Decreasing length of stay: Are there effects on outcomes of psychiatric hospitalization?

Objective: The authors compared hospital outcomes for depressed patients hospitalized between 1988 and 1996. Method: Between 1988 and 1996, 206 depressed patients in three cohorts were evaluated at admission; of these, 161 (78.2%) were evaluated at discharge and 119 (78.3% of those followed [N=152]) 1 month later. Evaluation consisted of measures of symptoms, global functioning, self-concept, ego defenses, work and social functioning, and readmission. Results: Lengths of stay significantly declined over time (26.5 versus 19.5 versus 8.3 days). At discharge, the most recently hospitalized group showed higher residual depression and lower residual global functioning scores than the other groups. Other measures did not differ among the groups at discharge. One month after discharge, the shortest-stay group continued to show lower global functioning, as well as lower quantity of work functioning. Readmission rates were equal. Within the shortest-stay group, no differences in outcome were found between patients treated in a partial hospital and those not so treated. Conclusions: Improvement during very brief admission is comparable to that in longer stays on many aspects of functioning. However, depressed patients discharged move quickly show significantly higher residual levels of depressive symptoms and lower levels of global functioning, which may place them at greater risk for adverse outcomes in the immediate posthospital period.