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The determinants and outcomes of long-stay psychiatric admissions

A case–control study

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Acute psychiatric admissions lasting over 6 months (long-stays) continue to occur in England. Previous studies have suggested an association between long-stay and both schizophrenia and challenging behaviour, as well as rehousing or placement difficulties, but no UK study to date has compared such cases with control admissions.


We performed a case–control study. All long-stay patients present on acute general psychiatric wards serving the London Boroughs of Croydon, Lambeth, Lewisham and Southwark on November 1st 2004 were compared with a group of ‘next admitted’ controls. We followed up long-stay cases 1 year later to determine whether they were still in hospital, and, if not, where they were living.


In unadjusted comparisons long stay was associated with schizophrenia, non-white ethnicity, admission not due to suicidality, violence, severe illness and need for rehousing. A logistic regression was used to adjust for associations among exposures and only violence, severity of illness and need for rehousing remained associated with long-stay. After 1 year, two-thirds of cases were living out of hospital.


Case–control studies may usefully contribute to the study of the complex social phenomenon of long-stay. Further research should address how the combination of individual and socially-determined effects that we found operate together over the course of admission to generate long-stays.

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The study was funded by the research and development fund of South London and Maudsley NHS Trust. Kyle DeBarry of the South London and Maudsley NHS Trust’s IT department coordinated the extraction of data from computerised databases and provided valuable assistance in developing algorithms for case and control finding. We are grateful for the assistance of those service users and staff who contributed to the study. The authors have no competing interests.

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Tulloch, A.D., Fearon, P. & David, A.S. The determinants and outcomes of long-stay psychiatric admissions. Soc Psychiat Epidemiol 43, 569–574 (2008).

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