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Day hospital versus admission for acute psychiatric disorders
Open accessAbstract
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 We approached trialists to identify unpublished studies.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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“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]
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Metadata
- 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
- 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
- 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
- green
- www.ncbi.nlm.nih.gov
- 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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