Main Article Content
Abstract
Schizophrenia contributes significantly to global disease burden, with hospitalization management being crucial for treatment outcomes. This study aimed to determine factors influencing length of stay and recovery outcomes among schizophrenia patients in Indonesian referral health facilities. Secondary data analysis was conducted using BPJS Kesehatan sample data from 2023. Of 54,820 mental health records, 2,562 schizophrenia patients treated at referral facilities were analyzed. Cox proportional hazards regression was used to identify factors associated with discharge status, while Kaplan-Meier analysis examined length of stay distribution. Mean length of stay was 19.9 days. Significant factors associated with better recovery outcomes included: treatment at general hospitals (HR=2.31, p<0.001), public hospitals (HR=0.57, p<0.001), undifferentiated (HR=1.45, p<0.001) and catatonic schizophrenia subtypes (HR=1.70, p=0.029), single medical procedure (HR=0.73, p<0.001), and local treatment facilities (HR=1.42, p=0.028). Healthcare service factors and clinical characteristics significantly outweigh demographic factors in determining recovery outcomes. These findings emphasize the importance of healthcare service quality and accessibility in schizophrenia treatment, supporting integrated care models and universal healthcare access policies.
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References
- Allam, S. (2024). Advancing Patient-Centered Care: A Nationwide Analysis of Hospital Efficiency and Morbidity Using Innovative Propensity Score Techniques. Cureus, 16(12), e76370. https://doi.org/10.7759/cureus.76370
- Anbasse, G. K., Tessema, W. G., Negash, A. T., & Alenko, A. A. (2024). Determinants of Disability Among Individuals Living with Schizophrenia Attending Psychiatric Follow-Up Clinic in Jimma, Southwest Ethiopia: An Institution-Based Case-Control Study. Neuropsychiatric Disease and Treatment, 20(May), 1119–1130. https://doi.org/10.2147/NDT.S452866
- Berk, M., Köhler-Forsberg, O., Turner, M., Penninx, B. W. J. H., Wrobel, A., Firth, J., Loughman, A., Reavley, N. J., Mcgrath, J. J., Momen, N. C., Plana-Ripoll, O., O’neil, A., Siskind, D., Williams, L. J., Carvalho, A. F., Schmaal, L., Walker, A. J., Dean, O., Walder, K., … Marx, W. (2023). Comorbidity between major depressive disorder and physical diseases: a comprehensive review of epidemiology, mechanisms, and management. In World Psychiatry (Vol. 22).
- Bian, Y., Lin, C., Yang, F., Han, X., Zhang, J., Ma, B., Zhu, Y., & Wang, Z. (2019). The Optimal Length of Hospitalization for Functional Recovery of Schizophrenia Patients, a Real-World Study in Chinese People. The Psychiatric Quarterly, 90(3), 661–670. https://doi.org/10.1007/s11126-019-09658-9
- Bruce, M., & Smith, J. (2020). Length of stay among multi-ethnic psychiatric inpatients in the United Kingdom. Comprehensive Psychiatry, 102, 152201. https://doi.org/https://doi.org/10.1016/j.comppsych.2020.152201
- Burrer, A., Egger, S. T., Spiller, T. R., Kirschner, M., Homan, P., Seifritz, E., & Vetter, S. (2024). Examining the impact of substance use on hospital length of stay in schizophrenia spectrum disorder: a retrospective analysis. BMC Medicine, 22, 1–9. https://doi.org/10.1186/s12916-024-03447-3
- Cheng, P., Wang, L., Xu, L., Zhou, Y., Zhang, L., & Li, W. (2022). Factors Related to the Length of Stay for Patients with Schizophrenia: A Retrospective Study. Frontiers in Psychiatry, 12. https://doi.org/10.3389/fpsyt.2021.818254
