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ORIGINAL RESEARCH article

Front. Psychiatry
Sec. Forensic Psychiatry
Volume 15 - 2024 | doi: 10.3389/fpsyt.2024.1456363

Institutional influence on length of stay in German forensic hospitals: A multilevel analysis of schizophrenia spectrum disorder patients

Provisionally accepted
Lukas Stürner Lukas Stürner 1,2*Thomas Ross Thomas Ross 3,4Jan Querengässer Jan Querengässer 5,6Hans-Joachim Traub Hans-Joachim Traub 1,2
  • 1 ZfP Südwürttemberg, Bad Schussenried, Germany
  • 2 Klinik für Psychiatrie und Psychotherapie I, Universitaetsklinikum Ulm, Ulm, Germany
  • 3 Zentrum für Psychiatrie Reichenau, Konstanz, Baden-Wurttemberg, Germany
  • 4 University of Ulm, Ulm, Baden-Wurttemberg, Germany
  • 5 LVR Clinic Cologne, Cologne, North Rhine-Westphalia, Germany
  • 6 Institut für Psychologie, FernUniversität Hagen, Hagen, North Rhine-Westphalia, Germany

The final, formatted version of the article will be published soon.

    Introduction: Scientific studies have focused on patient-related characteristics as predictors of length of stay in forensic psychiatry. However, little attention has been paid to the specificities of forensic psychiatric settings. This study aims to test whether differences in forensic admissions transcend individual factors by comparing length of stay between different psychiatric units, controlling for hospital characteristics and patient characteristics.The dataset was derived from a forensic documentation system containing a wide range of information on forensic psychiatric patients. N = 594 patients with schizophrenia spectrum disorders discharged from 6 forensic hospitals in southern Germany were included in a linear mixed regression model. Linear mixed models were calculated, allowing for the simultaneous estimation of variance between patients and hospitals.The final regression model explained 49% of the total variance. The only statistically significant patient-related predictors were age at admission, education and severity of the index offence. Hospital differences explained 41% (ICC) of the variance in length of stay without finding a significant hospital effect in the data.Discussion: Previous research has primarily analysed predictors of length of stay in terms of individual patient characteristics. This work suggests that variables other than patient-related factors need to be considered when assessing the length of stay in forensic units. Further multi-centre studies are needed to gain a better understanding of how forensic psychiatric hospitals and other institutional influences affect length of stay.

    Keywords: mental disorder, Forensic Psychiatry, offender treatment, linear mixed models, Hospital effect

    Received: 28 Jun 2024; Accepted: 17 Sep 2024.

    Copyright: © 2024 Stürner, Ross, Querengässer and Traub. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Lukas Stürner, ZfP Südwürttemberg, Bad Schussenried, Germany

    Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.