Impact of psychiatric hospitalisations on the social integration of patients with severe mental illness: a study in five European countries

Smith, Pierre;Nicaise, Pablo;Lorant, Vincent
(2018) Doctoral School Day in Public Health — Location: Liege, Belgium (13.November.2018)

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Background: During the last three decades, a decrease in psychiatric hospital admissions and a reduction in the length of stay (LoS) occurred in high-income countries, with a view to promote community care and the social integration of patients with severe mental illness (SMI). However, the impact of hospitalisations on patients’ social integration remains unclear. The aim was to determine (1) whether readmissions and longer LoS in psychiatric wards decreased the social integration of SMI patients and (2) which are the most affected dimensions of social integration. Methods: Within the European COFI study, data were collected for 2009 SMI patients hospitalised in 2015 in the UK, Italy, Germany, Poland and Belgium. Social integration was measured using the SIX index at baseline and at one year of follow-up. The SIX index includes four dimensions: employment, housing, living situation and friendship. Pearson and spearman correlations and multiple regression models were performed to test the association between LoS, the number of admissions, and the change in patient’s social integration over a year. Results: There was a significant negative correlation between LoS (rs =-0.06, p < 0.01), the number of admissions (rs = -0.04, p = 0.04) and the change of patients’ social integration over a year. After controlling for patients’ clinical and sociodemographic variables, an increase of the total LoS was significantly associated with a decrease of the employment (OR = 1.19, p = 0.02) and housing (OR = 1.95, p < 0.01) status levels, but not the number of readmissions. Conclusions: Lengthy LoS in psychiatric ward have a more negative impact on SMI patients’ social integration than repeated admissions. Housing and employment are the main dimensions of social integration negatively associated with LoS. Therefore, special attention should be paid to helping patients find and retain housing and employment during psychiatric hospitalisations.
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Smith, P. (2018). Impact of psychiatric hospitalisations on the social integration of patients with severe mental illness: a study in five European countries. Institut Scientifique de Sante Publique. https://hdl.handle.net/2078.5/218596