Factors associated with hospitalization times and length of stay in patients with bipolar disorder

Xiaoning Shi; Yingying Zhao; Haichen Yang; Xiufeng Xu; Yiru Fang; Xin Yu; Qingrong Tan; Huichun Li; Guangqiang Sun; Hang Wu; Pengfei Wang; Jie Yang; Xuequan Zhu; Gang Wang; Ling Zhang

doi:10.3389/fpsyt.2023.1140908

Factors associated with hospitalization times and length of stay in patients with bipolar disorder

Front Psychiatry. 2023 May 19:14:1140908. doi: 10.3389/fpsyt.2023.1140908. eCollection 2023.

Authors

Xiaoning Shi^#^{1

2}, Yingying Zhao^#^{1

2}, Haichen Yang³, Xiufeng Xu⁴, Yiru Fang⁵, Xin Yu⁶, Qingrong Tan⁷, Huichun Li⁸, Guangqiang Sun^{1

2}, Hang Wu^{1

2}, Pengfei Wang^{1

2}, Jie Yang^{1

2}, Xuequan Zhu^{1

2}, Gang Wang^{1

2}, Ling Zhang^{1

2}

Affiliations

¹ Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders and National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China.
² Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China.
³ Division of Mood Disorders, Shenzhen Mental Health Centre, Shenzhen, Guangdong Province, China.
⁴ Department of Psychiatry, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China.
⁵ Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
⁶ The Key Laboratory of Mental Health, National Clinical Research Center for Mental Disorders, Peking University Institute of Mental Health (The Sixth Hospital), Ministry of Health (Peking University), Beijing, China.
⁷ Department of Psychiatry, Xijing Hospital, Fourth Military Medical University, Xi'an, Shanxi, China.
⁸ The Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.

^# Contributed equally.

Abstract

Aim: Appraise the clinical features and influencing factors of the hospitalization times and length of stay in bipolar disorder (BD) patients.

Methods: This is a multicenter, observational, cohort study of patients diagnosed of type I or type II bipolar disorder. Five hundred twenty outpatients in seven hospitals from six cities in China were recruited from February 2013 to June 2014 and followed up using a continuous sampling pattern. The research included a retrospective period of 12 months and the prospective period of 9 months. The demographic and clinical features of the patients were collected. The influencing factors that could affect the length of stay (number of days spent in the hospital in the prospective period) were analyzed by poisson's regression and the hospitalization times (times of hospitalization in the prospective and retrospective period) was analyzed by general linear model. The selected variables included gender, age, years of education, occupational status, residence status, family history of mental disease, comorbid substance abuse, comorbid anxiety disorder, times of suicide (total suicide times that occurred in the retrospective and prospective period), polarity of the first mood episode, and BD type(I/II).

Results: Poisson's regression analysis showed that suicide times [Incidence Rate Ratio (IRR) = 1.20, p < 0.001], use of antipsychotic (IRR = 0.62, p = 0.011), and use of antidepressant (IRR = 0.56, p < 0.001) were correlated to more hospitalization times. Linear regression analysis showed that BD type II (β = 0.28, p = 0.005) and unemployment (β = 0.16, p = 0.039) which might mean longer duration of depression and poor function were correlated to longer length of stay. However, patients who experienced more suicide times (β = -0.21, p = 0.007) tended to have a shorter length of stay.

Conclusion: Overall, better management of the depressive episode and functional rehabilitation may help to reduce the length of stay. BD patients with more hospitalization times were characterized by higher risk of suicide and complex polypharmacy. Patients at high risk of suicide tended to have inadequate therapy and poor compliance, which should be assessed and treated adequately during hospitalization.

Clinical trial registration: www.ClinicalTrials.gov, Identifier: NCT01770704.

Keywords: bipolar disorder; hospitalization; length of stay; readmission; risk factor.

Associated data

ClinicalTrials.gov/NCT01770704

Grants and funding

The study was supported by the Beijing Hospitals Authority Clinical Medicine Development of special funding support (XMLX202128) and the Beijing Municipal Administration of Hospitals Incubating Program (PX2021069 and PX2019068).