (1.6) | 2.51 | (1.7) | 2.23 | (1.6) | 2.03 | (1.5) |
Percentage population of local community resident in NHS psychiatric establishment (mean, sd) | 0 | (0.3) | 0.03 | (0.4) | 0.02 | (0.3) | 0.02 | (0.3) |
GP quality - % practice population with SMI with care plan (mean, sd) | 1 | (0.1) | 0.84 | (0.1) | 0.85 | (0.1) | 0.84 | (0.1) |
GP access - % practice population able to see GP within 48 h (mean, sd) | 1 | (0.1) | 0.82 | (0.1) | 0.82 | (0.1) | 0.83 | (0.1) |
Data sources
Data
Exclusions
Analysis
Results
Descriptive analysis
All (F20-F31) (1) | Schizophrenia (F20) (2) | Psychotic and schizoaffective disorder (F21-F29) (3) | Manic and bipolar disorder (F30-F31) (4) | |||||
---|---|---|---|---|---|---|---|---|
Financial year | Mean | SD | Mean | SD | Mean | SD | Mean | SD |
2006/07 | 44.4 | 40.0 | 48.0 | 43.3 | 41.6 | 38.5 | 41.6 | 35.7 |
2007/08 | 43.3 | 39.7 | 47.0 | 42.7 | 40.8 | 38.5 | 40.2 | 35.9 |
2008/09 | 45.0 | 40.1 | 49.0 | 42.9 | 42.1 | 39.1 | 42.2 | 36.7 |
2009/10 | 43.7 | 39.6 | 47.7 | 42.7 | 40.6 | 37.8 | 41.1 | 36.3 |
2010/11 | 42.7 | 38.4 | 46.1 | 40.9 | 40.2 | 37.5 | 40.5 | 35.7 |
Pooled | 43.9 | 39.7 | 47.7 | 42.7 | 41.1 | 38.3 | 41.2 | 36.1 |
Estimation results - overview
Pooled (F20-F31) (1) | Schizophrenia (F20) (2) | Psychotic and schizoaffective disorder (F21-F29) (3) | Manic and bipolar disorder (F30-F31) (4) | |||||
---|---|---|---|---|---|---|---|---|
Variable | APE | SE | APE | SE | APE | SE | APE | SE |
Main diagnosis | ||||||||
Schizophrenia (F20) | (base category) | (base category) | ||||||
Schizotypal disorder (F21) | −4.16 | 0.71*** | (base category) | |||||
Persistent delusional disorder (F22) | −19.56 | 1.04*** | −2.12 | 2.86 | ||||
Acute and transient psychotic disorder (F23) | −11.57 | 4.69* | −17.20 | 2.15*** | ||||
Induced delusional disorder (F24) | 0.75 | 0.52 | −9.34 | 5.65 | ||||
Schizoaffective disorders (F25) | −11.67 | 2.32*** | 3.78 | 3.18 | ||||
Other nonorganic psychotic disorders (F28) | −11.42 | 1.10*** | −9.29 | 3.79* | ||||
Unspecified nonorganic psychosis (F29) | −6.36 | 0.48*** | −9.03 | 2.69*** | ||||
Manic episode (F30) | −3.02 | 2.80 | (base category) | |||||
Bipolar affective disorder (F31) | −12.57 | 1.01*** | 7.42 | 1.27*** | ||||
Patient demographics and clinical characteristics | ||||||||
Age 25-34 | −1.63 | 0.61** | −1.72 | 0.81* | −0.93 | 1.13 | −2.64 | 1.44 |
Age 35-44 | −3.54 | 0.53*** | −3.84 | 0.76*** | −3.68 | 1.10*** | −3.65 | 1.37** |
Age 45-54 | −2.25 | 0.59*** | −3.22 | 0.98*** | −2.25 | 1.00* | −0.66 | 1.42 |
Age 55-64 | 1.64 | 0.63** | −0.49 | 0.98 | 4.56 | 1.35*** | 4.31 | 1.80* |
