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.

Keywords

• schizophrenia
• schizoaffective disorder
• length of inpatient stay
• readmission
• substance use
• placement
• deinstitutionalisation.