Use this URL to cite or link to this record in EThOS: http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.641178
Title: Determinants of prolonged psychiatric hospitalization
Author: Babiker, I. E.
Awarding Body: University of Edinburgh
Current Institution: University of Edinburgh
Date of Award: 1977
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Abstract:
The aim of the study, to investigate prospectively the outcome of an admission cohort of psychiatric patients at successive intervals with special reference to the attainment of long-stay statue, was prompted by the lack of such prospective studies in the psychiatric literature. A review of the existing literature revealed that previous studies in the U.K. were largely descriptive accounts of the-long-stay patients containing no reference to the factors which determined the continued retention of these patients. On the other hand, because studies on prediction of outcome in terms of length of hospitalization were found to have been carried out largely in the United States and on male patients, the relevance of their findings to the study of the predominantly female British psychiatric hospital population could only be regarded as marginal. However, from the findings of the studies in both countries three hypotheses, relating prolonged psychiatric hospitalization to social disadvantage, severity of illnesss and early selection, were derived. To test these hypotheses a prospective follow-up study of a total one-year cohort of admissions to the Royal Edinburgh Hospital was designed. For the purpose of the study long-stay was defined as a continuous stay of 12 months in hospital. A limited amount of data was available on the whole cohort at admission. This was supplemented by data obtained by interviewing 162 patients who remained in hospital for six months. These patients were again interviewed 12 months after admission whether they were still in or out of hospital. Thus a large body of information was available on patients retained for six months. This included sociodemographic data, details of previous psychiatric history, clinical and behavioural ratings, diagnosis and data on the patients' functioning and prospects as rated by their doctors. These data were used to study the characteristics of patients retained for six months. Successive comparisons of the characteristics of patients who were discharged with those who were retained were carried out to identify the factors associated, firstly, with retention for six months and, secondly, with further retention for 12 months. Patients retained for six months were found to be largely female, elderly, single or widowed and out of work. They received a good deal of support from their relatives. Clinically, they were characterised by the absence of florid symptomatology and the presence of a marked degree of motor retardation and social withdrawal. The factors which determined retention for six months included, for the under 65 age group, being single, living with a first degree relative, being unemployed or retired, having had a long recent admission and being admitted on a compulsory order; and, for the over 65 age group, being over 75 years, having had no previous psychiatric admission and being admitted to a psychogeriatric or rehabilitation ward. A diagnosis of senile or presenile dementia determined continued retention for both age groups. Retention for 12 months, on the other hand, was determined largely by a diagnosis of dementia. For the remaining patients, being elderly, retired or unemployed, not obtaining weekend passes, having no contact with the social worker, being rated as unemployable, difficult to accommodate in the community and requiring permanent institutional care were among the six months' factors determining further retention. Consultants correctly predicted the outcome of the large majority of their patients. The social disadvantage hypothesis received qualified support; of the four parameters, only disadvantage in terms of age and employment was found to be directly related to retention in hospital; the relationship of marital status and living group to outcome proved to be a complex one. The severity of illness hypothesis was supported when diagnosis was used as an index of severity, but not, when symptom severity was used as an indicator. The early selection hypothesis was supported in the sense that the majority of the six months patients proceeded to become long-stay. However, stating a definite wish to remain in hospital did not determine the attainment of long-stay status. The significance of the findings and their implications for the management of those patients and for further research are discussed.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID: uk.bl.ethos.641178  DOI: Not available
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