Psychiatric hospitalizations by the Unified Health System in Brazil between 2000 and 2014

Rocha, Hugo André da; Reis, Ilka Afonso; Santos, Marcos Antônio da Cunha; Melo, Ana Paula Souto; Cherchiglia, Mariangela Leal

doi:10.11606/s1518-8787.2021055002155

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Original Article • Rev. Saúde Pública 55 • 2021 • https://doi.org/10.11606/s1518-8787.2021055002155 copy

Psychiatric hospitalizations by the Unified Health System in Brazil between 2000 and 2014

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

OBJECTIVE

To characterize the profile of patients hospitalized for mental and behavioral disorders by the Unified Health System (SUS) in Brazil between 2000 and 2014, and to verify how aspects of the new mental health policy influenced the rate of hospitalized patients in that period.

METHODS

Non-concurrent prospective cohort study using secondary data from inpatients with a primary diagnosis of mental and behavioral disorders between 01/01/2000 and 12/31/2014. Sociodemographic, clinical, and hospital characteristics variables were selected. Overall rates of hospitalized patients were calculated according to reason for admission, type of hospital, legal nature, and number of admissions per year for each patient. The association between rates of hospitalized patients, number of psychiatric beds per year, and number of Psychosocial Care Centers per year were tested.

RESULTS

We selected a total of 1,549,298 patients, whose most frequent diagnoses on first admission were psychoactive substance use disorders, followed by schizophrenia and mood disorders. The median of hospitalizations per patient was 1.9 and the length of stay per patient was 29 days. The overall rate of hospitalized patients was reduced by almost half in the period. The number of beds per year was positively associated with the rates of hospitalized patients; the number of CAPS per year was negatively associated with some rates of hospitalized patients.

CONCLUSION

Even in the face of adversity, the National Mental Health Policy has advanced in its goal of progressively reducing hospital beds and increasing the supply of substitute services such that both strategies were associated with the reduced inpatient rates. But the changes were felt with greater intensity in the first years of the policy’s implementation, becoming less pronounced in recent years.

Mental Disorders; Day Care, Medical; Hospitalization; Commitment of Mentally Ill; Unified Health System; Mental Health; Public Health Policy

Patients	n	(%)
Patients	1.549.298	(100)
Gender
Female	550,464	35.5
Male	998,834	64.5
Region
North	33,651	2.2
Northeast	303,886	19.6
Southeast	673,688	43.5
South	403,229	26.0
Midwest	134,844	8.7
Reason for Hospitalization by ICD-10 Group
F10-F19 Mental and behavioral disorders due to psychoactive substance use	609,822	39.4
F20-F29 Schizophrenia, schizotypal and delusional disorders	532,083	34.3
F30-F39 Mood [affective] disorders	238,164	15.4
F00-F09 Organic, including symptomatic, mental disorders	88,569	5.7
F40-F99 Other Mental Disorders	80,660	5.2
Death
No	1,35,528	87.8
Yes	189,770	12.2
Death during psychiatric hospitalization
No	175,207	92.3
Yes	14,563	7.7
Number of hospitalizations per patient
One	1,043,048	67.3
Two	240,210	15.5
Three	162,212	10.5
Four or more	103,828	6.7
Type of hospital
Specialized	1,020,276	65.9
General	461,943	29.8
Others	35,197	2.2
N.A.*	31,882	2.1
Legal nature of the hospital
Non-profit private	551,526	35.6
Private	511,378	33.0
Public	483,711	31.2
N.A.*	2,683	0.2

