Hospitalisation and length of hospital stay following first-episode psychosis: systematic review and meta-analysis of longitudinal studies.
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.
National Institute for Health Research (NIHR) Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King’s College London. National Institute for Health Research (NIHR) (NIHR Post-Doctoral Fellowship - PDF-2018-11-ST2-020) NIHR Maudsley BRC. Health Education England and the National Institute for Health Research HEE/NIHR ICA Programme Clinical Lectureship (ICA-CL- 2017-03-001). National Institute for Health Research Collaboration for Leadership in Applied Health Research & Care Funding scheme with support from the National Institute for Health Research (NIHR) Biomedical Research Centre at South London and Maudsley NHS Foundation Trust. Stanley Medical Research Institute)
CommentsThis article has been published in a revised form in Psychological Medicine. https://doi.org/10.1017/S0033291719000904 This version is free to view and download for private research and study only. Not for re-distribution, re-sale or use in derivative works. © copyright holder. http://www.cambridge.org/about-us/legal-notices/copyright/
Published CitationAjnakina O, Stubbs B, Francis E, Gaughran F, David AS, Murray RM, Lally J. Hospitalisation and length of hospital stay following first-episode psychosis: systematic review and meta-analysis of longitudinal studies. Psychological Medicine. 2019;6:1-11
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