Schizophrenia and schizoaffective disorder: Length of stay and associated factors

Abstract

Background: Patients with schizophrenia and schizoaffective disorder often require longer admissions.Aim: To explore length of stay (LOS) and associated factors of patients with schizophrenia and schizoaffective disorder, admitted to a public sector specialised psychiatric hospital, over a 4-year period.Setting: The study was conducted at Tara Hospital in Johannesburg.Methods: A retrospective record review of 367 adult schizophrenia and schizoaffective disorder patients admitted between 01 January 2015 and 31 December 2018. Average LOS was calculated and the proportion of short-stay ( 30 days), medium-stay (31–90 days) and long-stay ( 90 days) admissions determined. Sociodemographic, clinical and admission outcome data were collected and analysed from a randomly selected subset of patients in each LOS category.Results: Mean LOS was 128 days (median 87, interquartile range [IQR] 49–164, range 0–755 days). A significantly greater proportion had long-stay admissions (p 0.001). Male gender (p = 0.018), being unmarried (p = 0.006), treatment resistant (p 0.001) and on clozapine (p = 0.009) were factors found to have a significant association with long-stay admissions. Rates of unemployment ( 80%), comorbid substance use disorders ( 40%), medical illnesses ( 40%), antipsychotic polypharmacy ( 40%) and readmissions ( 80%) were high. Most ( 80%) were discharged.Conclusion: Long-stay admissions were frequently required for patients with schizophrenia and schizoaffective disorder admitted to Tara Hospital.Contribution: This study highlights factors associated with long-stay admissions in patients with schizophrenia and schizoaffective disorder. More research is needed into whether increased access to community-based services, such as residential and daycare facilities, outpatient substance rehabilitation programmes and dual diagnosis clinics, could translate into shorter admissions, less frequent relapses and improved outcomes in this population.