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.
Humans ; Retrospective Studies ; Male ; Length of Stay/statistics & numerical data* ; Female ; Middle Aged ; Adult ; Psychological Distress ; Inpatients/psychology* ; Aged ; Anxiety/diagnosis* ; Depression/diagnosis*

Objective To explore the efficacy of transpedicular fixation combined with mixed transpedicular structural and cancellous bone granule graft for the treatment of severe compressed or burst thoracolumbar spinal fractures.Methods From January 2001 to January 2008,18 cases of severe compressed or burst thoracolumbar spinal fractures was treated with transpedicular fixation of spondylolisthesis and fracture(SF) or atlas fixation(AF) combined with mixed transpedicular structural and cancellous bone granule graft in the compressed vertebral body.Results In this group,no injuries to the spinal cord or nerves occurred.The mean blood loss was 50-300 ml(average 80 ml).The mean operation time was 100-180 min(mean 120 min),and the mean postoperative hospital stay was 12 to 30 days(14 days on average).Follow-up was available in 18 cases for a mean of 24 months(5-72 months),all the patients achieved satisfying recovery of the height and physiological curve of the vertebral body: 17 of the cases had normal height and physiological curve;in the other patient,the natural curve was partly destroyed;no patient had loosing and disrupted internal fixation.According to preoperative Frankel evaluation,1 case was classified as Frankel A,1 Frankel B;5 Frankel C,3 Frankel D,and 8 Frankel E before the operation;while postoperative classification showed 1 case of Frankel B;1 cases of Frankel C,and 16 cases of Frankel E.Conclusions Transpedicular fixation combined with mixed transpedicular structural and cancellous bone granule graft is safe and effective for the treatment of severe compressed or burst thoracolumbar spinal fractures.