- Dimitri, G., Giacco, D., Bauer, M., Bird, V. J., Greenberg, L., Lasalvia, A., Lorant, V., Moskalewicz, J., Nicaise, P., Pfennig, A., Ruggeri, M., Welbel, M., & Priebe, S. (2018). Predictors of length of stay in psychiatric inpatient units: Does their effect vary across countries? European Psychiatry: The Journal of the Association of European Psychiatrists, 48, 6–12. https://doi.org/10.1016/j.eurpsy.2017.11.001
- Hansen, H. G., Starzer, M., & Nilsson, S. F. (2023). Clinical Recovery and Long-Term Association of Specialized Early Intervention Services vs Treatment as Usual Among Individuals with First-Episode Schizophrenia Spectrum Disorder. JAMA Psychiatry, 80(4), 371–379. https://doi.org/10.1001/jamapsychiatry.2022.5164
- Hareru, H. E., Gezae, K. E., W/tsadik, D. S., & Gebregergs, G. B. (2023). Time to Relapse and Relapse Predictors in Patients with Schizophrenia at Ayder Comprehensive Specialized Hospital, Northern Ethiopia. Mental Illness, 2023(1), 6230063. https://doi.org/10.1155/2023/6230063
- Harvey, P. D., & Strassnig, M. T. (2019). Cognition and disability in schizophrenia: cognition-related skills deficits and decision-making challenges add to morbidity. World Psychiatry: Official Journal of the World Psychiatric Association (WPA), 18(2), 165–167. https://doi.org/10.1002/wps.20647
- Hwang, T.-Y., Jung, G., Lee, C.-J., & Kim, H.-Y. (2020). Analysis of involuntary admissions in Korea through the admission management information system. International Journal of Law and Psychiatry, 68, 101542. https://doi.org/https://doi.org/10.1016/j.ijlp.2020.101542
- Johnson, S., Dalton-Locke, C., Baker, J., Hanlon, C., Salisbury, T. T., Fossey, M., Newbigging, K., Carr, S. E., Hensel, J., Carrà, G., Hepp, U., Caneo, C., Needle, J. J., & Lloyd-Evans, B. (2022). Forum-Acute Psychiatric Care: Increasing The Range of Services And Improving Their Effectiveness And Acceptability. Acute psychiatric care: approaches to increasing the range of services and improving access and quality of care. In World Psychiatry (Vol. 21, Issue 2).
- Kemenkes RI. (2023). Survei Kesehatan Indonesia (SKI) 2023.
- Kline, C. L., Suzuki, T., Simmonite, M., & Taylor, S. F. (2022). Catatonia is associated with higher rates of negative affect amongst patients with schizophrenia and schizoaffective disorder.
- Koizumi, F., Otsuka, K., Endo, J., Hinta, E., Sato, H., Nakamura, H., & Sakai, A. (2017). Predictors for the length of stay of emergency psychiatric patients. JIMA, 69(3), 125–136.
- Noohi, S., Kalantari, S., Hasanvandi, S., & Elikaei, M. (2020). Determinants of Length of Stay in a Psychiatric Ward: a Retrospective Chart Review. The Psychiatric Quarterly, 91(2), 273–287. https://doi.org/10.1007/s11126-019-09699-0
- Pedersen, C. B., Antonsen, S., Timmermann, A., Pedersen, M. G., Ejlskov, L., Horsdal, H. T., Agerbo, E., Webb, R. T., Raaschou-Nielsen, O., Sigsgaard, T., Sabel, C. E., Fan, C. C., & Thompson, W. K. (2022). Urban-Rural Differences in Schizophrenia Risk: Multilevel Survival Analyses of Individual- and Neighborhood-Level Indicators, Urbanicity and Population Density in a Danish National Cohort Study. Schizophrenia Bulletin Open, 3(1). https://doi.org/10.1093/SCHIZBULLOPEN/SGAB056
- Rantala, M. J., Luoto, S., Borráz-León, J. I., & Krams, I. (2022). Schizophrenia: The new etiological synthesis. Neuroscience & Biobehavioral Reviews, 142, 104894. https://doi.org/https://doi.org/10.1016/j.neubiorev.2022.104894
- Rivelli, A., Fitzpatrick, V., Nelson, M., Laubmeier, K., Zeni, C., & Mylavarapu, S. (2021). Real-World Predictors of Relapse in Patients with Schizophrenia and Schizoaffective Disorder in a Large Health System. Schizophrenia, 10(28), 1–11. https://doi.org/10.1038/s41537-024-00448-2
- Rustiyanto, E. (2021). Sistem Pelaporan Rumah Sakit. Gadjah Mada University Press.
