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SHORT COMMUNICATION
Year : 2022  |  Volume : 31  |  Issue : 2  |  Page : 354-358  Table of Contents     

The pattern of inpatient psychiatry admissions at a general hospital psychiatry unit in South India: A retrospective study


1 Department of Psychiatric Nursing, College of Nursing, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India
2 Department of Psychiatry, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India
3 Department of Bio-Statistics, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India

Date of Submission17-Jun-2021
Date of Acceptance29-Oct-2021
Date of Web Publication30-Aug-2022

Correspondence Address:
Dr. Padmavathi Nagarajan
Department of Psychiatric Nursing, College of Nursing, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ipj.ipj_138_21

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   Abstract 


Background: Mental illnesses are becoming a major health issue across the world. The availability of inpatient facilities for mentally ill patients is very much limited in developing countries such as India. Aim: This study was aimed to explore the pattern of psychiatric admissions at a general hospital psychiatry unit (GHPU) in South India. Methodology: The study was conducted at a multispecialty tertiary care hospital in South India. A retrospective, chart-based study design was adopted to achieve the objectives. All inpatient case records available from the department of psychiatry, the medical records department, and the electronic hospital information system of the institute were reviewed between April 2006 and March 2016. Results: A total of 3082 patients were admitted as psychiatry inpatients during the 10-year study period, representing an average of 308.2 admissions per calendar year. The majority of inpatients were male (n = 1824; 59.2%). Concerning diagnostic categories, mood disorders were accounted for 33.6% of admissions, followed by psychotic disorders (26.4%) and substance use disorders (19.3%), respectively. The median length of hospital stay was 14 days (range 0–163 days). A statistically significant seasonality pattern was noticed for mood disorders (December to February) and anxiety and neurotic disorders (August to October). Conclusion: It is obvious that treatment-seeking attitude among individuals with mental illnesses is increasing and the awareness regarding treatment aspects is also increasing among the general public. Hence, there is a need to improve the existing resources to facilitate intensive management for better treatment outcomes and this, in turn, will enhance the quality of life of mentally ill individuals.

Keywords: General hospital psychiatry unit, inpatient admissions, mental illness


How to cite this article:
Nagarajan P, Rajkumar RP, Harichandrakumar K T, Varadharajan N. The pattern of inpatient psychiatry admissions at a general hospital psychiatry unit in South India: A retrospective study. Ind Psychiatry J 2022;31:354-8

How to cite this URL:
Nagarajan P, Rajkumar RP, Harichandrakumar K T, Varadharajan N. The pattern of inpatient psychiatry admissions at a general hospital psychiatry unit in South India: A retrospective study. Ind Psychiatry J [serial online] 2022 [cited 2022 Dec 2];31:354-8. Available from: https://www.industrialpsychiatry.org/text.asp?2022/31/2/354/355055



As per the National Mental Health Survey, 10.6% of the population has a current mental disorder.[1] A subset of patients with severe mental illnesses require inpatient care, usually because of the severity of their disorder and an attendant risk of harm to themselves or those around them, or due to a failure of outpatient or community care.[1]

General hospital psychiatry units (GHPUs) have open ward facilities and caters in many ways including clinical care of especially poor patients, undergraduate and postgraduate training, community services, and research.[2] Despite the important role, there is little research regarding inpatient utilization which is necessary for understanding the allocation of resources. A study from a GHPU in Imphal, in the northeastern part of India, revealed that over 2 years – around 420 patients were admitted per year, with the most common diagnoses being alcohol dependence in men and dissociative disorders in women, followed by psychotic and mood disorders.[3] Such service utilization is not uniformly distributed across a given year; a study from a GHPU in Chandigarh revealed that the bed occupancy rate was highest during the summer months (June and July).[4] No studies from South India have attempted to evaluate the profile of inpatients in GHPU's as in a larger country like ours; health policies and climatic variables differ between North and South India which influence admissions.

Hence, this current study was planned to assess the pattern of psychiatric inpatients admitted at a GHPU in South India. In addition, we explored the seasonality in admissions of various disorders.


   Methodology Top


Study setting and design

The current study is a retrospective, chart-based study conducted at a multispecialty tertiary care hospital in South India. The institute provides daily out- and in-patient psychiatry services, including a separate psychiatric ward with 30 inpatient beds. The study was carried out after approval by the Institute Ethics Committee.

Data collection

All inpatient case records available from the department of psychiatry, the medical records department, and the electronic hospital information system of the institute were reviewed during the period between April 1, 2006, and March 31, 2016. Information related to sociodemographic variables, date and length of admission, and clinical diagnosis was collected without retaining any identifying information. De-identification was done by a third person who was not involved in analyzing the study data. For purposes of comparison with overall trends, statistics on total hospital admissions during the same period were also obtained from the medical records department.

Because of the large variety of diagnoses made in the entire study sample, diagnoses were grouped into categories as per the International Classification of Diseases, 10th edition[5] for meaningful analysis.

