Table 24, Summary of included studies for comparison 4 acute psychiatric day hospital versus inpatient care - Service delivery Models and settings for delivery of services

Study	Population	Intervention	Comparison	Comments
Creed 1990 RCT UK	N=102 Non-psychotic severe mental illness Diagnosis: 27% schizophrenia; 20% depression; 9% mania; 27% neurotic disorder; 9% personality disorder; 8% addiction/organic disorder Mean age (years): 42.5 Sex (% female): 51 Ethnicity (% BME): NR	Acute day hospital care. Teaching hospital serving small socially deprived inner city area. Day hospital designed to take acute admissions because of few beds (8 nurses, 3 OTs)	Inpatient care (routine inpatient)	Duration of follow-up: 12 months Outcomes: Duration of index admission Readmission at 12 months post-admission Social functioning response at 12 months post-admission
Creed 1997 RCT UK	N=187 Non-psychotic severe mental illness Diagnosis: 43% schizophrenia; 34% depression; 23% neurosis Mean age (years): 38.0 Sex (% female): 43 Ethnicity (% BME): 18	Acute day hospital care. Teaching hospital serving small socially deprived inner city area. Day hospital designed to take acute admissions because of few beds (CPN out of hours).	Inpatient care (routine inpatient)	Duration of follow-up: 12 months Outcomes: Psychiatric symptom severity at 3 months post-admission Psychiatric symptom severity at 12 months post-admission Duration of index admission Readmission at 12 months post-admission Carer distress at 3 months post-admission Carer distress at 12 months post-admission
Dick 1985 RCT UK	N=91 Non-psychotic severe mental illness Diagnosis: Neurosis (56% depressive neurosis), personality disorder, or adjustment reaction Mean age (years): ~35 Sex (% female): 68 Ethnicity (% BME): NR	Acute day hospital care. 2 trained staff + OT, patient/staff ratio: 12.5:1, individual counselling, groups, activities and medication	Inpatient care. Mixed sex and female wards	Duration of follow-up: 12 months Outcomes: Readmission at 4 months post-admission Emergency contacts at 4 months post-admission Outpatient contact at 4 months post-admission Satisfaction at 4 months post-admission
Dinger 2014 RCT Germany	N=44 Depression Diagnosis: 97.7% had a major depressive episode, 2.3% had primary dysthymia Mean age (years): 35.1 Sex (% female): 50 Ethnicity (% BME): NR	Acute day hospital care. Therapeutic staff were the same for both treatment arms. Both groups received equal amounts of psychotherapeutic interventions. Day-clinic patients attended therapy on 5 weekdays from 8 a.m. to 4 p.m. (8 weeks of treatment)	Inpatient care. Therapeutic staff were the same for both treatment arms. Both groups received equal amounts of psychotherapeutic interventions. Inpatients were free to leave the unit outside of night hours and therapy sessions and spent 6 weekends at home (8 weeks of treatment)	Duration of follow-up: 3 months Outcomes: Depression symptomatology at 3 months post-admission Remission at 3 months post-admission Response at 3 months post-admission
Kallert 2007 RCT Germany, UK, Poland, Slovakia and Czech Republic	N=1117 Non-psychotic severe mental illness Diagnosis: 27% schizophrenia, schizotypal, delusional, and other non-mood psychotic disorders (ICD-10 F20-F29); 41% mood [affective] disorders (ICD-10 F30-F39); 22% anxiety, dissociative, stress-related, somatoform and other non-psychotic mental disorders (ICD-10 F40-F49); 9% disorders of adult personality and behaviour (ICD-10 F60-F69) Mean age (years): ~38 Sex (% female): 56 Ethnicity (% BME): NR	Acute day hospital care. Provided between 15 and 35 places, mean staff hours per week per treatment place ranged from 8.8 to 16.0. Staff patient ratios not reported	Inpatient care (routine inpatient)	Duration of follow-up: 14 months Outcomes: Psychiatric symptom severity at 2 months post-admission Psychiatric symptom severity at 14 months post-admission Duration of index admission Quality of life at 2 months post-admission Quality of life at 14 months post-admission Social functioning at 2 months post-admission Social functioning at 14 months post-admission Satisfaction at 2 months post-admission
Schene 1993 RCT Netherlands	N=222 Non-psychotic severe mental illness Diagnosis: 21% psychosis; 38% mood disorders; 24% anxiety disorders; 10% eating disorders; 8% other Mean age (years): 31.9 Sex (% female): 58 Ethnicity (% BME): NR	Acute day hospital care. Provided 24 places. For each day treatment patient, a 0.08 full-time equivalent social psychiatric nurse was available	Inpatient care. Open inpatient ward with 20 beds. For each inpatient, a 0.40 full-time equivalent psychiatric nurse was available	Duration of follow-up: 13 months Outcomes: Remission at 13 months post-admission Duration of index admission Social functioning response at 13 months post-admission

Study

Population

Intervention

Comparison

Comments

Creed 1990

RCT

N=102

Non-psychotic severe mental illness

Diagnosis: 27% schizophrenia; 20% depression; 9% mania; 27% neurotic disorder; 9% personality disorder; 8% addiction/organic disorder