- Setiawati, N. M. (2020). Differences in Sociodemographic Characteristics of Schizophrenia Patients between Rural and Urban Areas in Badung Regency. WMJ (Warmadewa Medical Journal), 5(2), 76–84. https://doi.org/10.22225/wmj.5.2.1831.76-84
- Shimogai, T., Izawa, K. P., Kawada, M., & Kuriyama, A. (2019). Factors affecting discharge to home of medical patients treated in an intensive care unit. International Journal of Environmental Research and Public Health, 16(22). https://doi.org/10.3390/ijerph16224324
- Silva, M., Antunes, A., Loureiro, A., Azeredo-Lopes, S., Saraceno, B., Caldas-de-Almeida, J. M., & Cardoso, G. (2020). Factors associated with length of stay and readmission in acute psychiatric inpatient services in Portugal. Psychiatry Research, 293, 113420. https://doi.org/10.1016/j.psychres.2020.113420
- van Genk, C., Roeg, D., van Vugt, M., van Weeghel, J., & Van Regenmortel, T. (2023). Current insights of community mental healthcare for people with severe mental illness: A scoping review. Frontiers in Psychiatry, 14, 1156235. https://doi.org/10.3389/FPSYT.2023.1156235
- Velelekou, A., Papathanasiou, I. V., Alikari, V., Papagiannis, D., Tsaras, K., & Fradelos, E. C. (2022). Factors influencing the duration of hospitalization of patients with schizophrenia. Medicine and Pharmacy Reports, 95(3), 290–299. https://doi.org/10.15386/mpr-2144
- Wallis, J. A., Shepperd, S., Makela, P., Han, J. X., Tripp, E. M., Gearon, E., Disher, G., Buchbinder, R., & O’Connor, D. (2024). Factors influencing the implementation of early discharge hospital at home and admission avoidance hospital at home: a qualitative evidence synthesis. In Cochrane Database of Systematic Reviews (Vol. 2024, Issue 3). John Wiley and Sons Ltd. https://doi.org/10.1002/14651858.CD014765.pub2
- Yang, L. H., Phillips, M. R., Li, X., Yu, G., Grivel, M. M., Zhang, J., Shi, Q., Ding, Z., Pang, S., & Susser, E. (2022). Determinants of never-treated status in rural versus urban contexts for individuals with schizophrenia in a population-based study in China. BMC Psychiatry, 22(1). https://doi.org/10.1186/s12888-021-03651-y
References
Allam, S. (2024). Advancing Patient-Centered Care: A Nationwide Analysis of Hospital Efficiency and Morbidity Using Innovative Propensity Score Techniques. Cureus, 16(12), e76370. https://doi.org/10.7759/cureus.76370
Anbasse, G. K., Tessema, W. G., Negash, A. T., & Alenko, A. A. (2024). Determinants of Disability Among Individuals Living with Schizophrenia Attending Psychiatric Follow-Up Clinic in Jimma, Southwest Ethiopia: An Institution-Based Case-Control Study. Neuropsychiatric Disease and Treatment, 20(May), 1119–1130. https://doi.org/10.2147/NDT.S452866
Berk, M., Köhler-Forsberg, O., Turner, M., Penninx, B. W. J. H., Wrobel, A., Firth, J., Loughman, A., Reavley, N. J., Mcgrath, J. J., Momen, N. C., Plana-Ripoll, O., O’neil, A., Siskind, D., Williams, L. J., Carvalho, A. F., Schmaal, L., Walker, A. J., Dean, O., Walder, K., … Marx, W. (2023). Comorbidity between major depressive disorder and physical diseases: a comprehensive review of epidemiology, mechanisms, and management. In World Psychiatry (Vol. 22).
