Length of first admission and treatment outcome in patients with unipolar depression

Unipolar depression is among the most common reasons for psychiatric hospitalisation. But only few studies focussed on inpatient treatment and its impact on short- or long-term outcome in these patients. Thus, we studied as to what extent patients with unipolar depression use psychiatric inpatient resources, and examined whether the length of stay is associated with short-term improvement and rehospitalisation. Finally, we analysed if there is an 'optimal' length of first hospitalisation.

In a catchment area in Switzerland, psychiatric inpatient utilisation over 5 years was analysed in 458 first-ever admitted patients with unipolar depressive disorder (ICD-10, F32 and F33).

365 patients (79.7%) were admitted only once. Patients with a first inpatient stay of 15-30 days had the shortest cumulative length of further inpatient treatment. Symptom improvement during first hospitalisation was immediately linked to the length of stay (first and further episodes) and to a regular discharge from first admission. Higher symptom improvement predicted shorter length of stay and less rehospitalisations. Demographic (age, gender, employment, living situation) and clinical variables (dual diagnosis, one or multiple episodes of unipolar depression, illness severity) did not significantly influence short-term outcome and long-term service use.

The study is biased towards the more severely ill as we only included inpatients.

Variables describing the first hospitalisation of patients with unipolar depression are more appropriate for clinical prognosis than sociodemographic or diagnostic factors. Moreover, improving clinical symptoms is more important for long-term outcome than the length of inpatient stay.