Patterns of psychiatric admissions and predictors of patient’s outcome in Jimma University Teaching and Referral Hospital: a retrospective study

A retrospective review of patient admissions to the psychiatric unit at Jimma University Teaching Hospital (JUTH) September 2012 to September 2015 was conducted. The data retrieved from standard Health Management Information System (HMIS) logbook. The hospital is located in Jimma City, 357 km away from Addis Ababa, in the southwest part of Ethiopia. It is a referral centre for the southwestern part of Ethiopia, and currently, the only teaching and referral hospital in the southwestern part of the country. It provides services for approximately 9000 inpatient and 80,000 outpatient attendances a year who are visiting the hospital from the catchment population. The psychiatric facility gives both outpatient and inpatient services for more than 30 million populations, which served a huge bulk of the community next to Paulos Hospital in Addis Ababa Ethiopia concerning Psychiatry health facility.

A total of 410 psychiatric admissions were recorded in the registration book for the period traversing September 2012 to September 2015. Out of 410 admissions reviewed, detailed documentation was available for 402 admissions. The psychiatry resident students under the supervision of a psychiatrist recorded the preliminary data in English. Data was charted on a structured paper format developed for the purpose of this study by the psychiatry residents and under the supervision of a clinical officer in mental health. The data was then coded and entered into the statistical software. Recorded data included, socio-demographic characteristics, place of residence, duration of admission (in days), whether the patient had to pay for the hospital care, diagnosis on discharge, and outcome at discharge (improved, absconded, no change and deceased). The Diagnostic Statistical Manual 4th revision (DSM-IV) diagnoses were categorised into: schizophrenia (including schizophreniform, schizoaffective, delusional disorder and psychotic disorder not otherwise specified), bipolar disorder, major depressive disorder, brief psychotic disorder, and other mental disorders. A psychiatrist assessed outcome at discharge using the clinical global impression (CGI). Co-morbidities such as medical–surgical conditions, substance use disorders, and extrapyramidal side effects were also documented. The use of khat (a commonly abused stimulant substance) was also highlighted. Extra pyramidal side effects included neuroleptic induced Parkinsonism, dystonia, akathisia and tardive dyskinesias.

Data were collected using checklists and questionnaire adopted from previously done research at Amanual Hospital, Addis Ababa to collect the required information for this study purpose. Two psychiatry resident students collected data for 5 days who are familiar with the medical records and that have an experience in data collection. The principal investigators trained data collectors for 1 day about the objective and purpose of the study. The quality of the data collection was monitored by giving clear instructions to data collectors, checking sample filled questionnaire and checklists checked by the principal investigators at daily bases and instance instruction was given on the spot if any incomplete or mistake appeared as well as through double entry of the collected data.

The Ethical Review Board of College of Health Science, Jimma University granted ethical approval. The data was collected with no personal identifiers at all stage of the study.

Concerning the previous admission history of patients, 311 (77. 4%) of them were not previously admitted to the psychiatric treatment facility. Among those 402 study participants’ case and diagnosis history, the diagnosis of admission was bipolar disorder which accounts 104 (25.9%), followed by depression and anxiety 101 (25.1%).

The mean length of health facility admission stay was 34 (SD ± 20.7) days with a minimum 1 day and maximum 152 days after admission to the psychiatry admission ward. Proportionally, 103 (25.6%) of them were within 31–44, followed by 102 (25.4%) of them were stayed within the range of 1–20 days and the remaining, 98 (24.4%) stayed 44 days or more and 98 (24.4%) were stayed 20–31 days (Table 1).

In order to predict the likelihood of the outcomes of the admission of the psychiatry cases, multiple logistic regression was used and the overall model to predict probability of improving patients psychiatric cases in respondents was statistically significant [−2Loglikelyhood = 231.808, X² = 109.749, df = 11 with a P value <0.0001] and the overall prediction of the model was 80.5%.

In multiple logistic regression patients with educational status being at 1–8th-grade level had 1.34 times more likely to improve than those patients who are not able to read or write [AOR = 1.34, 95% CI (1.18–2.78), P < 0.009)]. Nevertheless, those patients in 7–12th grade or above 12th grade had no statistical association with the outcomes. The odds ratio for marital status indicates the probability of client’s psychiatric improvements among married patients were 2.81 times more likely to improve than patients who were single [AOR = 2.81, CI (1.90–4.50), P < 0.043)]. However, those widowed and divorced patients had no statistical association with client’s psychiatric improvement status.

The probability improvements in psychiatric admitted patients, on those patients who were not previously admitted, had 2.82 times more likely improved than patients who had previous admissions history, [AOR = 2.82, CI (2.05–3.17), P < 0.034]. The odds ratio of patients’ length of stay indicated that, the probability of client’s psychiatric improvement on patients who were stayed in the range of 31–44 days in the psychiatric clinic were found 1.88 times more likely than those patients who stayed in the range of 1–20 days, [AOR = 1.88, CI = (1.42–2.65), P < 0.035)]. However, admission stay for more than 44 days did not show any statistical association with the patient’s improvement status (Table 2).