Portuguese public hospitals registered 25,385 hospitalizations for schizophrenia or other psychotic disorders over an eight-year period. However, many of those hospitalizations were readmissions.

These data are part of a study carried out by researchers from the Faculty of Medicine of the University of Porto (FMUP), CINTESIS – Center for Health Technology and Services Research, and the Department of Psychiatry and Mental Health of the Centro Hospitalar do Tâmega e Sousa.

The work, which is has been published in the online edition of the international scientific journal Psychiatric Quarterly, is the first to characterize all the hospitalizations that occurred in public hospitals of patients with a primary diagnosis of schizophrenia, nationwide.

Most hospitalized patients are male (68%) and are between 31 and 50 years old. In men, the age group between 18 and 30 years is the second most affected, while in women, it is the group from 51 to 70 years of age.

Between 2008 and 2015, there was a decrease in the number of hospitalizations for schizophrenia. The last year analyzed was the one that registered the lowest number of hospitalizations associated with this mental illness (2,958, in 2015, against 3,314, in 2008), corresponding to 28.6 hospitalizations per 100,000 inhabitants. Each hospitalization had a median duration of 18 days.

As Manuel Gonçalves-Pinho, researcher CINTESIS / FMUP, physician and first author of this study, explains, “this decrease is due to the progressive policy of deinstitutionalization of people with psychiatric diseases that has been adopted in Portugal in recent decades”.

Another reason given is “the advent of new pharmacological treatments that are more effective and that allow better management of the symptoms presented by patients outside the hospital”.

“It is important to know the numbers of hospitalizations for schizophrenia in mental health care in Portugal since it is impossible to plan treatment strategies without knowing the global panorama of the country”, says the researcher Manuel Gonçalves-Pinho.

“Care quality must be guaranteed after discharge”

For the authors of this study, “reducing the length of hospital stay associated with mental illness may be an objective, but only if the quality of health care provided at the community level is guaranteed, immediately after discharge”.

The researchers stress “the need to reinforce investment in mental health care, which encompasses different levels, from proximity care to hospitals and long-term inpatient units, clearly undersized for the needs of our country”.

As they explain, “psychiatric hospitalizations of patients with acute conditions are currently overwhelmed with social cases (not purely for medical reasons) given the clear lack of structures/places to receive these patients in the social sector”.

The costs amount to 89.1 million euros

As for the costs involved, in the period between 2008 and 2015, the total costs of these hospitalizations amounted to 89.1 million euros. Each hospitalization cost about 3,500 euros, on average. Compared to other European countries, Portugal is in the middle of the table, above Ukraine, which spent only 533 euros for each episode, but well below Germany, which spent about 12 thousand euros for hospitalization.

Worldwide, hospitalizations for schizophrenia are known to be the longest among hospitalizations for mental illnesses, which in turn are already higher than those for other illnesses. With the aging of these patients, it is expected that the complexity of the symptoms associated with the progression of schizophrenia will also increase, as well as the concomitant diseases, which can prolong the hospital stay.

This study is co-authored by João Pedro Ribeiro, psychiatrist at Centro Hospitalar do Tâmega e Sousa, and coordinator Alberto Freitas, researcher at CINTESIS and professor at FMUP.