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Hospitalisation and length of hospital stay following first-episode psychosis: systematic review and meta-analysis of longitudinal studies

Published online by Cambridge University Press:  06 May 2019

Olesya Ajnakina Open the ORCID record for Olesya Ajnakina [Opens in a new window] ,
Brendon Stubbs ,
Emma Francis ,
Fiona Gaughran ,
Anthony S. David ,
Robin M. Murray  and
John Lally
Olesya Ajnakina*
Affiliation:
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
Brendon Stubbs
Affiliation:
Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK Physiotherapy Department, South London and Maudsley NHS Foundation Trust, London, UK
Emma Francis
Affiliation:
Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
Fiona Gaughran
Affiliation:
Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK National Psychosis Service, South London and Maudsley NHS Foundation Trust, London, UK
Anthony S. David
Affiliation:
Institute of Mental Health, University College London, London, UK
Robin M. Murray
Affiliation:
Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK Department of Psychiatry, Experimental Biomedicine and Clinical Neuroscience (BIONEC), University of Palermo, PalermoPA, Italy
John Lally
Affiliation:
Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland Department of Psychiatry, School of Medicine and Medical Sciences, University College Dublin, St Vincent's University Hospital, Dublin, Ireland
*
Author for correspondence: Olesya Ajnakina, E-mail: [email protected]
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Abstract

Background

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.

Methods

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.

Results

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.

Conclusion

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.

Keywords

First episode psychosisfollow-uphospitalisationinpatientlength of stayoutcomeschizophrenia
Type
Original Articles
Information
Psychological Medicine , Volume 50 , Issue 6 , April 2020 , pp. 991 - 1001
Copyright
Copyright © Cambridge University Press 2019

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