Schizophrenia is a mental disorder characterized by long hospitalizations and frequent need for chronic/acute psychiatric care. Hospitalizations represent a valuable quality of care indicator in schizophrenia patients. The aim of this study was to describe a nationwide perspective of schizophrenia related hospitalizations. We performed a retrospective observational study using a nationwide hospitalization database containing all hospitalizations registered in Portuguese public hospitals from 2008 to 2015. Hospitalizations with a primary diagnosis of schizophrenia were selected based on the definition by CCS – Clinical Classification Software diagnostic single-level 659. Schizophrenia subtypes were identified based on International Classification of Diseases version 9, Clinical Modification (ICD-9-CM) codes of diagnosis 295.xx. A total of 25,385 hospitalizations were registered belonging to 14,279 patients. 68.0% of the hospitalizations occurred in male patients and the median length of stay was 18.0 days. In male patients’ hospitalizations, the most frequent age group was 31–50 years followed by the age group of 18–30 years (55.9 and 24.0% respectively). For female patients, the most frequent age group was 31–50 years followed by 51–70 years (54.1 and 22.6%, respectively). There were 73 hospitalization with a deadly outcome (0.29%). Paranoid type was the most frequent subtype of schizophrenia (50.5%). The mean hospitalization charges were 3509.7€ per episode, with a total charge of 89.1 M€ in the 8-year period. This is a nationwide study using Big Data analysis giving a broad perspective of schizophrenia hospitalization panorama at a nationwide level. We found differences in hospitalization characteristics according to patients’ gender, age and primary diagnosis.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
Tax calculation will be finalised during checkout.
Mueser KT, McGurk SR. Schizophrenia. Lancet (London, England). 2004;363(9426):2063–72. https://doi.org/10.1016/s0140-6736(04)16458-1.
Murray CJ, Lopez AD, Organization WH. The global burden of disease: a comprehensive assessment of mortality and disability from diseases, injuries, and risk factors in 1990 and projected to 2020: summary. World Health Organization; 1996.
Rice DP. The economic impact of schizophrenia. J Clin Psychiatry. 1999;60 Suppl 1:4–30.
Tandon R, Gaebel W, Barch DM, Bustillo J, Gur RE, Heckers S, et al. Definition and description of schizophrenia in the DSM-5. Schizophr Res. 2013;150(1):3–10.
Sartorius N, Chiu H, Heok KE, Lee M-S, Ouyang W-C, Sato M, et al. Name change for schizophrenia. Schizophr Bull. 2014;40(2):255–8.
Schennach R, Riedel M, Obermeier M, Jäger M, Schmauss M, Laux G, et al. What happens with schizophrenia patients after their discharge from hospital? Results on outcome and treatment from a “real-world” 2-year follow-up trial. Eur Arch Psychiatry Clin Neurosci. 2019:1–11. https://doi.org/10.1007/s00406-019-01055-4.
Orrico-Sanchez A, Lopez-Lacort M, Munoz-Quiles C, Sanfelix-Gimeno G, Diez-Domingo J. Epidemiology of schizophrenia and its management over 8-years period using real-world data in Spain. BMC Psychiatry. 2020;20(1):149. https://doi.org/10.1186/s12888-020-02538-8.
Ramalho A, Vinci A, De Lima I, Castro P, Teixeira J, Gonçalves-Pinho M, et al. Quality indicators for mental health in primary care-a comparison between literature review methods. Stud Health Technol Inform. 2019;262:316–9.
Stewart R, Davis K. ‘Big data’in mental health research: current status and emerging possibilities. Soc Psychiatry Psychiatr Epidemiol. 2016;51(8):1055–72.
McGrath J, Saha S, Welham J, El Saadi O, MacCauley C, Chant D. A systematic review of the incidence of schizophrenia: the distribution of rates and the influence of sex, urbanicity, migrant status and methodology. BMC Med. 2004;2:13. https://doi.org/10.1186/1741-7015-2-13.
Pedersen CB, Mors O, Bertelsen A, Waltoft BL, Agerbo E, McGrath JJ, et al. A comprehensive nationwide study of the incidence rate and lifetime risk for treated mental disorders. JAMA Psychiat. 2014;71(5):573–81. https://doi.org/10.1001/jamapsychiatry.2014.16.