  • Group I - Schizophrenia, schizotypal, and delusional disorders (F20–29)
  • Group II - Mood disorders (F30–39)
  • Group III - Mental and behavioral disorders due to psychoactive substance use (F10–19)
  • Group IV - Organic, including symptomatic, mental disorders (F00–F09)
  • Group V - Neurotic, stress-related, and somatoform disorders (F40–49).


A residual “Other” group was created for patients with other diagnoses not covered by Groups I–V, or with unclear diagnoses, as the number of such cases was small.

Statistical analysis

Descriptive statistics were used to summarize the data obtained: frequencies and percentages for categorical variables and the mean and standard deviation for continuous variables. Associations between demographic variables, diagnosis, and length of stay were assessed using the Chi-square test or one-way analysis of variance as appropriate. The tests for seasonality (Freedman's, Ratchet circular scan, and Hewitt's rank-sum tests) from the WinPepi Version 11.65 (Abramson JH, BioMed Central Ltd., 2011).


   Results Top


A total of 3082 patients were admitted during the study period, representing an average of 308.2 admissions per calendar year, or 25.7 admissions per month. However, these admissions were not distributed evenly over the year. Significant seasonal variation (Freedman's V(n) = 0.03, P < 0.01) was found with a short seasonal peak of 3 months spanning from January to March (Ratchet's circular scan statistic = 3.39, P < 0.005).

On sociodemographic details, the majority of inpatients were male (1824; 59.2%), married (1910; 62%), and Hindu by religion (2821; 91.5%). Mood disorders group (Group II) accounted for 33.6% of admissions, followed by schizophrenia, schizotypal, and delusional disorders (Group I) - 26.4%. Group IV and Group V were the least common, accounting for 2.0% and 2.9% of admissions, respectively [Table 1].
Table 1: Distribution of sociodemographic characteristics (n=3082)

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The median length of hospital stay was 14 days (range 0–163 days). There was no significant relationship between demographic variables and length of admission, though the duration of admission was significantly longer in patients with psychotic and mood disorders (P = 0.009). No statistical significance was observed across different diagnostic categories for gender and marital status each (χ2 = 2.841, P = 0.724; χ2 = 9.371, P = 0.497) [Table 2].
Table 2: Comparison of age and length of stay with diagnostic category (n=3082)

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Over the study period, there was no evidence for an increase or decrease in overall admissions to the psychiatry ward. This was in contrast to overall hospital statistics which showed a clear increase in inpatient numbers (from 51,071 in 2006 to 86,093 in 2016; P < 0.01, change-point test).

Finally, we examined seasonal variations in admissions for the individual diagnostic groups [Figure 1]. Overall, there was significant evidence of seasonality only for mood disorders (Freedman's V(n) = 0.07; P < 0.01) and anxiety and neurotic disorders (Freedman's V(n) = 0.148; P < 0.05). The seasonal peaks were observed from December to February for mood disorders (Ratchet's circular scan statistic = 3.3; P < 0.01) and August to October for anxiety and neurotic disorders (Ratchet's circular scan statistic = 2.99; P < 0.025), respectively.
Figure 1: Seasonal variations in admissions of various diagnoses over the years 2006–2016. On the Y-axis, on the left-hand side is the number of patients admitted, and on the right-hand side is the groups of diagnosis of admitted patients. G 1: Schizophrenia, schizotypal, and delusional disorders; G 2: Mood disorders; G 3: Mental and behavioral disorders due to psychoactive substance use; G 4: Organic, including symptomatic, mental disorders; G 5: Neurotic, stress-related, and somatoform disorders

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   Discussion Top


The important finding from our study was that mood disorders followed by schizophrenia, schizotypal, and delusional disorders contributed to about three-fifths of the inpatient admissions and seasonality pattern observed for mood disorders and neurotic disorders.

A total of 3082 patients were admitted in our setting during the 10 years. This number is slightly lower than that reported from an earlier study, where an average of 420 admissions/year was reported,[3] but slightly higher than the annual admission rate in a comparable study from Bhutan, where 1336 patients were admitted over 7 years, with an average of 190.9 admissions/year.[6] These variations may reflect variations in service availability and accessibility across different geographical locations. In addition, there were no increasing or decreasing trends observed among inpatient admissions when compared with overall hospital statistics (bed strength has remained 30 throughout); this reflects that resources allocated for mental health facilities are inadequate.[1],[2]

The median length of inpatient stay was 14 days quite similar to other Indian studies where it varied from 7 to 30 days,[7],[8],[9],[10] and this reflects the trend toward shorter admissions and higher patient turnover in GHPUs compared to mental hospitals.[7],[8],[11] Longer duration of stay for mood disorders and psychotic disorders is similar to other studies from India.[12],[13],[14],[15],[16] This variation may reflect differences in public versus private funding of mental healthcare, as well as other psychosocial variables.[17]

The most frequent diagnoses among our inpatients were mood disorders followed by psychotic disorders, and no association was noticed between gender and marital status with diagnostic categories. The majority of the studies reported schizophrenia and related psychotic disorders (27%–61.24%) predominated followed by mood disorders (23.4%–38.76%).[9],[10],[12],18],[19] Few studies reported predominance of either mood and anxiety disorders inpatients or substance-induced disorders, respectively (29.2%).[20] The difference could be explained due to seasonality and prevalence of substance use in the region which can influence psychiatric admission patterns.[13],[21]

