Partial versus full hospitalization for adults in psychiatric distress: A systematic review of the published literature (1957-1997)

Objective: The authors reviewed published research that compared partial an d full hospitalization as alternative programs for the care of mentally ill adults, with the goal of both systematizing the knowledge base and providi ng directions for future research. Method: Studies published since 1950 were obtained through manual and elect ronic searches. Results were stratified by outcome domain, type of measure used to report between-group differences (global, partial, or rate-based), and time of assessment. Effect sizes were computed and combined within a ra ndom-effects framework. Results: Eighteen investigations published between 1957 and 1997 were syste matically reviewed. Over half of eligible patients were excluded a priori; diagnostic severity of enrollees varied widely. On measures of psychopathol ogy, social functioning, family burden, and service utilization, the author s found no evidence of differential outcome in the selected patient populat ion admitted to the studies reviewed. Rates of satisfaction with services s uggested an advantage for partial hospitalization within 1 year of discharg e, with the gap being largest at 7-12 months. Conclusions: Although partial hospitalization is not an option for all pati ents requiring intensive services, outcomes of partial hospitalization pati ents in these studies were no different from those of inpatients. Further, patients and families were more satisfied with partial hospitalization in t he short term. Weaknesses of the studies limited the scope of our inquiry a nd the generalizability of findings. Positive findings require replication under the present circumstances of mental health care, and more research is needed to identify predictors of differential outcome and successful parti al hospitalization. A clearer definition of partial hospitalization will he lp consolidate its role in the continuum of mental health services.