Kuhl JOG, Laursen TM, Thorup A, Nordentoft M. The incidence of schizophrenia and schizophrenia spectrum disorders in Denmark in the period 2000-2012. A register-based study. Schizophr Res. 2016;176(2–3):533–9. https://doi.org/10.1016/j.schres.2016.06.023.
van der Werf M, Hanssen M, Kohler S, Verkaaik M, Verhey FR, van Winkel R, et al. Systematic review and collaborative recalculation of 133,693 incident cases of schizophrenia. Psychol Med. 2014;44(1):9–16. https://doi.org/10.1017/s0033291712002796.
Bouza C, López-Cuadrado T, Amate JM. Hospital admissions due to physical disease in people with schizophrenia: a national population-based study. Gen Hosp Psychiatry. 2010;32(2):156–63.
Fan Z, Wu Y, Shen J, Ji T, Zhan R. Schizophrenia and the risk of cardiovascular diseases: a meta-analysis of thirteen cohort studies. J Psychiatr Res. 2013;47(11):1549–56.
Charlson FJ, Ferrari AJ, Santomauro DF, Diminic S, Stockings E, Scott JG, et al. Global epidemiology and burden of schizophrenia: findings from the global burden of disease study 2016. Schizophr Bull. 2018;44(6):1195–203. https://doi.org/10.1093/schbul/sby058.
Estatística I-INd. Estatísticas de Saúde 2017: INE2019.
Aleman A, Kahn RS, Selten JP. Sex differences in the risk of schizophrenia: evidence from meta-analysis. Arch Gen Psychiatry. 2003;60(6):565–71. https://doi.org/10.1001/archpsyc.60.6.565.
Abel KM, Drake R, Goldstein JM. Sex differences in schizophrenia. Int Rev Psychiatry (Abingdon, England). 2010;22(5):417–28. https://doi.org/10.3109/09540261.2010.515205.
Weber NS, Cowan DN, Millikan AM, Niebuhr DW. Psychiatric and general medical conditions comorbid with schizophrenia in the National Hospital Discharge Survey. Psychiatr Serv. 2009;60(8):1059–67.
Lewine RR. Sex differences in schizophrenia: timing or subtypes? Psychol Bull. 1981;90(3):432–44.
(AWG) ECDEatEPC. The 2009 Ageing Report : Economic and budgetary projections for the EU–27 Member States (2008–2060) 2009.
Goldstein JM, Lewine RR. Overview of sex differences in schizophrenia: where have we been and where do we go from here. Women and schizophrenia. Cambridge University Press, Cambridge, 2000, 111–143.
Röder-Wanner U-U, Oliver JP, Priebe S. Does quality of life differ in schizophrenic women and men? An empirical study. Int J Soc Psychiatry. 1997;43(2):129–43.
Angermeyer MC, Goldstein JM, Kuehn L. Gender differences in schizophrenia: rehospitalization and community survival. Psychol Med. 1989;19(2):365–82.
Angermeyer MC, Kühnz L. Gender differences in age at onset of schizophrenia. Eur Arch Psychiatry Neurol Sci. 1988;237(6):351–64.
Häfner H, Maurer K, Löffler W, Riecher-Rössler A. Schizophrenie und Lebensalter [Schizophrenia and the life cycle]. Der Nervenarzt. 1991;62(9), 536–548.
Lewine RR. Sex differences in age of symptom onset and first hospitalization in schizophrenia. Am J Orthopsychiatry. 1980;50(2):316–22.
Chung W, Chang HS, Oh SM, Yoon CW. Factors associated with long-stay status in patients with schizophrenia: an analysis of national databases covering the entire Korean population. Int J Soc Psychiatry. 2013;59(3):207–16. https://doi.org/10.1177/0020764011431794.
Jacobs R, Gutacker N, Mason A, Goddard M, Gravelle H, Kendrick T, et al. Determinants of hospital length of stay for people with serious mental illness in England and implications for payment systems: a regression analysis. BMC Health Serv Res. 2015;15(1):439.
Chen S, Collins A, Anderson K, McKenzie K, Kidd S. Patient characteristics, length of stay, and functional improvement for schizophrenia spectrum disorders: a population study of inpatient care in Ontario 2005 to 2015. Can J Psychiatry. 2017;62(12):854–63.
Appleby L, Desai PN, Luchins DJ, Gibbons RD, Hedeker DR. Length of stay and recidivism in schizophrenia: a study of public psychiatric hospital patients. Am J Psychiatry. 1993;150:72.