Finally, we found evidence of seasonal trends for the case of mood disorders (December to February) and anxiety and neurotic disorders (August to October). The seasonal trend reported for mood disorders replicates an earlier study which reported a peak between November and January; however, it covered a shorter time frame[14] and found winter association too but is in contrast to the summer peak (June and July) for mood disorder presentations reported in other Indian studies.[4],[15] On the other hand, both our study and Singh et al. reported a roughly similar seasonal peak for neurotic disorders, but the latter was for outpatients.[4] Such association with summer and winter seasons have been observed in studies[12],[18] abroad too and this difference may be due to our center located in the tropical region. While seasonal variation in mood disorders has been extensively described in the literature,[16],[22] seasonality in anxiety and neurotic disorders is a relatively under-studied area that requires further examination.

Our study results are subject to certain limitations. As it is retrospective data, a finer analysis of important variables, such as bed occupancy and re-admissions, were unavailable and hence could not be done. These also highlight that mental health is not prioritized by the existing health information systems. We did not examine large-scale social changes over this period which may have indirectly impacted the utilization of mental health services. Finally, the study is from a single center which limits generalization and needs replication from different centers across the country.


   Conclusion Top


Regardless of these limitations, this study represents an addition to the small body of literature dealing with psychiatric admission patterns in India. Nevertheless, they may serve a valuable role in understanding certain phenomena related to mental illness, such as seasonality and monitoring the responses to the act to allocate resources accordingly in Indian GHPUs.

Acknowledgments

The authors wish to acknowledge the assistance provided by the Medical Records Department and Hospital Information Services, JIPMER, in conducting this study.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

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Gautham MS, Gururaj G, Varghese M, Benegal V, Rao GN, Kokane A, et al. The National Mental Health Survey of India (2016): Prevalence, socio-demographic correlates and treatment gap of mental morbidity. Int J Soc Psychiatry 2020;66:361-72.  Back to cited text no. 1
    
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World Health Organization. The ICD-10 Classification of Mental and Behavioural Disorders: Clinical Descriptions and Diagnostic Guidelines. Geneva: World Health Organization; 2006.  Back to cited text no. 5
    
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Vasudeva S, Narendra Kumar MS, Sekhar KC. Duration of first admission and its relation to the readmission rate in a psychiatry hospital. Indian J Psychiatry 2009;51:280-4.  Back to cited text no. 9
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Kar SK, Roy P, Singh J, Tripathi A, Dalal PK. Clinical profile and correlates of hospital stay in patients with severe mental illness. Asian J Psychiatr 2019;45:41-3.  Back to cited text no. 10
    
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Amr M, Volpe FM. Seasonal influences on admissions for mood disorders and schizophrenia in a teaching psychiatric hospital in Egypt. J Affect Disord 2012;137:56-60.  Back to cited text no. 12
    
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Lee HC, Tsai SY, Lin HC. Seasonal variations in bipolar disorder admissions and the association with climate: A population-based study. J Affect Disord 2007;97:61-9.  Back to cited text no. 13
    
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Rajkumar RP, Sarkar S. Seasonality of admissions for mania: Results from a general hospital psychiatric unit in Pondicherry, India. Prim Care Companion CNS Disord 2015;17. doi: 10.4088/PCC.15m01780.  Back to cited text no. 14
    
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Avasthi A, Sharma A, Gupta N, Kulhara P, Varma VK. Seasonality and unipolar recurrent mania: Preliminary findings from a retrospective study. Indian J Psychiatry 1996;38:236-9.  Back to cited text no. 15
    
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Aguglia A, Borsotti A, Maina G. Bipolar disorders: Is there an influence of seasonality or photoperiod? Braz J Psychiatry 2018;40:6-11.  Back to cited text no. 16
    
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Preti A, Rucci P, Santone G, Picardi A, Miglio R, Bracco R, et al. Patterns of admission to acute psychiatric in-patient facilities: A national survey in Italy. Psychol Med 2009;39:485-96.  Back to cited text no. 18
    
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Wheeler A, Robinson E, Robinson G. Admissions to acute psychiatric inpatient services in Auckland, New Zealand: A demographic and diagnostic review. N Z Med J 2005;118:U1752.  Back to cited text no. 19
    
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Thompson A, Shaw M, Harrison G, Ho D, Gunnell D, Verne J. Patterns of hospital admission for adult psychiatric illness in England: Analysis of hospital episode Statistics data. Br J Psychiatry 2004;185:334-41.  Back to cited text no. 20
    
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Jarman B, Hirsch S, White P, Driscoll R. Predicting psychiatric admission rates. BMJ 1992;304:1146-51.  Back to cited text no. 21
    
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Øverland S, Woicik W, Sikora L, Whittaker K, Heli H, Skjelkvåle FS, et al. Seasonality and symptoms of depression: A systematic review of the literature. Epidemiol Psychiatr Sci 2019;29:e31.  Back to cited text no. 22
    


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