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Social Psychiatry and Psychiatric Epidemiology

, Volume 54, Issue 11, pp 1411–1417 | Cite as

Identifying patterns in psychiatric hospital stays with statistical methods: towards a typology of post-deinstitutionalization hospitalization trajectories

  • Philippe GolayEmail author
  • Stéphane Morandi
  • Philippe Conus
  • Charles Bonsack
Original Paper

Abstract

Purpose

Over the past 50 years, deinstitutionalization changed the face of psychiatry. However, outpatient treatment in the community does not always fit the needs of those who left institutions and sometimes leads to frequent re-hospitalizations, a mechanism known as the “revolving door” phenomenon. The study aim was to identify different typologies of hospitalization trajectories.

Methods

Records of 892 inpatients from the Department of Psychiatry of Lausanne University Hospital were analyzed over a 3-year period with discrete sequential-state analysis.

Results

Trajectories could be split between atypical users (4.9% of patients totalling 30.6% of hospital days) and regular users. Within the atypical users group, three categories were identified: “Permanent stays” (3 patients totalling 6.3% of hospital days), “long stays” (1.7% patients/8.6% hospital days) and “revolving door” stays (2.9% patients/15.8% hospital days). The remaining 95.1% of the patients were classified into “unique episodes” (70.0% patients/24.5% hospital days) and “repeated episodes” (25.0% patients/44.9% hospital days). Diagnoses of schizophrenia were overrepresented among heavy users.

Conclusions

Most patients went through a unique or low number of brief hospital admissions over the 3 years of the study. While the shift of previously institutionalized individuals towards high users of psychiatric hospital seems limited, this phenomenon should not be neglected since 4.9% of patients use about a third of hospital beds. Early identification of problematic profiles could allow the implementation of relapse prevention strategies and facilitate the development of alternatives to hospitalization such as assertive community treatment or housing first programs.

Keywords

Psychiatric hospitalization Patterns Revolving door phenomenon Re-hospitalization 

Notes

Funding

This study was based on institutional funding.

Compliance with ethical standards

Conflict of interest

The authors have declared that there are no conflicts of interest in relation to the subject of the study.

References

  1. 1.
    Zusman J, Friedman RM, Levin BL (1988) Moving treatment into the community: implications for psychiatry. Psychiatr Q 59(2):140–149CrossRefGoogle Scholar
  2. 2.
    Cohen S (1985) Visions of social control: crime, punishment and classification. Polity Press, CambridgeGoogle Scholar
  3. 3.
    McDonnell E, Bartholomew T (1997) Community treatment orders in Victoria: emergent issues and anomalies. Psychiatry Psychol Law 4(1):25–36CrossRefGoogle Scholar
  4. 4.
    Lamb HR, Bachrach LL (2001) Some perspectives on deinstitutionalization. Psychiatr Serv 52(8):1039–1045CrossRefGoogle Scholar
  5. 5.
    H + . Les Grandes tendances de la psychiatrie (2017). http://www.hplus.ch/fr/chiffres_faits/moniteur_des_hopitaux_et_cliniques_de_h/psychiatrie/. Accessed 15 Sept 2017
  6. 6.
    Gabadinho A, Ritschard G, Mueller NS, Studer M (2011) Analyzing and visualizing state sequences in R with TraMineR. J Stat Softw 40(4):1–37CrossRefGoogle Scholar
  7. 7.
    Gabadinho A, Ritschard G, Studer M, Müller NS (2009) Mining sequence data in R with the TraMineR package: a users guide for version 1.2. University of Geneva, GenevaGoogle Scholar
  8. 8.
    Gabadinho A, Ritschard G, Studer M, Müller NS (eds) (2009) Extracting and rendering representative sequences. In: International joint conference on knowledge discovery, knowledge engineering, and knowledge management. Springer, BerlinGoogle Scholar
  9. 9.
    Lewis T, Joyce PR (1990) The new revolving-door patients: results from a national cohort of first admissions. Acta Psychiatr Scand 82(2):130–135CrossRefGoogle Scholar
  10. 10.
    Haywood TW, Kravitz HM, Grossman LS, Cavanaugh JL Jr (1995) Predicting the” revolving door” phenomenon among patients with schizophrenic, schizoaffective, and affective disorders. Am J Psychiatry 152(6):856CrossRefGoogle Scholar
  11. 11.
    Hiday VA, Scheid-Cook TL (1991) Outpatient commitment for “revolving door” patients: compliance and treatment. J Nerv Ment Dis 179(2):83–88CrossRefGoogle Scholar
  12. 12.
    Jeppesen R, Christensen T (2017) Changes in utilization of psychiatric hospital facilities in Denmark by patients diagnosed with Schizophrenia from 1970 through 2012: the advent of ‘revolving door’patients. Eur Psychiatry. 41:S159–S160CrossRefGoogle Scholar
  13. 13.
    Randall JR, Vokey S, Loewen H, Martens PJ, Brownell M, Katz A et al (2015) A systematic review of the effect of early interventions for psychosis on the usage of inpatient services. Schizophr Bull 41(6):1379–1386CrossRefGoogle Scholar
  14. 14.
    Clausen H, Ruud T, Odden S, Šaltytė Benth J, Heiervang KS, Stuen HK et al (2016) Hospitalisation of severely mentally ill patients with and without problematic substance use before and during Assertive Community Treatment: an observational cohort study. BMC Psychiatry 16:125CrossRefGoogle Scholar
  15. 15.
    Clausen H, Landheim A, Odden S, Šaltytė Benth J, Heiervang KS, Stuen HK et al (2016) Hospitalization of high and low inpatient service users before and after enrollment into Assertive Community Treatment teams: a naturalistic observational study. Int J Ment Health Syst 10(1):14CrossRefGoogle Scholar
  16. 16.
    Gulcur L, Stefancic A, Shinn M, Tsemberis S, Fischer SN (2003) Housing, hospitalization, and cost outcomes for homeless individuals with psychiatric disabilities participating in continuum of care and housing first programmes. J Community Appl Soc Psychol 13(2):171–186CrossRefGoogle Scholar
  17. 17.
    Golay P, Conus P, Bonsack C (2017) Variabilité des trajectoires d’hospitalisation en psychiatrie : analyses de séquences discrètes. Variability of hospitalization trajectories in psychiatry: discrete sequence analysis. 6èmes Journées MODEVAIIA (MODElisation de la VAriabilité Inter et IntrAindividuelle); MarcevolGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Service of Community Psychiatry, Department of PsychiatryLausanne University Hospital and University of LausanneLausanneSwitzerland
  2. 2.Service of General PsychiatryLausanne University Hospital and University of LausanneLausanneSwitzerland

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