Length of stay and recidivism in schizophrenia: a study of public psychiatric hospital patients

OBJECTIVE: Psychiatric beds in public hospitals have decreased 80% since 1955, but admissions have risen correspondingly, largely because of high recidivism rates. Decreases in numbers of beds have been partly achieved by shortening the length of stay, which lessened by half between 1970 and 1980. This study was undertaken to determine whether duration of hospital treatment affects the rate and rapidity of relapse among schizophrenic patients. METHOD: Data on 1,500 patients from 10 state hospitals were gathered for 18 months after initial discharge. Predictor variables included age, sex, marital status, race, number of previous admissions, location of the facility, and length of stay. Data were analyzed by survival analysis with a Cox regression model for two times to initial relapse: 30 days and 18 months (outcome). RESULTS: Length of stay was significantly related to each time to relapse after the effects of number of previous admissions and age were partialed out. Facility location was not predictive, but intrahospital effects were tested by examining the data on the largest facility; again, length of stay significantly predicted relapse. CONCLUSIONS: Although the magnitude of the effect was small, the clinical significance of the findings is the greater likelihood that brief-stay patients will be rehospitalized within 30 days after discharge than will patients treated for longer periods. Brief hospitalization seems generally applicable to psychiatric populations, but there may be a small but important group of seriously mentally ill patients for whom other alternatives are possibly more appropriate and should be explored.