Barraclough, BrianAbas, Melanie Amna2009-11-192009-11-192003Thesis (MD--Psychiatry)--University of Auckland, 2003.http://hdl.handle.net/2292/5494Full text is available to authenticated members of The University of Auckland only.Background and Method An extensive period of in-patient stay is a proxy for a poor patient outcome, and is costly to services. While length of stay (=LOS) is used as a hospital performance indicator, it will be influenced by factors related to the patient. There is some suggestion that those from more deprived areas have longer periods of inpatient psychiatric stay than those from less deprived areas. The aim was to see if socio-economic deprivation, as measured by the NZDep96 index of deprivation for small areas, was associated with LOS. The sample was 660 inpatients admitted consecutively to the acute psychiatric unit at South Auckland, New Zealand. Additional data were gathered on a sub-sample of 291. Generalised linear modelling was used to investigate the association between deprivation and days of stay. Results There was a 58% increase in the length of index (first) admissions in the study period (= LOS-I) for patients from most deprived areas; 19 days compared with 12 days for those from less deprived areas (LR test χ2 (2df) =17.56, p= 0.0002). There was also a 56% increase in total length of stay over the 2.6-year period for patients from most deprived areas; 27 days compared with 17 days for those from less deprived areas (LR test χ2 (2df) =16.71, p= 0.0002). After adjusting for age, gender, ethnicity, marital status, urban residence, diagnosis, clinical severity and function, physical disability, responsible consultant psychiatrist and involuntary admission, the effect of deprivation on LOS-I remained significant (43% increase in days, p= 0.048). Conclusions 1. Greater deprivation is associated with greater LOS. Area deprivation should be taken into account when comparing LOS between hospitals and when allocating resources. 2. There is a need to assess neighbourhood and individual deprivation in routine clinical practice and to take account of these in patient management. 3. It is not clear if greater deprivation leads to greater LOS, or if greater LOS, perhaps via previous long admissions and chronic disability, leads to greater deprivation. 4. Research is required on the association between deprivation and use of community mental health services; on the factors within neighbourhoods that may contribute to mental disorders; on the relative contribution of neighbourhood deprivation compared with individual deprivation to mental disorders; and on interventions to improve outcomes for deprived people with mental disorders.Items in ResearchSpace are protected by copyright, with all rights reserved, unless otherwise indicated.Restricted Item. Available to authenticated members of The University of Auckland.https://researchspace.auckland.ac.nz/docs/uoa-docs/rights.htmThesisFields of Research::320000 Medical and Health Sciences::320100 Medicine-GeneralCopyright: the authorQ112858253