Psychiatric inpatient care in Finland – Challenges for deinstitutionalization,factors in rehospitalisation.Peija Haaramo Niko Marola, Kristian Wahlbeck

1. PSYCHIATRIC INPATIENT
CARE IN FINLAND
– Challenges for deinstitutionalization,
factors in rehospitalisation
Peija Haaramo, Niko Marola,
Johanna Cresswell-Smith, Kristian Wahlbeck
& the CEPHOS-LINK group
This project has received funding from the European Union’s Seventh Framework Programme
for research, technological development and demonstration under grant agreement no 603264

2. BACKGROUND: THE FINNISH
PSYCHIATRIC SERVICES
• Mainly publicly delivered and tax-funded
• Past 30 years: deinstitutionalization
• closing down separate psychiatric hospitals
• decreasing the number of psychiatric beds, ALoS, care days/periods
• increasing outpatient services and visits
• Still a hospital-oriented system compared to other countries (especially Nordic) on many
measures:
• number of psychiatric beds
• long-term psychiatric care
• disability pensions due to mental disorders
• number of involuntary admissions
• suicide rates
• unplanned rehospitalisation
• ALoS
• Possible explanations:
• limited outpatient services
• poorly regulated housing services
• under-developed primary care
• regional variations in services17.6.2016
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3. AIM OF THIS PRELIMINARY
STUDY
To examine rehospitalisation and identify its predictors
among Finnish psychiatric patients
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Finland: Psychiatric inpatient care and readmission / Peija
Haaramo
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4. DATA
• The Finnish Care Register for Health Care
• All specialised health care visits in Finland
• Data keeper: National Institute for Health and Welfare (THL)
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5. COHORT / INCLUSION CRITERIA
• Patients discharged from any hospital in Finland in 2012 (at least an
overnight stay)
• Not transferred to another hospital
• Age 18+
• A main ICD-10 psychiatric diagnosis (F2–F6):
• F20–F29: Schizophrenia, schizotypal and delusional disorders
• F30–F39: Mood (affective) disorders
• F40–F48: Neurotic, stress-related and somatoform disorders
• F50–F59: Behavioural syndromes associated with physiological
disturbances and physical factors
• F60–F69: Disorders of adult personality and behaviour
• Specialty psychiatry, not forensic examination or treatment
• N=13,574
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6. STATISTICAL
METHODS
• One-year readmission examined
• Analysed using logistic regression
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7. STUDY POPULATION
(N=13.574)
Men
(N=6,257, 46%)
Women
(N=7,317, 54%)
Age, years (mean, SE) 42.6 (0.20) 45.8 (0.22)
Diagnoses (%)
Psychotic
- F20–F29 (schizophrenia etc.) 49.8 38.4
- F30–F31 (bipolar disorder etc.) 12.2 12.3
Non-psychotic
- F32–F39 (depression etc.) 24.9 31.8
- F40–F48 (anxiety etc.) 9.9 11.5
- F50–F59 (psychosomatic disorders etc.) 0.6 1.9
- F60–F69 (personality disorder etc.) 2.6 4.1
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8. LENGTH OF STAY
(INDEX HOSPITALISATION)
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• Median 17 days (mean 37, range 1–1,863 days, i.e. up to
approximately 5 years)
LoS, days
+ 101–1863 days,
N=983

9. READMISSION DURING THE 1-
YEAR FOLLOW-UP (N=13,574)
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• 6,730 patients readmitted - rate of readmission 50% (men 49%, women 50%)
• Time to readmission: median 81 days, mean 111 days
• 16% of readmissions within the first two weeks, 42% within the first two months
Days

10. POSSIBLE PREDICTORS OF READMISSION (1 YEAR):
DIAGNOSIS (N=13,574)
0
0.5
1
1.5
2
F40-F48 F50-F59 F32-F39 F60-F69 F30-F31 F20-F29
Crude model
Age- and gender-adjusted
*
OR
ref.
ref. = reference group
* = adjusted model statistically significant
*
Anxiety
(N=1,460)
Psychosomatic
(N=178)
Depression
(N=3,882)
Personality d.
(N=465)
Bipolar d.
(N=1,660)
Schizophrenia
(N=5,929)

11. POSSIBLE PREDICTORS OF READMISSION (1 YEAR):
LENGTH OF STAY (N=13,574)
0
0.5
1
1.5
2
1 2-7 8-14 15-30 31-180 181-365 > 365
Crude model
Age- and gender-adjusted
(N=679) (N=3,350) (N=2,193) (N=2,910) (N=4,050) (N=275) (N=117)
OR
ref.
ref. = reference group
* = adjusted model statistically significant
*
LoS, days

12. NEXT STEPS
• Readmission and use of health care services will be
further examined using
• advanced statistical methods (e.g. dynamic modelling)
• international comparisons
• extensive register linkages between data on
• hospitalisations
• outpatient care
• medication
• deaths
• key socioeconomic factors
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13. THANK YOU FOR YOUR
INTEREST!
This project has received funding from the European Union’s Seventh Framework Programme
for research, technological development and demonstration under grant agreement no 603264
Contact information: peija.haaramo@thl.fi
Website: www.cephos-link.org

14. AGE DISTRIBUTION AT INDEX
DISCHARGE
• Both genders (N=13,517)
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15. EXCLUDED
DIAGNOSES
• F00–F09: Organic, including symptomatic, mental disorders
• F10–F19: Mental and behavioural disorders due to
psychoactive substance use
• F70–F79: Mental retardation
• F80–F89: Disorders of psychological development
• F90–F98: Behavioural and emotional disorders with onset
usually occurring in childhood and adolescence
• F99: Unspecified mental disorder
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