Bian, Y., Lin, C., Yang, F., Han, X., Zhang, J., Ma, B., Zhu, Y., & Wang, Z. (2019). The Optimal Length of Hospitalization for Functional Recovery of Schizophrenia Patients, a Real-World Study in Chinese People. The Psychiatric Quarterly, 90(3), 661–670. https://doi.org/10.1007/s11126-019-09658-9
Bruce, M., & Smith, J. (2020). Length of stay among multi-ethnic psychiatric inpatients in the United Kingdom. Comprehensive Psychiatry, 102, 152201. https://doi.org/https://doi.org/10.1016/j.comppsych.2020.152201
Burrer, A., Egger, S. T., Spiller, T. R., Kirschner, M., Homan, P., Seifritz, E., & Vetter, S. (2024). Examining the impact of substance use on hospital length of stay in schizophrenia spectrum disorder: a retrospective analysis. BMC Medicine, 22, 1–9. https://doi.org/10.1186/s12916-024-03447-3
Cheng, P., Wang, L., Xu, L., Zhou, Y., Zhang, L., & Li, W. (2022). Factors Related to the Length of Stay for Patients with Schizophrenia: A Retrospective Study. Frontiers in Psychiatry, 12. https://doi.org/10.3389/fpsyt.2021.818254
Dimitri, G., Giacco, D., Bauer, M., Bird, V. J., Greenberg, L., Lasalvia, A., Lorant, V., Moskalewicz, J., Nicaise, P., Pfennig, A., Ruggeri, M., Welbel, M., & Priebe, S. (2018). Predictors of length of stay in psychiatric inpatient units: Does their effect vary across countries? European Psychiatry: The Journal of the Association of European Psychiatrists, 48, 6–12. https://doi.org/10.1016/j.eurpsy.2017.11.001
Hansen, H. G., Starzer, M., & Nilsson, S. F. (2023). Clinical Recovery and Long-Term Association of Specialized Early Intervention Services vs Treatment as Usual Among Individuals with First-Episode Schizophrenia Spectrum Disorder. JAMA Psychiatry, 80(4), 371–379. https://doi.org/10.1001/jamapsychiatry.2022.5164
Hareru, H. E., Gezae, K. E., W/tsadik, D. S., & Gebregergs, G. B. (2023). Time to Relapse and Relapse Predictors in Patients with Schizophrenia at Ayder Comprehensive Specialized Hospital, Northern Ethiopia. Mental Illness, 2023(1), 6230063. https://doi.org/10.1155/2023/6230063
Harvey, P. D., & Strassnig, M. T. (2019). Cognition and disability in schizophrenia: cognition-related skills deficits and decision-making challenges add to morbidity. World Psychiatry: Official Journal of the World Psychiatric Association (WPA), 18(2), 165–167. https://doi.org/10.1002/wps.20647
Hwang, T.-Y., Jung, G., Lee, C.-J., & Kim, H.-Y. (2020). Analysis of involuntary admissions in Korea through the admission management information system. International Journal of Law and Psychiatry, 68, 101542. https://doi.org/https://doi.org/10.1016/j.ijlp.2020.101542
Johnson, S., Dalton-Locke, C., Baker, J., Hanlon, C., Salisbury, T. T., Fossey, M., Newbigging, K., Carr, S. E., Hensel, J., Carrà, G., Hepp, U., Caneo, C., Needle, J. J., & Lloyd-Evans, B. (2022). Forum-Acute Psychiatric Care: Increasing The Range of Services And Improving Their Effectiveness And Acceptability. Acute psychiatric care: approaches to increasing the range of services and improving access and quality of care. In World Psychiatry (Vol. 21, Issue 2).
Kemenkes RI. (2023). Survei Kesehatan Indonesia (SKI) 2023.
Kline, C. L., Suzuki, T., Simmonite, M., & Taylor, S. F. (2022). Catatonia is associated with higher rates of negative affect amongst patients with schizophrenia and schizoaffective disorder.
Koizumi, F., Otsuka, K., Endo, J., Hinta, E., Sato, H., Nakamura, H., & Sakai, A. (2017). Predictors for the length of stay of emergency psychiatric patients. JIMA, 69(3), 125–136.
