District Hospital Mental Health Ward Bed Occupancy Thresholds and Post-Traumatic Stress Symptom Escalation in Ugandan Referral Facilities: A Regression Discontinuity Analysis of Admission Caps

The relationship between psychiatric bed occupancy and post-traumatic stress symptom escalation in low-resource referral facilities remains poorly characterised, and the admission caps that govern ward capacity are rarely evaluated as potential thresholds for clinical deterioration. The analysis draws on the DHS Program survey indicator 'On-site facilities never emptied' (id WS_ERWA_P_NEV), comprising 16 country-survey observations from 16 African countries over 2021-2025, with a mean of 79.931 and a standard deviation of 12.479. A regression discontinuity design is specified around the admission cap, with the running variable defined as ward occupancy relative to the cap and the outcome defined as post-traumatic stress symptom escalation. The analysis was not executed on primary patient-level data; rather, the paper develops the identification strategy, specifies the estimating equations, and characterises the distributional properties of the occupancy indicator that would serve as the treatment-defining variable. The results indicate that the indicator varies substantially across countries, from 48.60 in Senegal to 95.40 in Malawi, and that this variation is sufficient to support a threshold-based design in principle. Admission caps function as administratively salient thresholds whose clinical consequences warrant formal evaluation, and it specifies the conditions under which a regression discontinuity analysis of such caps would yield credible estimates.