Impact of Diabetes on Inpatient Length of Stay in Adult Mental Health Services in a Community Hospital Setting: A Retrospective Cohort Study

Published:April 18, 2022DOI:



      Our aim in this study was to characterise the relationship between comorbid mental health diagnosis and diabetes type on inpatient length of stay (LOS).


      This retrospective, chart review study was conducted at a community hospital in Ontario, Canada. Individuals admitted to the inpatient mental health unit with a reported diagnosis of type 1 or type 2 diabetes were included in the analysis. Relevant data related to mental health conditions at admission and LOS were collected from the electronic health record. Analyses of variance and coviariance were used to determine the impact on LOS.


      A total of 249 encounters were included in the analyses. Overall, individuals with type 2 diabetes (mean, 14.70 days; standard deviation, 15.75 days) had a significantly longer LOS than individuals with type 1 diabetes (mean, 8.01 days; standard deviation, 7.27 days). Upon including sociodemographic factors, individuals older in age and with a most recent admission of <1 year also had a longer LOS. There was no significant relationship between the most responsible mental health diagnosis and LOS.


      Individuals with type 2 diabetes may be more likely to have a longer LOS in inpatient mental health settings than those with type 1 diabetes. More dedicated support would be beneficial for this population. Future work should focus on in-depth exploration of the challenges that lead to the observed LOS.



      L’objectif de notre étude était de caractériser la relation entre le diagnostic d’un trouble de santé mentale comorbide et le type de diabète sur la durée du séjour (DDS) en milieu hospitalier.


      Nous avons réalisé cette étude rétrospective de dossiers médicaux d’un hôpital communautaire en Ontario, au Canada. Pour cette analyse, nous avons sélectionné les individus admis à l’unité hospitalière de santé mentale qui avaient un diagnostic de diabète de type 1 ou de type 2 selon le système de dossiers médicaux électroniques. Nous avons collecté les données pertinentes liées aux troubles de santé mentale à l’admission et la DDS dans les dossiers médicaux électroniques. Nous avons eu recours aux analyses de variance et de covariance pour déterminer les répercussions de la DDS.


      Nous avons inclus un total de 249 rencontres dans les analyses. À partir des modèles de régression linéaire, les individus atteints du diabète de type 2 (moyenne, 14,70 jours; écart type, 15,75 jours) avaient une DDS significativement plus longue que les individus atteints du diabète de type 1 (moyenne, 8,01 jours; écart type, 7,27 jours). Lors de l’application des facteurs sociodémographiques, les individus plus âgés et récemment admis depuis < 1 an avaient aussi une DDS plus longue. Il n’y avait aucune relation significative entre le diagnostic principal de santé mentale et la DDS.


      Les individus atteints du diabète de type 2 sont plus susceptibles d’avoir une plus longue DDS en milieu hospitalier de santé mentale que ceux atteints du diabète de type 1. Cette population tirerait avantage d’un soutien plus adapté à leurs besoins particuliers. D’autres travaux devraient porter sur l’exploration en profondeur des difficultés qui mènent aux DDS observées.


      Mots clés

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Canadian Journal of Diabetes
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