Age 65-74 | 10.88 | 1.23*** | 6.21 | 1.60*** | 14.39 | 2.33*** | 18.55 | 3.01*** |
Age 75 and over | 18.64 | 1.57*** | 11.60 | 2.45*** | 25.57 | 3.84*** | 27.45 | 3.73*** |
Male | −0.41 | 0.38 | −1.35 | 0.53* | −0.62 | 0.62 | 0.72 | 0.77 |
Detained | 15.98 | 1.17*** | 19.48 | 1.81*** | 14.72 | 2.26*** | 16.51 | 1.76*** |
Ethnicity: mixed | 2.31 | 0.99* | 0.57 | 1.49 | 3.65 | 1.80* | 7.74 | 3.45* |
Ethnicity: Asian | 0.69 | 0.64 | 0.68 | 0.82 | 1.92 | 1.42 | −0.45 | 0.89 |
Ethnicity: black | 4.46 | 0.63*** | 5.28 | 0.93*** | 3.99 | 1.25** | 4.88 | 1.70** |
Ethnicity: unknown or missing | −0.77 | 0.72 | 0.10 | 1.21 | −0.81 | 1.17 | −2.31 | 1.87 |
Patient has a carer | 3.16 | 1.14** | 3.19 | 1.35* | 1.44 | 1.64 | 5.50 | 2.22* |
Patient was previously treated for mental health issues | −1.00 | 0.76 | −2.51 | 0.94** | 0.15 | 0.94 | 0.41 | 1.22 |
MH benefit claimants - 2nd quintile | 0.63 | 0.41 | −0.07 | 0.62 | 1.12 | 0.94 | 1.32 | 0.75 |
MH benefit claimants - 3rd quintile | 1.41 | 0.47** | 0.59 | 0.67 | 1.24 | 1.00 | 3.14 | 0.97** |
MH benefit claimants - 4th quintile | 2.43 | 0.78** | 1.41 | 0.99 | 1.75 | 1.28 | 5.76 | 1.09*** |
MH benefit claimants - 5th quintile | 2.65 | 0.68*** | 1.11 | 0.88 | 3.03 | 1.34* | 6.08 | 1.13*** |
Number of comorbidities | 1.17 | 0.33*** | 1.04 | 0.35** | 1.29 | 0.36*** | 1.53 | 0.53** |
Alcohol and substance misuse | −4.21 | 0.67*** | −4.96 | 1.05*** | −2.40 | 1.38 | −5.10 | 1.50*** |
Co-morbid personality disorder | −7.81 | 1.30*** | −9.14 | 2.19*** | −7.18 | 2.91* | −9.46 | 2.19*** |
Discharge | ||||||||
Self-discharged | −19.99 | 1.85*** | −19.24 | 2.48*** | −20.37 | 3.11*** | −29.17 | 2.76*** |
Died in hospital | −3.30 | 1.64* | −3.56 | 2.73 | −0.96 | 4.12 | −6.03 | 3.09 |
Access to care | ||||||||
Urban | 0.41 | 0.61 | −0.10 | 0.91 | 0.67 | 1.02 | 1.20 | 1.06 |
% residents of local community in psychiatric establishment | −0.04 | 0.41 | 0.11 | 0.52 | 0.01 | 1.30 | −0.41 | 0.87 |
Ability to access GP within 48 h | −0.54 | 1.12 | 0.10 | 1.73 | −2.74 | 2.68 | 0.10 | 2.79 |
Care plan developed in primary care | −1.01 | 0.95 | −2.18 | 1.57 | 2.92 | 2.16 | −1.70 | 2.23 |
Time effects | ||||||||
Year 2007 | −1.18 | 0.97 | −1.25 | 1.17 | −1.27 | 1.45 | −1.77 | 1.34 |
Year 2008 | 0.22 | 0.86 | 0.49 | 1.06 | −0.44 | 1.19 | 0.43 | 1.37 |
Year 2009 | −1.47 | 0.99 | −1.34 | 1.33 | −2.30 | 1.20 | −1.79 | 1.33 |
Year 2010 | −3.08 | 1.15** | −3.50 | 1.45* | −3.67 | 1.44* | −3.22 | 1.78 |
Pseudo-R2 | 0.061 | 0.046 | 0.091 | 0.050 | ||||
N | 89,510 | 38,216 | 21,415 | 29,879 |
Pooled (F20-F31) (1) | Schizophrenia (F20) (2) | Psychotic and schizoaffective disorder (F21-F29) (3) | Manic and bipolar disorder (F30-F31) (4) | |||||
