Impact of early detection and management of emotional distress on length of stay in non-psychiatric inpatients: A retrospective hospital-based cohort study.
10.1097/CM9.0000000000003599
- Author:
Wanjun GUO
1
;
Huiyao WANG
2
;
Wei DENG
1
;
Zaiquan DONG
1
;
Yang LIU
1
;
Shanxia LUO
1
;
Jianying YU
1
;
Xia HUANG
1
;
Yuezhu CHEN
1
;
Jialu YE
1
;
Jinping SONG
3
;
Yan JIANG
3
;
Dajiang LI
4
;
Wen WANG
5
;
Xin SUN
5
;
Weihong KUANG
1
;
Changjian QIU
1
;
Nansheng CHENG
6
;
Weimin LI
7
;
Wei ZHANG
1
;
Yansong LIU
8
;
Zhen TANG
8
;
Xiangdong DU
8
;
Andrew J GREENSHAW
9
;
Lan ZHANG
1
;
Tao LI
10
Author Information
1. Mental Health Center, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China.
2. Psychiatric Laboratory, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China.
3. Nursing Department, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China.
4. Department of Medical Administration, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China.
5. Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China.
6. Department of Hepato-bilio-pancreatic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China.
7. Respiratory Department, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China.
8. Department of Clinical Psychology, Suzhou Psychiatric Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, Jiangsu 215137, China.
9. Department of Psychiatry, University of Alberta, Edmonton, T6G 2B7, Canada.
10. Affiliated Mental Health Center & Hangzhou Seventh People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310063, China.
- Publication Type:Journal Article
- Keywords:
Anxiety;
Depression;
Emotional distress;
General hospital;
Hospital length of stay;
Medical resources;
Non-psychiatric departments
- MeSH:
Humans;
Retrospective Studies;
Male;
Length of Stay/statistics & numerical data*;
Female;
Middle Aged;
Adult;
Psychological Distress;
Inpatients/psychology*;
Aged;
Anxiety/diagnosis*;
Depression/diagnosis*
- From:
Chinese Medical Journal
2025;138(22):2974-2983
- CountryChina
- Language:English
-
Abstract:
BACKGROUND:While emotional distress, encompassing anxiety and depression, has been associated with negative clinical outcomes, its impact across various clinical departments and general hospitals has been less explored. Previous studies with limited sample sizes have examined the effectiveness of specific treatments (e.g., antidepressants) rather than a systemic management strategy for outcome improvement in non-psychiatric inpatients. To enhance the understanding of the importance of addressing mental health care needs among non-psychiatric patients in general hospitals, this study retrospectively investigated the impacts of emotional distress and the effects of early detection and management of depression and anxiety on hospital length of stay (LOS) and rate of long LOS (LLOS, i.e., LOS >30 days) in a large sample of non-psychiatric inpatients.
METHODS:This retrospective cohort study included 487,871 inpatients from 20 non-psychiatric departments of a general hospital. They were divided, according to whether they underwent a novel strategy to manage emotional distress which deployed the Huaxi Emotional Distress Index (HEI) for brief screening with grading psychological services (BS-GPS), into BS-GPS ( n = 178,883) and non-BS-GPS ( n = 308,988) cohorts. The LOS and rate of LLOS between the BS-GPS and non-BS-GPS cohorts and between subcohorts with and without clinically significant anxiety and/or depression (CSAD, i.e., HEI score ≥11 on admission to the hospital) in the BS-GPS cohort were compared using univariable analyses, multilevel analyses, and/or propensity score-matched analyses, respectively.
RESULTS:The detection rate of CSAD in the BS-GPS cohort varied from 2.64% (95% confidence interval [CI]: 2.49%-2.81%) to 20.50% (95% CI: 19.43%-21.62%) across the 20 departments, with a average rate of 5.36%. Significant differences were observed in both the LOS and LLOS rates between the subcohorts with CSAD (12.7 days, 535/9590) and without CSAD (9.5 days, 3800/169,293) and between the BS-GPS (9.6 days, 4335/178,883) and non-BS-GPS (10.8 days, 11,483/308,988) cohorts. These differences remained significant after controlling for confounders using propensity score-matched comparisons. A multilevel analysis indicated that BS-GPS was negatively associated with both LOS and LLOS after controlling for sociodemographics and the departments of patient discharge and remained negatively associated with LLOS after controlling additionally for the year of patient discharge.
CONCLUSION:Emotional distress significantly prolonged the LOS and increased the LLOS of non-psychiatric inpatients across most departments and general hospitals. These impacts were moderated by the implementation of BS-GPS. Thus, BS-GPS has the potential as an effective, resource-saving strategy for enhancing mental health care and optimizing medical resources in general hospitals.