Mean age (years): 42.5

Sex (% female): 51

Ethnicity (% BME): NR

Acute day hospital care. Teaching hospital serving small socially deprived inner city area. Day hospital designed to take acute admissions because of few beds (8 nurses, 3 OTs)

Inpatient care (routine inpatient)

Duration of follow-up: 12 months

Outcomes:

Duration of index admission
Readmission at 12 months post-admission
Social functioning response at 12 months post-admission

Creed 1997

RCT

N=187

Non-psychotic severe mental illness

Diagnosis: 43% schizophrenia; 34% depression; 23% neurosis

Mean age (years): 38.0

Sex (% female): 43

Ethnicity (% BME): 18

Acute day hospital care. Teaching hospital serving small socially deprived inner city area. Day hospital designed to take acute admissions because of few beds (CPN out of hours).

Inpatient care (routine inpatient)

Duration of follow-up: 12 months

Outcomes:

Psychiatric symptom severity at 3 months post-admission
Psychiatric symptom severity at 12 months post-admission
Duration of index admission
Readmission at 12 months post-admission
Carer distress at 3 months post-admission
Carer distress at 12 months post-admission

Dick 1985

RCT

N=91

Non-psychotic severe mental illness

Diagnosis: Neurosis (56% depressive neurosis), personality disorder, or adjustment reaction

Mean age (years): ~35

Sex (% female): 68

Ethnicity (% BME): NR

Acute day hospital care. 2 trained staff + OT, patient/staff ratio: 12.5:1, individual counselling, groups, activities and medication

Inpatient care. Mixed sex and female wards

Duration of follow-up: 12 months

Outcomes:

Readmission at 4 months post-admission
Emergency contacts at 4 months post-admission
Outpatient contact at 4 months post-admission
Satisfaction at 4 months post-admission

Dinger 2014

RCT

Germany

N=44

Depression

Diagnosis: 97.7% had a major depressive episode, 2.3% had primary dysthymia

Mean age (years): 35.1

Sex (% female): 50

Ethnicity (% BME): NR

Acute day hospital care. Therapeutic staff were the same for both treatment arms. Both groups received equal amounts of psychotherapeutic interventions. Day-clinic patients attended therapy on 5 weekdays from 8 a.m. to 4 p.m. (8 weeks of treatment)

Inpatient care. Therapeutic staff were the same for both treatment arms. Both groups received equal amounts of psychotherapeutic interventions. Inpatients were free to leave the unit outside of night hours and therapy sessions and spent 6 weekends at home (8 weeks of treatment)

Duration of follow-up: 3 months

Outcomes:

Depression symptomatology at 3 months post-admission
Remission at 3 months post-admission
Response at 3 months post-admission

Kallert 2007

RCT

Germany, UK, Poland, Slovakia and Czech Republic

N=1117

Non-psychotic severe mental illness

Diagnosis: 27% schizophrenia, schizotypal, delusional, and other non-mood psychotic disorders (ICD-10 F20-F29); 41% mood [affective] disorders (ICD-10 F30-F39); 22% anxiety, dissociative, stress-related, somatoform and other non-psychotic mental disorders (ICD-10 F40-F49); 9% disorders of adult personality and behaviour (ICD-10 F60-F69)

Mean age (years): ~38

Sex (% female): 56

Ethnicity (% BME): NR

Acute day hospital care. Provided between 15 and 35 places, mean staff hours per week per treatment place ranged from 8.8 to 16.0. Staff patient ratios not reported

Inpatient care (routine inpatient)

Duration of follow-up: 14 months

Outcomes:

Psychiatric symptom severity at 2 months post-admission
Psychiatric symptom severity at 14 months post-admission
Duration of index admission
Quality of life at 2 months post-admission
Quality of life at 14 months post-admission
Social functioning at 2 months post-admission
Social functioning at 14 months post-admission
Satisfaction at 2 months post-admission

Schene 1993

RCT

Netherlands

N=222

Non-psychotic severe mental illness

Diagnosis: 21% psychosis; 38% mood disorders; 24% anxiety disorders; 10% eating disorders; 8% other

Mean age (years): 31.9

Sex (% female): 58

Ethnicity (% BME): NR

Acute day hospital care. Provided 24 places. For each day treatment patient, a 0.08 full-time equivalent social psychiatric nurse was available

Inpatient care. Open inpatient ward with 20 beds. For each inpatient, a 0.40 full-time equivalent psychiatric nurse was available

Duration of follow-up: 13 months

Outcomes:

Remission at 13 months post-admission
Duration of index admission
Social functioning response at 13 months post-admission

From: Service delivery Models and settings for delivery of services

Cover of Service delivery Models and settings for delivery of services

Service delivery Models and settings for delivery of services: Depression in adults: Evidence review A.

NICE Guideline, No. 222.

London: National Institute for Health and Care Excellence (NICE); 2022 Jun.

NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.

Table 24Summary of included studies for comparison 4 acute psychiatric day hospital versus inpatient care