---|---|---|---|---|---|---|---|---|
Variable | IRR | 95 % CI | IRR | 95 % CI | IRR | 95 % CI | IRR | 95 % CI |
Main diagnosis | ||||||||
Schizophrenia (F20) | (base category) | (base category) | ||||||
Schizotypal disorder (F21) | 0.91 | (0.88; 0.94) | (base category) | |||||
Persistent delusional disorder (F22) | 0.64 | (0.62; 0.66) | 0.96 | (0.84; 1.08) | ||||
Acute and transient psychotic disorder (F23) | 0.77 | (0.62; 0.95) | 0.69 | (0.61; 0.78) | ||||
Induced delusional disorder (F24) | 1.02 | (0.99; 1.04) | 0.82 | (0.63; 1.05) | ||||
Schizoaffective disorders (F25) | 0.77 | (0.69; 0.85) | 1.09 | (0.96; 1.23) | ||||
Other nonorganic psychotic disorders (F28) | 0.77 | (0.74; 0.81) | 0.82 | (0.68; 0.98) | ||||
Unspecified nonorganic psychosis (F29) | 0.87 | (0.85; 0.88) | 0.82 | (0.72; 0.94) | ||||
Manic episode (F30) | 0.93 | (0.82; 1.06) | (base category) | |||||
Bipolar affective disorder (F31) | 0.75 | (0.72; 0.78) | 1.14 | (1.10; 1.18) | ||||
Patient demographics and clinical characteristics | ||||||||
Age 25-34 | 0.99 | (0.93; 1.04) | 1.00 | (0.91; 1.10) | 1.01 | (0.93; 1.10) | 0.96 | (0.89; 1.03) |
Age 35-44 | 0.94 | (0.90; 0.99) | 0.95 | (0.88; 1.03) | 0.94 | (0.86; 1.02) | 0.95 | (0.88; 1.02) |
Age 45-54 | 0.99 | (0.94; 1.03) | 0.98 | (0.91; 1.07) | 0.98 | (0.91; 1.05) | 1.00 | (0.93; 1.08) |
Age 55-64 | 1.10 | (1.05; 1.16) | 1.06 | (0.97; 1.15) | 1.17 | (1.07; 1.27) | 1.12 | (1.04; 1.21) |
Age 65-74 | 1.32 | (1.25; 1.39) | 1.23 | (1.12; 1.34) | 1.40 | (1.30; 1.52) | 1.37 | (1.26; 1.48) |
Age 75 and over | 1.50 | (1.41; 1.60) | 1.34 | (1.22; 1.48) | 1.63 | (1.47; 1.81) | 1.56 | (1.41; 1.72) |
Male | 1.06 | (1.00; 1.12) | 1.04 | (0.95; 1.13) | 1.05 | (0.96; 1.16) | 1.06 | (0.99; 1.14) |
Detained | 1.41 | (1.35; 1.47) | 1.52 | (1.45; 1.60) | 1.35 | (1.28; 1.42) | 1.31 | (1.25; 1.37) |
Ethnicity: mixed | 1.07 | (1.01; 1.13) | 1.05 | (0.97; 1.14) | 1.09 | (0.99; 1.19) | 1.10 | (0.99; 1.23) |
Ethnicity: Asian | 1.03 | (0.99; 1.06) | 1.04 | (0.99; 1.09) | 1.04 | (0.97; 1.12) | 1.01 | (0.97; 1.05) |
Ethnicity: black | 1.12 | (1.09; 1.15) | 1.15 | (1.10; 1.20) | 1.11 | (1.05; 1.17) | 1.11 | (1.04; 1.17) |
Ethnicity: unknown or missing | 0.99 | (0.95; 1.03) | 1.03 | (0.96; 1.09) | 0.97 | (0.91; 1.04) | 0.95 | (0.88; 1.02) |
Interaction: Detained + Ethnicity: mixed | 0.94 | (0.84; 1.06) | 0.85 | (0.74; 0.98) | 0.98 | (0.80; 1.20) | 1.14 | (0.92; 1.41) |
Interaction: Detained + Ethnicity: Asian | 0.95 | (0.89; 1.02) | 0.91 | (0.83; 1.00) | 1.00 | (0.91; 1.11) | 0.93 | (0.83; 1.05) |
