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Does a longer stay help?

How long should someone stay in Rehab?

I’m sure this is a million dollar question and of course depends on so many things, how many problems we have, how bad they are and so on, but still, some people come in for a very brief respite and others stay longer so it’s interesting to know if there is any evidence for different benefits for different lengths of stay.

People come to clinics with many different problems, depression, addiction, alcoholism, eating disorders and so on. Unfortunately we rarely only have just one problem and so treatment needs to be tailored to helping on all these fronts at the same time.

Equally, there are many different treatments, Psychiatry, medicine, psychology, psychotherapy and so on. Understanding exactly which one works best for each individual and in what combination, is a very complicated process and makes research quite tricky. To do any research then, we need to find one common measurable factor and see how it is affected by the combined treatments.

I this study I looked at how depressed people were when they arrive and how this changed through treatment. The Becks Depression Index was created by the co-founder of CBT, Dr Aaron Beck. Thankfully it’s a fairly brief questionnaire but it has the benefit that it has been used in so many different clinical situations that there is very good evidence for its ability to accurately measure depression.

The BDI scores different ranges for depression you can see here:

1-10____________________These ups and downs are considered normal
11-16___________________ Mild mood disturbance
17-20___________________Borderline clinical depression
21-30___________________Moderate depression
31-40___________________Severe depression
over 40__________________Extreme depression

I decided to look at the scores of all the patients in the last year who came in with a score greater than 31, indicating Severe Depression. I then wanted to compare the average score on admission with the average score before leaving depending on how long they stayed. I know this is a small sample group since the research was conducted in a small clinic and I only took the data from the last year, so I may be able to do further analysis and build up greater numbers but it was still an interesting first analysis.

What we found was that for those who only stayed one week, the average score on admission was 37, so close to extreme depression, and the score on discharge, after that one week, was 26, so in the middle of the range of moderate depression. Not a bad shift in just one week!

In the group who stayed two weeks, the scores were quite similar to those who stayed just one week, the admission score was a bit higher, this group were scoring an average of 41 which is categorized as Extreme Depression but after just two weeks the scores came down two categories to 25, described as Moderate Depression.

It is really interesting to note what happened in the next two groups. For the clients who stayed for 3 weeks, the average admitting score was 40, so still very close to the Extreme Depression category, but the score after three weeks of treatment came down to just 13, described as ‘mild’ mood disturbance. Equally, the group who stayed four weeks also had a very high average score on admission of 38 and were just 14 on discharge, four weeks later.

So what can we conclude from this? Again, as I said at the beginning, we have to be careful to draw too many conclusions from such a small sample of patients but it does seem as though, although a one week and two weeks stay is beneficial, it looks as though three and four week stays are where you will see much more significant shifts.

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