Factors associated with long length of stay in an inpatient psychiatric facility in Lahore, Pakistan.

Abstract

Objective: To describe the clinical and socio-demographic characteristics of long-stay psychiatric inpatients and to identify factors associated with prolonged hospitalization within this cohort. Study Design: Hospital-based Descriptive Cross-sectional. Setting: Punjab Institute of Mental Health (PIMH), Lahore, Pakistan. Period: June to November 2025. Methods: A total of 128 consecutive long-stay inpatients (length of stay >90 days) were included using non-probability consecutive sampling. Socio-demographic variables (age, gender, marital status, education level, family support), clinical diagnoses, and documented psychiatric and behavioural symptoms were extracted from medical records. Length of stay (LOS) was highly skewed; therefore, Mann–Whitney U tests were used to compare LOS between groups for each binary variable, with significance set at p < 0.05. Analyses were done using SPSS version 25.0. Results: The median length of stay (LOS) was 1,825 days (interquartile range [IQR] 1,095–2,555 days), and the mean was 2,368 days (approximately 6.4 years), showing a highly skewed distribution with LOS ranging from 146 to 16,425 days (0.4–45 years). The median patient age was 45 years, and 94 (73%) were male. Older age (p < 0.001), low education level (p = 0.027), family refusal to take the patient home (p = 0.001), comorbid chronic medical illness (p = 0.014), and cognitive impairment (p = 0.018) were significantly associated with longer LOS. In contrast, male gender, unmarried status, schizophrenia diagnosis, intellectual disability, mandatory care, treatment resistance, medication non-compliance, substance use disorder, sleep disturbance, suicidal ideation, and violent behaviour were not statistically significantly associated with LOS (all p ≥ 0.05). Notably, the absence of statistical significance does not eliminate potential clinical relevance, particularly in subgroups with limited statistical power. Conclusion: Among long-stay psychiatric inpatients, social vulnerability (older age, low education, absent family support), medical complexity (comorbid chronic illness), and cognitive impairment were the strongest correlates of prolonged hospitalization. The exceptionally prolonged stays observed in this cohort indicate systemic deficiencies in community mental health services and persistent social barriers to discharge, rather than acute psychiatric symptoms alone. Targeted discharge planning, family engagement programs, and investment in community mental health infrastructure are essential to reduce unnecessary institutionalization.