Socio-demographic and clinical predictors of time to discharge among patients admitted with bipolar disorder at Butabika Hospital
Wengi, Apio Irene
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INTRODUCTION: Bipolar disorder (BD) is recognized as a significant psychiatric condition worldwide and accounts for 30-35% of annual admissions at Butabika National Referral hospital. However, little is known about predictors of time to discharge from an acute episode of BD. OBJECTIVE: This study aimed at identifying social-demographic and clinical predictors of time to discharge from an acute episode of BD, among patients admitted at Butabika hospital. METHODS: Individuals who met DSM-IV criteria for a manic, hypo manic or mixed episode were identified from the acute admission wards of Butabika hospital. They were prospectively followed for one month or until day of discharge from the wards. A standardized questionnaire was used to obtain socio-demographic and clinical data. The Young Mania Rating scale (YMRS) and the Becks Depression Inventory (BDI-II) were used to rate manic and depression symptom severity respectively. The M.I.N.I Structured Clinical Interview for (DSM-IV) was used to confirm diagnosis of co-morbid psychiatric disorders( substance use disorders). The primary outcome measure was time to discharge from the acute admission ward. Statistical analysis was performed using Stata 10.0 (Stata Corp., College Station, Texas). Frequencies of socio-demographic and clinical characteristics of the study participants were presented in tables, graphs, histograms and pie charts. Survival analysis with Cox regression models was used to compare time to discharge from an acute manic episode between individuals with different socio-demographics and clinical characteristics. (For example males versus females, substance users versus non-substance users, first mood episode versus recurrent episode etc). RESULTS; The study participants had a median time to discharge of 2.9 weeks. (mean 2.97, SD 1.54, range 0.7 days to 5 weeks). Socio-demographic predictors found to be significantly associated with time to discharge were employment status (Log rank X2=5.51, P= 0.02), family role (Log rank X2 =4.19, P=0.04) and age of onset of BD ( Log rank X2 =19.22, P = 0.001). Clinical predictors found to be significantly associated with time to discharge were DUP (Log rank X2= 4.07, P=0.0436), family history of mental illness ( Log rank X2=6.32, P=0.011), presence of suicidal ideations (Log rank X2= 3.36, P=0.067) and substance use ( Log rank X2=3.34, p=0.068). CONCLUSIONS: Later age of onset of BD, being a family head and having employment predict a better outcome for BD patients in the acute phase of their illness. A longer duration of untreated symptoms (DUP), presence of suicidal ideations, no family history of mental illness and substance use predict a poorer outcome for BD patients in the acute phase of their illness. RECOMMENDATIONS: Socio-demographic and clinical characteristics such as substance abuse and suicidal risk, must always be carefully identified by clinicians when handling BD patients, because they affect the time of recovery.