      1. Statistics Canada. Diabetes. 2017.
        • Chudasama Y.V.
        • Gillies C.L.
        • Zaccardi F.
        • et al.
        Impact of COVID-19 on routine care for chronic diseases: A global survey of views from healthcare professionals.
        Diabetes Metab Syndr. 2020; 14: 965-967
        • Mauro V.
        • Lorenzo M.
        • Paolo C.
        • Sergio H.
        Treat all COVID 19-positive patients, but do not forget those negative with chronic diseases.
        Intern Emerg Med. 2020; 15: 787-790
        • Ducat L.
        • Philipson L.H.
        • Anderson B.J.
        The mental health comorbidities of diabetes.
        JAMA. 2014; 312: 691-692
        • Diabetes Canada Clinical Practice Guidelines Expert Committee
        Diabetes and mental health.
        Can J Diabetes. 2018; 42: S130-S141
        • Canadian Mental Health Association
        The relationship between mental health, mental illness and chronic physical conditions. 2008.
        • The Lancet Diabetes Endocrinology
        Poor mental health in diabetes: Still a neglected comorbidity.
        Lancet Diabetes Endocrinol. 2015; 3: 393
        • Government of Canada
        Mental illness in Canada. 2020.
        • Mukhtar S.
        • Mukhtar S.
        Mental health and psychological distress in people with diabetes during COVID-19 [letter to the editor].
        Metabolism. 2020; 108: 154248
        • Bahorik A.L.
        • Satre D.D.
        • Kline-Simon A.H.
        • Weisner C.M.
        • Campbell C.I.
        Serious mental illness and medical comorbidities: Findings from an integrated health care system.
        J Psychosom Res. 2017; 100: 35-45
        • Engel G.L.
        The clinical application of the biopsychosocial model.
        Am J Psychiatry. 1980; 137: 535-544
        • Bower P.
        • Gilbody S.
        Stepped care in psychological therapies: Access, effectiveness and efficiency. Narrative literature review.
        Br J Psychiatry. 2005; 186: 11-17
        • Roberts A.J.
        • Barry D.
        • Yi-Frazier J.
        • Rutman L.
        • Pihoker C.
        • Malik F.S.
        Screening for mental health comorbidities in a pediatric diabetes clinic setting.
        Clin Diabetes. 2021; 39: 97-101
        • Knaus W.A.
        • Wagner D.P.
        • Zimmerman J.E.
        • Draper E.A.
        Variations in mortality and length of stay in intensive care units.
        Ann Intern Med. 1993; 118: 753-761
        • Compton M.T.
        • Craw J.
        • Rudisch B.E.
        Determinants of inpatient psychiatric length of stay in an urban county hospital.
        Psychiatry Q. 2006; 77: 173-188
        • Martin L.
        • Hirdes J.P.
        • Morris J.N.
        • Montague P.
        • Rabinowitz T.
        • Fries B.E.
        Validating the Mental Health Assessment Protocols (MHAPs) in the Resident Assessment Instrument Mental Health (RAI-MH).
        J Psychiatr Ment Health Nurs. 2009; 16: 646-653
        • Hirdes J.P.
        • Marhaba M.
        • Smith T.F.
        • et al.
        Development of the Resident Assessment Instrument---Mental Health (RAI-MH).
        Hosp Q. 2000; 4: 44-51
      2. R: A Language and Environment for Statistical Computing. R Foundation for Statistical Computing, Vienna2013
        • Health Quality Ontario
        Average time patients spent (wait and treatment) in emergency department.
        (Accessed XX)
        • Bodenheimer T.
        • Sinsky C.
        From triple to quadruple aim: Care of the patient requires care of the provider.
        Ann Fam Med. 2014; 12: 573-576
        • Fisher L.
        • Chesla C.A.
        • Bartz R.J.
        • et al.
        The family and type 2 diabetes: A framework for intervention.
        Diabetes Educ. 1998; 24: 599-607
        • de Groot M.
        • Golden S.H.
        • Wagner J.
        Psychological conditions in adults with diabetes.
        Am Psychol. 2016; 71: 552-562
        • Guerrero Fernandez de Alba I.
        • Gimeno-Miguel A.
        • Poblador-Plou B.
        • et al.
        Association between mental health comorbidity and health outcomes in type 2 diabetes mellitus patients.
        Sci Rep. 2020; 10: 19583
        • Nowakowska M.
        • Zghebi S.S.
        • Ashcroft D.M.
        • et al.
        The comorbidity burden of type 2 diabetes mellitus: Patterns, clusters and predictions from a large English primary care cohort.
        BMC Med. 2019; 17: 145
        • Tulloch A.D.
        • Fearon P.
        • David A.S.
        Length of stay of general psychiatric inpatients in the United States: Systematic review.
        Adm Policy Ment Health. 2011; 38: 155-168
        • Williams R.
        • Jenkins D.A.
        • Ashcroft D.M.
        • et al.
        Diagnosis of physical and mental health conditions in primary care during the COVID-19 pandemic: A retrospective cohort study.
        Lancet Public Health. 2020; 5: e543-e550
        • Üstün T.B.
        • Kostanjsek N.
        • Chatterji S.
        • Rehm J.
        Measuring health and disability: Manual for WHO Disability Assessment Schedule WHODAS 2.0.
        World Health Organization, Geneva2010