Comparison of the Clinical Effectiveness of “Short” Versus “Long” Stay Psychiatric Hospitalization

One hundred seventy-three patients were randomly assigned to long term (LT: unlimited length of stay, mean = 179 days) or short term (ST: stay limited to 90 days, mean = 89 days) hospitalization in an intensive treatment psychiatric hospital. In-hospital data and partial 3-year posthospital follow-up results were published previously. This paper reports on 3-year follow-up results in the areas of psychopathology and social adjustment as evaluated by patient and relative questionnaires derived from previously standardized questionnaires. Results showed few differences between LT and ST patients on the patient questionnaires and few differences in the area of social adjustment on the relative questionnaires, but the relative questionnaires showed the LT patients to have significantly less psychopathology than did the ST patients. This appeared related to the fact that LT patients had more private psychotherapy after discharge; holding private therapy constant eliminated the LT-ST differences on the relative questionnaires. The combination then of LT hospitalization and more private therapy after discharge apparently led to the superior outcome as evaluated by the relative questionnaires. Possibly LT hospitalization was helpful primarily by convincing the patient of the need for LT psychiatric care after discharge. The superior benefit for LT patients, while statistically significant, was relatively slight clinically. Overall, in view of the previously reported findings showing that: a) of rehospitalized patients, LT patients were rehospitalized more often and longer than were ST patients, b) ST patients felt they had received more benefit from the hospital than did LT patients, and c) no significant differences between LT and ST patients were found in other areas of adjustment including role functioning, and in view of the extra cost of LT hospitalization, the authors recommend ST hospitalization whenever possible. Further analyses are underway to attempt to delineate subgroups of patients preferentially helped by LT or ST hospitalization.