Interaction: Detained + Ethnicity: black | 0.93 | (0.88; 0.98) | 0.90 | (0.85; 0.96) | 0.91 | (0.84; 0.99) | 0.91 | (0.84; 0.98) |
Interaction: Detained + Ethnicity: unknown or missing | 0.99 | (0.92; 1.06) | 0.91 | (0.82; 1.01) | 1.03 | (0.92; 1.16) | 1.05 | (0.90; 1.22) |
Patient has a carer | 1.07 | (1.02; 1.12) | 1.07 | (1.01; 1.13) | 1.03 | (0.96; 1.10) | 1.10 | (1.03; 1.17) |
Patient was previously treated for mental health issues | 0.98 | (0.94; 1.01) | 0.95 | (0.91; 0.99) | 1.00 | (0.96; 1.04) | 1.01 | (0.97; 1.05) |
MH benefit claimants - 2nd quintile | 1.01 | (1.00; 1.03) | 1.00 | (0.97; 1.03) | 1.03 | (0.99; 1.07) | 1.02 | (1.00; 1.05) |
MH benefit claimants - 3rd quintile | 1.03 | (1.01; 1.06) | 1.01 | (0.98; 1.04) | 1.03 | (0.99; 1.07) | 1.06 | (1.02; 1.09) |
MH benefit claimants - 4th quintile | 1.06 | (1.02; 1.09) | 1.03 | (0.99; 1.08) | 1.04 | (0.99; 1.09) | 1.11 | (1.07; 1.14) |
MH benefit claimants - 5th quintile | 1.06 | (1.03; 1.09) | 1.03 | (0.99; 1.07) | 1.07 | (1.01; 1.13) | 1.11 | (1.07; 1.15) |
Number of comorbidities | 1.03 | (1.01; 1.04) | 1.02 | (1.01; 1.04) | 1.03 | (1.01; 1.04) | 1.03 | (1.01; 1.05) |
Alcohol and substance misuse | 0.90 | (0.88; 0.93) | 0.89 | (0.85; 0.93) | 0.95 | (0.89; 1.01) | 0.91 | (0.86; 0.96) |
Co-morbid personality disorder | 0.82 | (0.77; 0.88) | 0.80 | (0.71; 0.90) | 0.84 | (0.73; 0.97) | 0.84 | (0.77; 0.91) |
Discharge | ||||||||
Self-discharged | 0.55 | (0.49; 0.62) | 0.57 | (0.50; 0.66) | 0.56 | (0.48; 0.66) | 0.50 | (0.44; 0.57) |
Died in hospital | 0.93 | (0.86; 1.00) | 0.92 | (0.81; 1.05) | 0.98 | (0.82; 1.17) | 0.90 | (0.80; 1.01) |
Access to care | ||||||||
Urban | 1.01 | (0.98; 1.04) | 1.00 | (0.96; 1.04) | 1.01 | (0.97; 1.06) | 1.02 | (0.99; 1.06) |
% residents of local community in psychiatric establishment | 1.00 | (0.98; 1.02) | 1.00 | (0.98; 1.03) | 1.00 | (0.95; 1.06) | 0.99 | (0.96; 1.02) |
Ability to access GP within 48 h | 0.99 | (0.94; 1.04) | 1.00 | (0.93; 1.08) | 0.94 | (0.83; 1.06) | 1.00 | (0.91; 1.10) |
Care plan developed in primary care | 0.98 | (0.94; 1.02) | 0.95 | (0.89; 1.02) | 1.07 | (0.98; 1.16) | 0.97 | (0.90; 1.05) |
Time effects | ||||||||
Year 2007 | 0.97 | (0.93; 1.02) | 0.97 | (0.92; 1.02) | 0.97 | (0.92; 1.03) | 0.97 | (0.93; 1.02) |
Year 2008 | 1.00 | (0.97; 1.04) | 1.01 | (0.97; 1.06) | 0.99 | (0.94; 1.04) | 1.01 | (0.96; 1.05) |
Year 2009 | 0.97 | (0.92; 1.01) | 0.97 | (0.92; 1.03) | 0.95 | (0.91; 1.00) | 0.97 | (0.93; 1.01) |
Year 2010 | 0.93 | (0.88; 0.98) | 0.92 | (0.86; 0.99) | 0.92 | (0.87; 0.98) | 0.95 | (0.89; 1.01) |
Pseudo-R2 | 0.061 | 0.046 | 0.091 | 0.050 | ||||
N | 89,510 | 38,216 | 21,415 | 29,879 |