Hospitalization costs and length of hospital stay of patients with first-episode psychosis: A retrospective single-center cohort study

Background: The present study was to investigate the hospitalization costs and length of hospital stay of patients with first-episode psychosis (FEP) following emergency department visits. Methods: Patients hospitalized for the first time with a diagnosis of psychotic disorder via the emergency department were retrospectively assessed through clinical records in a mental health center in East China from Jan 1 ^st 2018, to Dec 12 ^th 2023. The total annual hospitalization cost, per capita cost of the first hospitalization, and length of hospital stay for such FEP patients were calculated separately. The related influencing factors were subsequently analyzed. Results: During the six-year observation period, a total of 737 individuals were enrolled, with a mean age of 42.30±19.54 years. There were 382 female patients (51.8%) predominantly. Among them, 399 cases (54.1%) were nonorganic mental disorders, with the 2 highest prevalences being mood (affective) disorders and schizophrenia. A total of 338 patients (45.8%) had organic mental disorders, with the 2 highest prevalences of infectious and immune-related diseases. The per capita direct cost per hospitalization for FEP patients was a median of 2,876.04 US dollars, with the highest cost associated with immune-related diseases (7431.43±8877.06). The per capita length of stay per hospitalization varied from 1 to 182 days, with a mean of 21.31±19.40 days and a median of 16 days. The average length of the first hospitalization was 16.87±12.38 days, with the longest duration of (43.83±43.83 days). A disease duration exceeding two weeks prior to consultation was associated with an increased length of hospital stay, and the time required for diagnosis more than one week after admission also prolonged the hospital stay and increased hospitalization costs. Conclusions Among all the FEP patients, the number of nonorganic mental disorders was greater than that of organic mental disorders, but the per capita hospitalization cost was significantly greater for organic disorders than for nonorganic disorders. The initial onset of psychiatric and behavioral symptoms caused by immune-related diseases should receive particular attention, given the higher hospitalization costs and longer hospital stays. When visits and diagnoses are delayed, the economic burden becomes even more pronounced for these organic mental disorders.