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Psychiatric Morbidity and Impact on Hospital Length of Stay Among Hematologic Cancer Patients Receiving Stem-Cell Transplantation

From the Department of Psychiatry, Clinical Institute of Psychiatry and Psychology and Stem-Cell Transplantation Unit, Department of Hematology, Institute of Hematology and Oncology, Institut d’Investigacions Biomèdiques August Pi i Sunyer, Hospital Clínic, University of Barcelona, Barcelona, Spain.

Address reprint requests to Jesús M. Prieto, MD, Centre de Salut Mental, Sta Llogaia 67, 17600 Figueres, Spain; email: jmprieto{at}comg.es

PURPOSE: To determine the prevalence of psychiatric disorders during hospitalization for hematopoietic stem-cell transplantation (SCT) and to estimate their impact on hospital length of stay (LOS).

PATIENTS AND METHODS: In a prospective inpatient study conducted from July 1994 to August 1997, 220 patients aged 16 to 65 years received SCT for hematologic cancer at a single institution. Patients received a psychiatric assessment at hospital admission and weekly during hospitalization until discharge or death, yielding a total of 1,062 psychiatric interviews performed. Psychiatric disorders were determined on the basis of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Univariate and multivariate linear regression analyses were used to identify variables associated with LOS.

RESULTS: Overall psychiatric disorder prevalence was 44.1%; an adjustment disorder was diagnosed in 22.7% of patients, a mood disorder in 14.1%, an anxiety disorder in 8.2%, and delirium in 7.3%. After adjusting for admission and in-hospital risk factors, diagnosis of any mood, anxiety, or adjustment disorder (P = .022), chronic myelogenous leukemia (P = .003), Karnofsky performance score less than 90 at hospital admission (P = .025), and higher regimen-related toxicity (P < .001) were associated with a longer LOS. Acute lymphoblastic leukemia (P = .009), non-Hodgkin’s lymphoma (P = .04), use of peripheral-blood stem cells (P < .001), second year of study (P < .001), and third year of study (P < .001) were associated with a shorter LOS.

CONCLUSION: Our data indicate high psychiatric morbidity and an association with longer LOS, underscoring the need for early recognition and effective treatment.

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