Standardized rate of hospitalized patients per year	Intercept (95%CI)^a	Time (95%CI)^a	Adjusted R²	p	Tendency
Overall rate of hospitalized patients	172.61 (149.82 to 195.39)	-5.72 (-8.22 to -3.21)	0.62	< 0.001	Reduction
Rate by cause group
F00-F09 organic disorders	14.22 (12.15 to 16.27)	-0.7 (-0.93 to -0.48)	0.76	< 0.001	Reduction
F10-F19 substance use	53.28 (45.77 to 60.78)	-0.8 (-1.62 to 0.02)	0.19	0.06	^b
F20-F29 schizophrenia	82.87 (71.60 to 94.13)	-3.96 (-5.19 to -2.72)	0.77	< 0.001	Reduction
F30-F39 mood disorders	20.57 (17.82 to 23.31)	0.03 (-0.27 to 0.32)	-0.07	0.85	^b
F40 to F99 other ICDs	11.17 (7.49 to 14.84)	-0.54 (-0.94 to -0.13)	0.34	< 0.05	Reduction
Rate by type of hospital
Specialized hospital	144.82 (127.19 to 162.43)	-6.6 (-8.53 to -4.66)	0.79	< 0.001	Reduction
General Hospital	19.93 (15.86 to 24.01)	1.7 (1.25 to 2.14)	0.83	< 0.001	Increase
Rate by legal nature of the hospital
Public Hospital	40.11 (33.69 to 46.53)	-0.32 (-1.02 to 0.38)	-0.003	0.35	^b
Private Hospital	91.14 (80.15 to 102.12)	-5.45 (-6.65 to -4.23)	0.87	< 0.001	Reduction
Non-profit Private Hospital	47.72 (40.54 to 54.90)	-0.09 (-0.88 to 0.69)	-0.07	0.80	^b
Rate by number of hospitalizations per year for each patient
One hospitalization per year	133.40 (119.60 to 147.19)	-4.16 (-5.67 to -2.64)	0.71	< 0.001	Reduction
Two hospitalizations per year	24.93 (18.83 to 31.02)	-0.9 (-1.56 to -0.22)	0.34	< 0.05	Reduction
Three hospitalizations per year	8.84 (5.95 to 11.73)	-0.43 (-0.74 to -0.10)	0.35	< 0.05	Reduction
Four or more hospitalizations per year	6.86 (4.21 to 9.51)	-0.31 (-0.59 to -0.01)	0.23	< 0.05	Reduction

Standardized rate of hospitalized patients per year	CAPS		Beds
Standardized rate of hospitalized patients per year	Coefficient (95%CI)^a	p	Coefficient (95%CI)^a	p
Overall rate of hospitalized patients	-0.043 (-0.09 to 0.004)	0.075	0.003 (0.001 to 0.004)^b	< 0.001
Rate by cause group
F00-F09 organic disorders	-0.005 (-0.008 to -0.002)	0.005	0.0003 (0.0002 to 0.0004)	< 0.001
F20-F29 schizophrenia	-0.024 (-0.067 to 0.018)	0.242	0.002 (0.001 to 0.002)^b	0.000
F40 to F99 other ICDs	-0.004 (-0.017 to 0.008)	0.479	0.0003 (0.0000008 to 0.001)^b	0.049
Rate by type of hospital
Specialized hospital	-0.049 (-0.083 to -0.016)	0.007	0.003 (0.002 to 0.003)^b	< 0.001
General Hospital	0.013 (0.009 to 0.017)	0.000	-0.001 (-0.001 to -0.00008)	0.025
Rate by legal nature of the hospital
Private Hospital	-0.038 (-0.07 to -0.007)	0.020	0.002 (0.002 to 0.003)	< 0.001
Rate by number of hospitalizations per year for each patient
One hospitalization per year	-0.03 (-0.053 to -0.008)	0.013	0.002 (0.001 to 0.003)^b	< 0.001
Two hospitalizations per year	-0.006 (-0.015 to 0.002)	0.141	0.0004 (0.00005 to 0.0007)^b	0.025
Four or more hospitalizations per year	-0.003 (-0.011 to 0.005)	0.497	0.0004 (0.0001 to 0.0007)^b	0.009

Faculdade de Saúde Pública da Universidade de São Paulo Avenida Dr. Arnaldo, 715, 01246-904 São Paulo SP Brazil, Tel./Fax: +55 11 3061-7985 - São Paulo - SP - Brazil
E-mail: revsp@usp.br

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[1] Correspondence: Hugo André da Rocha Avenida Professor Alfredo Balena, 190 – Santa Efigênia 30.130-100 Belo Horizonte, MG E-mail: rochahugoandre@gmail.com