Background During the last three decades, in high-income countries, a transition from institutional psychiatric care to community care and a reduction in the hospital length of stay has taken place to provide community care and promote patients’ social integration. However, the impact of length of stay in psychiatric inpatient unit on the different dimensions of patients’ social integration remains unclear. The aim of this study is to determine whether longer length of stay in psychiatric inpatient unit decreases the social integration of Severe Mentally-Ill (SMI) patients.
Methods Within the European COFI study (prospective cohort study), data were collected for 7302 SMI patients hospitalised in 2015 in the UK, Italy, Germany, Poland and Belgium. Social integration was measured using the SIX index in baseline and at one year of follow-up. The SIX index includes the following dimensions of social integration: employment, housing, living situation and contacts with friends. Correlation and regressions models were performed to test the association between length of stay in psychiatric inpatient unit and patients’ social integration.
Results The average score of social integration of SMI patients in baseline was 3.8/6 (SD=1.39) and decreased by −0.14 (SD=1.29) one year later. We found a small but significant negative correlation between length of stay in hospital and social integration of patients at one year (r=-0.04, p=0.03). This association remained significant when adjusting for patient characteristics and hospitals as a random intercept. At one year, the most correlated dimensions of social integration with length of stay were housing (β=– 6.3, p<0.0001) and employment (β=– 1.8, p=0.01).
Conclusion This study supports the importance of policies and interventions to reduce the length of stay in psychiatric inpatient unit for SMI patients to preserve their social integration. Housing and employment are the main dimensions of social integration negatively impacted by length of stay. Therefore, special attention must be given to help SMI patients to find and retain housing and employment during psychiatric hospitalisations.
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