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Cited by 137Psychiatric care and mental health servicesSchizophrenia research and treatmentHistorical Psychiatry and Medical Practices

Day hospital versus admission for acute psychiatric disorders

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Marshall, Max, Crowther, Ruth, Sledge, William Hurt, Rathbone, John, Soares-Weiser, Karla·2011·Cochrane Database of Systematic Reviews
DOI 10.1002/14651858.cd004026.pub2PMC PMC4160006
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Abstract

BACKGROUND: Inpatient treatment is an expensive way of caring for people with acute psychiatric disorders. It has been proposed that many of those currently treated as inpatients could be cared for in acute psychiatric day hospitals. OBJECTIVES: To assess the effects of day hospital versus inpatient care for people with acute psychiatric disorders. SEARCH METHODS: We searched the Cochrane Schizophrenia Group Trials Register (June 2010) which is based on regular searches of MEDLINE, EMBASE, CINAHL and PsycINFO. We approached trialists to identify unpublished studies. SELECTION CRITERIA: Randomised controlled trials of day hospital versus inpatient care, for people with acute psychiatric disorders. Studies were ineligible if a majority of participants were under 18 or over 65, or had a primary diagnosis of substance abuse or organic brain disorder. DATA COLLECTION AND ANALYSIS: Two review authors independently extracted and cross-checked data. We calculated risk ratios (RR) and 95% confidence intervals (CI) for dichotomous data. We calculated weighted or standardised means for continuous data. Day hospital trials tend to present similar outcomes in slightly different formats, making it difficult to synthesise data. We therefore sought individual patient data so that we could re-analyse outcomes in a common format. MAIN RESULTS: Ten trials (involving 2685 people) met the inclusion criteria. We obtained individual patient data for four trials (involving 646 people). We found no difference in the number lost to follow-up by one year between day hospital care and inpatient care (5 RCTs, n = 1694, RR 0.94 CI 0.82 to 1.08). There is moderate evidence that the duration of index admission is longer for patients in day hospital care than inpatient care (4 RCTs, n = 1582, WMD 27.47 CI 3.96 to 50.98). There is very low evidence that the duration of day patient care (adjusted days/month) is longer for patients in day hospital care than inpatient care (3 RCTs, n = 265, WMD 2.34 days/month CI 1.97 to 2.70). There is no difference between day hospital care and inpatient care for the being readmitted to in/day patient care after discharge (5 RCTs, n = 667, RR 0.91 CI 0.72 to 1.15). It is likely that there is no difference between day hospital care and inpatient care for being unemployed at the end of the study (1 RCT, n = 179, RR 0.88 CI 0.66 to 1.19), for quality of life (1 RCT, n = 1117, MD 0.01 CI -0.13 to 0.15) or for treatment satisfaction (1 RCT, n = 1117, MD 0.06 CI -0.18 to 0.30). AUTHORS' CONCLUSIONS: Caring for people in acute day hospitals is as effective as inpatient care in treating acutely ill psychiatric patients. However, further data are still needed on the cost effectiveness of day hospitals.

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  • Overall costs of treatment are significantly lower for psychiatric day hospitals.

    “At the same time, overall costs of the treatment are significantly lower for psychiatric day hospitals (3, 4)”

    From Acceptance and commitment therapy in a psychiatric day hospital—A longitudinal naturalistic effectiveness trial (2023) · cites this paper as [4]

    The Results (Effects of interventions, §1.10; page not provided) report lower costs for day hospital care in four trials, with six of eight comparisons statistically significant. But the claim overstates this as an unqualified finding about overall costs: the review also reports higher mean total support costs at UK sites and, in §2.7, no significant cost difference in another trial. (LLM, conf=0.88)

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  1. Davidson L Tebes JK Rakfeldt J Sledge WH Differences in social environment between inpatient and day hospital-crisis respite settings Psychiatric Services 1996 47 714 20 8807684
  2. Wu Y Liu C Yu L A controlled study of day treatment effect on chronic schizophrenia Chinese Journal of Neurology and Psychiatry 1995 28 4 220 2
  3. Donnison J An evaluation of the clinical effectiveness of cognitive-behavioural rapid stabilisation group therapy in a day hospital setting National Research Register 2001 Vol. 1
  4. Pang J Partial hospitalization: an alternative to inpatient care Psychiatric Clinics of North America 1985 8 587 95 4059096
  5. The Nordice Cochrane Centre, The Cochrane Collaboration Review Manager. 5.0 2008 The Nordice Cochrane Centre, The Cochrane Collaboration 2008
  6. Wiersma D De Jong A Kraaijkamp HJM Ormel J GSDS II: The Groningen Social Disabilities Schedule, Second Revision: Manual, Questionnaire and Rating Form 1990 Department of Social Psychiatry, University of Groningen Groningen, Germany Second Edition
  7. Xia J Adams CE Bhagat N Bhagat V Bhoopathi P El-Sayeh H Pinfold V Takriti Y The Leeds outcomes stakeholders survey (LOSS) study 2007 Proceedings of the 15th Cochrane Colloquium Sao Paulo 2007 Oct 23-27 The Cochrane Collaboration

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Authors
Marshall, M., Crowther, R., Sledge, W. H., Rathbone, J., & Soares-Weiser, K.
Affiliations
  • University of Manchester (GB)
  • The University of Queensland (AU)
  • Yale University (US)
  • University of Sheffield (GB)
  • Enhance Reviews Ltd; Central Office, Cobweb Buildings The Lane, Lyford Wantage UK OX12 0EE
ORCID
Venue
Cochrane Database of Systematic Reviews
Publisher
Wiley
Published
2011-12-07
Volume
2011
Issue
12
Pages
CD004026-CD004026
ISSN
  • 1361-6137 (ISSN-L)
  • 1465-1858
DOI
10.1002/14651858.cd004026.pub2
PMC
PMC4160006
OpenAlex
W1731037216
Cited by
137
References
180
Citations by year
2026: 2 · 2025: 5 · 2024: 5 · 2023: 4 · 2022: 9 · 2021: 12 · 2020: 6 · 2019: 11 · 2018: 3 · 2017: 13 · 2016: 10 · 2015: 4 · 2014: 13 · 2013: 6 · 2012: 8
FWCI
1.68
Type
journal article
Language
en
Open access
Locations
  • Cochrane Database of Systematic Reviews (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
National Institute for Health and Care Research (HTA/96/41/03)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
  • Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
  • Social Sciences › Psychology › Clinical Psychology › Historical Psychiatry and Medical Practices
Keywords
psychiatric day hospital, psychiatric inpatient care, acute psychiatric disorders, length of hospital stay, hospital readmission, loss to follow-up, cost-effectiveness, mental health services
MeSH terms
Acute Disease, Mental Disorders, Day Care, Medical, Hospitalization, Humans, Length of Stay, Psychotic Disorders, Randomized Controlled Trials as Topic

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