Length of Stay of General Psychiatric Inpatients in the United States: Systematic Review

  • Alex D. TullochEmail author
  • Paul Fearon
  • Anthony S. David
Original Paper


Psychiatric length of stay (LOS) has reduced but is still longer than for physical disorders. Inpatient costs are 16% of total mental health spending. Regression analyses of the determinants of LOS for US adult psychiatric inpatients were systematically reviewed. Most studies predated recent LOS reductions. Psychosis, female gender and larger hospital size were associated with longer LOS, while discharge against medical advice, prospective payment, being married, being detained and either younger or middle age were associated with shorter LOS. Associations appeared consistent, especially where sample size was above 3,000. Updated studies should be adequately powered and include the variables above.


Length of stay Psychiatric hospitals Healthcare utilization 



Dr. Tulloch is supported by a UK Medical Research Council Special Research Training Fellowship in Health Services Research. The authors are grateful for the assistance of the many study authors who were contacted in relation to particular queries. Professor Steven Stern (University of Virginia) and Dr. Michael Compton (Emory University School of Medicine) generously provided additional data which were used in the analyses.


References marked with an asterisk indicate the studies that were selected for analysis

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Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Alex D. Tulloch
    • 1
    Email author
  • Paul Fearon
    • 1
    • 2
  • Anthony S. David
    • 1
  1. 1.Department of Psychiatry, Institute of PsychiatryKings College LondonLondonUK
  2. 2.Trinity College Dublin and St Patrick’s University Hospital DublinDublin 8Ireland

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