1. Patterns of psychiatric hospital admission for schizophrenia and related psychosis in England: A retrospective cross-sectional survey
Thompson A. D.¹, Harrison G.¹ Shaw M. ² Verne J.³ Gunnell D. ²
¹ Department of Psychiatry, University of Bristol, UK, ² Department of Social Medicine, University of Bristol, UK, ³ Regional Public Health Group, Bristol, UK.
Introduction:
While a number of studies have quantified patterns of first admissions for schizophrenia¹ ² there is limited previous analysis of national patterns for all admissions for schizophrenia. In the light of recent initiatives to promote community treatment the assessment and reporting of national patterns of psychiatric hospital admissions for schizophrenia is important for strategic service development and planning.
Aims:
To investigate the patterns of psychiatric hospital admissions for schizophrenia for year olds in England using Hospital Episode Statistics (HES)
Methods:
We obtained data for psychiatric hospital admissions for April 1999 to March 2001 using the HES (Source: Department of Health ¹), which records all admissions to NHS hospitals in England. Appropriate census population figures were used to calculate mean annual admission rates (age standardized). We looked at ICD10 diagnosis (specifically at the admissions in the diagnostic category schizophrenia and related psychoses (ICD codes F20 to F29)) by region, sex, age and length of stay (median, and proportions staying for greater than 90 and 365 days).
Results:
There were admissions for schizophrenia and related psychosis in the two year period, the mean annual admission rate for England being 0.85 per 1000 population. Schizophrenia and related psychoses accounted for 26.9% of all admissions to psychiatric hospitals nationally less than that for depression and anxiety (29.4%) (Figure 1) . This was similar for all regions except London where psychosis accounted for the highest proportion of admissions (37.8% compared to 21.4%). There was a more than two fold difference in admission rates between some regions (Figure 2). Rates were highest for the two large urban areas of the North West and London. Males had a higher admission rate than females for schizophrenia and related psychoses in younger age groups but this male excess was reversed in the age group (Figure 3) . Length of stay in hospital exceeded 90 days in 19.2% of patients with schizophrenia and related compared to the psychosis and for 2.7% exceeded 1 year compared to 9.7% and 1.1% for all admissions. The median length of stay for schizophrenia and related psychoses was 28 days median for all diagnoses of 16 days. The male dominance was even more pronounced in both long stay groups with the same trend to equivalence with increasing age.
Figure 1: Proportion of total admissions accounted for by each Figure 2: Admission rate/1000 population for ICD 10 codes Figure 3: Admission rate/1000 population for ICD 10 diagnostic group, England, April 1999-March by region of England, April 1999-March codes by sex and age group, England, April1999-March 2001
Conclusions and discussion:
There are few similar large national or international comparator studies. A local study in the South West of England³ found a similar distribution and proportion of diagnoses. There are some distinct regional differences in admission rates for schizophrenia and related psychoses in England. These could be accounted for by urban/rural differences in regions or by differences in total admission rates in these regions. Whether these regional differences represent a difference in need or service provision needs further study. The observation that schizophrenia and related psychoses do not account for the highest proportion of admissions is somewhat unexpected given the pressure on in-patient resources to admit the most severe cases, although the longer lengths of stay of these patients creates the impression of psychiatric wards being predominated by psychosis.
Acknowledgements:
The authors would like to thank Davidson Ho for his work refining the HES dataset and Dr Ruth Shakespeare. Hospital Episodes Statistics (HES) data were made available by the Department of Health to the authors courtesy of the HES National Service Framework project (Prof. Shah Ebrahim and colleagues), funded by a South and West Regional project R and D grant.
Summary:
Schizophrenia and related psychoses does not account for the highest proportion of admissions in England
There a greater than two fold difference in admission rates between the some regions of England
There is a male excess of admissions which is more pronounced in the younger age group
Around 1 in 5 of patients with ICD 10 code stay in hospital for greater than 90 days 1 in 40 stay for longer than 1 year
References:
Department of Health (1998) Department of Health Statistics Section SD2 HES. HES The Book. London: Stationary Office.