Tulloch AD, Fearon P, David AS. Length of stay of general psychiatric inpatients in the United States: systematic review. Admin Pol Ment Health. 2011;38(3):155–68. https://doi.org/10.1007/s10488-010-0310-3.
Kessler T, Lev-Ran S. The association between comorbid psychiatric diagnoses and hospitalization-related factors among individuals with schizophrenia. Compr Psychiatry. 2019;89:7–15.
Capdevielle D, Boulenger J, Villebrun D, Ritchie K. Schizophrenic patients' length of stay: mental health care implication and medicoeconomic consequences. L'Encephale. 2009;35(4):394–9.
Sytema S, Burgess P, Tansella M. Does community care decrease length of stay and risk of rehospitalization in new patients with schizophrenia disorders? A comparative case register study in Groningen, The Netherlands; Victoria, Australia; and South-Verona, Italy. Schizophr Bull. 2002;28(2):273–81. https://doi.org/10.1093/oxfordjournals.schbul.a006937.
Lin HC, Tian WH, Chen CS, Liu TC, Tsai SY, Lee HC. The association between readmission rates and length of stay for schizophrenia: a 3-year population-based study. Schizophr Res. 2006;83(2–3):211–4. https://doi.org/10.1016/j.schres.2006.01.012.
Goldstein JM. Gender differences in the course of schizophrenia. Am J Psychiatry. 1988;145(6):684–9. https://doi.org/10.1176/ajp.145.6.684.
Angermeyer MC, Kuhn L, Goldstein JM. Gender and the course of schizophrenia: differences in treated outcomes. Schizophr Bull. 1990;16(2):293–307. https://doi.org/10.1093/schbul/16.2.293.
Brown SL. Variations in utilization and cost of inpatient psychiatric services among adults in Maryland. Psychiatr Serv. 2001;52(6):841–3.
Zaprutko T, Goder R, Kus K, Rakhman L, Bilobryvka R, Nowakowska E. The cost of inpatient Care of Schizophrenia and Treatment Schedules Used in German academic center: Kiel. Psychiatry Q. 2016;87(4):595–603. https://doi.org/10.1007/s11126-015-9412-0.
Zaprutko T, Nowakowska E, Kus K, Bilobryvka R, Rakhman L, Poglodzinski A. The cost of inpatient care of schizophrenia in the Polish and Ukrainian academic centers--Poznan and Lviv. Acad Psychiatry : the journal of the American Association of Directors of Psychiatric Residency Training and the Association for Academic Psychiatry. 2015;39(2):165–73. https://doi.org/10.1007/s40596-014-0198-4.
Knapp M, Mangalore R, Simon J. The global costs of schizophrenia. Schizophr Bull. 2004;30(2):279–93. https://doi.org/10.1093/oxfordjournals.schbul.a007078.
Schofield P. Big data in mental health research–do the ns justify the means? Using large data-sets of electronic health records for mental health research. BJPsych Bull. 2017;41(3):129–32.
Brandao D, Freitas A, Paul C, Ribeiro O. Psychiatric disorders as main discharge diagnosis by the Portuguese oldest old from 2000 to 2014: exploring national acute inpatient admissions. Int Psychogeriatr. 2018;30(5):685–94. https://doi.org/10.1017/s1041610217002034.
We would like to acknowledge ACSS for providing the administrative data on hospitalisations and Fernando Lopes, MD, for his support throughout the elaboration of the study and his valuable help in ICD-9-CM(International Classification of Diseases version 9, Clinical Modification) codification detailing.
Disclosure of potential conflicts of interest – The authors declare that they have no conflict of interest.
Consent to Participate
Consent for Publication
All author authorize the publication of the manuscript.
Research Involving Human Participants and/or Animals
The data used was given by a Portuguese governmental agency guaranteeing all identification information was anonymous.
No informed consent was needed once we used an administrative database built for hospital billing with no access to patients identification.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
About this article
Cite this article
Gonçalves-Pinho, M., Ribeiro, J.P. & Freitas, A. Schizophrenia Related Hospitalizations – a Big Data Analysis of a National Hospitalization Database. Psychiatr Q 92, 239–248 (2021). https://doi.org/10.1007/s11126-020-09793-8
- Mental disorders
- Big data
- Patient admission
- Administrative data