Factors Associated with Difficult Discharge in Patients with Mental Disorders Following Prolonged Hospitalization: A Retrospective Study of 1254 Inpatients

<title>Abstract</title> <p>Background Difficult discharge among patients with mental disorders following prolonged hospitalization poses a significant barrier to deinstitutionalization and community reintegration. This study aimed to identify risk factors for difficult discharge and characterize the attribution of discharge barriers in this population. Methods This retrospective observational study included 1254 inpatients with mental disorders discharged between January 2014 and December 2023. Patients were classified into successful discharge (n = 104) and difficult discharge (n = 1150) groups. Baseline characteristics were compared using chi-squared or Fisher's exact test, and binary logistic regression was used to identify independent risk factors. Among 1147 patients with complete discharge barrier records, barriers were categorized into illness-related factors, social support factors, cognitive and attitudinal factors, and other factors. Separate logistic regression models were constructed for each barrier category, and the interaction between guardian status and insurance type was tested. Results Multivariable analysis showed that male sex (P &lt; 0.001), absence of a guardian (OR = 7.258, P = 0.007), and two or more physical comorbidities (P = 0.001) were independently associated with difficult discharge. Social support factors accounted for the largest proportion of discharge barriers (73.41%), followed by illness-related (25.98%), cognitive and attitudinal (18.48%), and other factors (6.89%). Illness-related barriers were associated with age ≥ 60 years (OR = 2.550, P = 0.001), physical comorbidities (one: OR = 4.214; two or more: OR = 7.971; both P &lt; 0.001), and employee medical insurance (OR = 1.813, P = 0.001). Social support barriers were associated with length of hospitalization ≥ 10 years (P &lt; 0.01) and guardianship by non-first-degree relatives (P &lt; 0.001). Guardian status and insurance type showed a significant interaction effect on difficult discharge (P = 0.033). Conclusions Absence of a guardian, male sex, and multiple physical comorbidities are independent risk factors for difficult discharge following prolonged hospitalization. The discharge dilemma for patients without guardians primarily stems from disruption of the social support system rather than illness instability. A multidimensional discharge support system integrating medical, social, and economic interventions should be established for this vulnerable population.</p>