Predictors of psychiatric hospitalization among outpatients with bipolar disorder in the real-world clinical setting

Keita Tokumitsu; Norio Yasui-Furukori; Naoto Adachi; Yukihisa Kubota; Yoichiro Watanabe; Kazuhira Miki; Takaharu Azekawa; Koji Edagawa; Eiichi Katsumoto; Seiji Hongo; Eiichiro Goto; Hitoshi Ueda; Masaki Kato; Atsuo Nakagawa; Toshiaki Kikuchi; Takashi Tsuboi; Koichiro Watanabe; Kazutaka Shimoda; Reiji Yoshimura

doi:10.3389/fpsyt.2023.1078045

Predictors of psychiatric hospitalization among outpatients with bipolar disorder in the real-world clinical setting

Front Psychiatry. 2023 Mar 16:14:1078045. doi: 10.3389/fpsyt.2023.1078045. eCollection 2023.

Authors

Keita Tokumitsu¹, Norio Yasui-Furukori^{1

2}, Naoto Adachi³, Yukihisa Kubota³, Yoichiro Watanabe³, Kazuhira Miki³, Takaharu Azekawa³, Koji Edagawa³, Eiichi Katsumoto³, Seiji Hongo³, Eiichiro Goto³, Hitoshi Ueda³, Masaki Kato^{2

4}, Atsuo Nakagawa^{2

5}, Toshiaki Kikuchi^{2

6}, Takashi Tsuboi^{2

7}, Koichiro Watanabe^{2

7}, Kazutaka Shimoda¹, Reiji Yoshimura^{2

8}

Affiliations

¹ Department of Psychiatry, Dokkyo Medical University School of Medicine, Tochigi, Japan.
² The Japanese Society of Clinical Neuropsychopharmacology, Tokyo, Japan.
³ The Japanese Association of Neuro-Psychiatric Clinics, Tokyo, Japan.
⁴ Department of Neuropsychiatry, Kansai Medical University, Osaka, Japan.
⁵ Department of Neuropsychiatry, St. Marianna University School of Medicine, Kanagawa, Japan.
⁶ Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.
⁷ Department of Neuropsychiatry, Kyorin University School of Medicine, Tokyo, Japan.
⁸ Department of Psychiatry, University of Occupational and Environmental Health, Fukuoka, Japan.

Abstract

Background: Bipolar disorder is a psychiatric disorder that causes recurrent manic and depressive episodes, leading to decreased levels of social functioning and suicide. Patients who require hospitalization due to exacerbation of bipolar disorder have been reported to subsequently have poor psychosocial functioning, and so there is a need to prevent hospitalization. On the other hand, there is a lack of evidence regarding predictors of hospitalization in real-world clinical practice.

Methods: The multicenter treatment survey on bipolar disorder (MUSUBI) in Japanese psychiatric clinics was an observational study conducted to provide evidence regarding bipolar disorder in real-world clinical practice. Psychiatrists were asked, as part of a retrospective medical record survey, to fill out a questionnaire about patients with bipolar disorder who visited 176 member clinics of the Japanese Association of Neuro-Psychiatric Clinics. Our study extracted baseline patient characteristics from records dated between September and October 2016, including comorbidities, mental status, duration of treatment, Global Assessment of Functioning (GAF) score, and pharmacological treatment details. The incidence and predictors of hospitalization among patients with bipolar disorder over a 1-year period extending from that baseline to September-October 2017 were examined.

Results: In total, 2,389 participants were included in our study, 3.06% of whom experienced psychiatric hospitalization over the course of 1 year from baseline. Binomial logistic regression analysis revealed that the presence of psychiatric hospitalization was correlated with bipolar I disorder, lower baseline GAF scores, unemployment, substance abuse and manic state.

Conclusions: Our study revealed that 3.06% of outpatients with bipolar disorder were subjected to psychiatric hospitalization during a 1-year period that extended to September-October 2017. Our study suggested that bipolar I disorder, lower baseline GAF scores, unemployment, substance abuse and baseline mood state could be predictors of psychiatric hospitalization. These results may be useful for clinicians seeking to prevent psychiatric hospitalization for bipolar disorder.

Keywords: bipolar disorder; hospitalization; outpatient; predictor; real-world.

Grants and funding

This study was supported by a Ken Tanaka memorial research grant (Grant Numbers: 2016–2, 2017–4, and 2019–3). The funder had no role in the study design, the data collection and analysis, the decision to publish, or the preparation of the manuscript.