Noohi, S., Kalantari, S., Hasanvandi, S., & Elikaei, M. (2020). Determinants of Length of Stay in a Psychiatric Ward: a Retrospective Chart Review. The Psychiatric Quarterly, 91(2), 273–287. https://doi.org/10.1007/s11126-019-09699-0
Pedersen, C. B., Antonsen, S., Timmermann, A., Pedersen, M. G., Ejlskov, L., Horsdal, H. T., Agerbo, E., Webb, R. T., Raaschou-Nielsen, O., Sigsgaard, T., Sabel, C. E., Fan, C. C., & Thompson, W. K. (2022). Urban-Rural Differences in Schizophrenia Risk: Multilevel Survival Analyses of Individual- and Neighborhood-Level Indicators, Urbanicity and Population Density in a Danish National Cohort Study. Schizophrenia Bulletin Open, 3(1). https://doi.org/10.1093/SCHIZBULLOPEN/SGAB056
Rantala, M. J., Luoto, S., Borráz-León, J. I., & Krams, I. (2022). Schizophrenia: The new etiological synthesis. Neuroscience & Biobehavioral Reviews, 142, 104894. https://doi.org/https://doi.org/10.1016/j.neubiorev.2022.104894
Rivelli, A., Fitzpatrick, V., Nelson, M., Laubmeier, K., Zeni, C., & Mylavarapu, S. (2021). Real-World Predictors of Relapse in Patients with Schizophrenia and Schizoaffective Disorder in a Large Health System. Schizophrenia, 10(28), 1–11. https://doi.org/10.1038/s41537-024-00448-2
Rustiyanto, E. (2021). Sistem Pelaporan Rumah Sakit. Gadjah Mada University Press.
Setiawati, N. M. (2020). Differences in Sociodemographic Characteristics of Schizophrenia Patients between Rural and Urban Areas in Badung Regency. WMJ (Warmadewa Medical Journal), 5(2), 76–84. https://doi.org/10.22225/wmj.5.2.1831.76-84
Shimogai, T., Izawa, K. P., Kawada, M., & Kuriyama, A. (2019). Factors affecting discharge to home of medical patients treated in an intensive care unit. International Journal of Environmental Research and Public Health, 16(22). https://doi.org/10.3390/ijerph16224324
Silva, M., Antunes, A., Loureiro, A., Azeredo-Lopes, S., Saraceno, B., Caldas-de-Almeida, J. M., & Cardoso, G. (2020). Factors associated with length of stay and readmission in acute psychiatric inpatient services in Portugal. Psychiatry Research, 293, 113420. https://doi.org/10.1016/j.psychres.2020.113420
van Genk, C., Roeg, D., van Vugt, M., van Weeghel, J., & Van Regenmortel, T. (2023). Current insights of community mental healthcare for people with severe mental illness: A scoping review. Frontiers in Psychiatry, 14, 1156235. https://doi.org/10.3389/FPSYT.2023.1156235
Velelekou, A., Papathanasiou, I. V., Alikari, V., Papagiannis, D., Tsaras, K., & Fradelos, E. C. (2022). Factors influencing the duration of hospitalization of patients with schizophrenia. Medicine and Pharmacy Reports, 95(3), 290–299. https://doi.org/10.15386/mpr-2144
Wallis, J. A., Shepperd, S., Makela, P., Han, J. X., Tripp, E. M., Gearon, E., Disher, G., Buchbinder, R., & O’Connor, D. (2024). Factors influencing the implementation of early discharge hospital at home and admission avoidance hospital at home: a qualitative evidence synthesis. In Cochrane Database of Systematic Reviews (Vol. 2024, Issue 3). John Wiley and Sons Ltd. https://doi.org/10.1002/14651858.CD014765.pub2
Yang, L. H., Phillips, M. R., Li, X., Yu, G., Grivel, M. M., Zhang, J., Shi, Q., Ding, Z., Pang, S., & Susser, E. (2022). Determinants of never-treated status in rural versus urban contexts for individuals with schizophrenia in a population-based study in China. BMC Psychiatry, 22(1). https://doi.org/10.1186/s12888-021-03651-y
