Intensive Home Treatment compared to Inpatient Psychiatric Treatment: A 36-Month Follow-Up of a Propensity-Score Matched Retrospective Multicenter Cohort Study

Intensive Home Treatment compared to Inpatient Psychiatric Treatment: A 36-Month Follow-Up of a Propensity-Score Matched Retrospective Multicenter Cohort Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Intensive Home Treatment compared to Inpatient Psychiatric Treatment: A 36-Month Follow-Up of a Propensity-Score Matched Retrospective Multicenter Cohort Study Konstantinos Nikolaidis, Sandeep Rout, Olaf Hardt, Christoph Richter, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7104562/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 16 Apr, 2026 Read the published version in BMC Psychiatry → Version 1 posted 15 You are reading this latest preprint version Abstract Background: Intensive Home Treatment (IHT) has emerged as an effective alternative to inpatient care for acute psychiatric crises, reducing hospital admissions in the short term. However, long-term outcomes beyond 12 months remain understudied, particularly regarding readmissions, cumulative treatment days, and broader psychiatric service utilization. This study evaluates the 36-month effectiveness of IHT compared to inpatient treatment (IT) in routine care, focusing on readmission rates, treatment days, and outpatient service engagement Methods A retrospective matched cohort study was conducted using electronic health records from three psychiatric hospitals in Berlin, Germany. Patients receiving IHT were propensity-score matched (1:1) to IT patients based on age, gender, diagnosis, and prior service use. Outcomes included inpatient/combined readmissions, treatment days, time to readmission, and first-time us of the Psychiatric Outpatient Department (POD) over 36 months. Statistical analyses employed logistic regression, survival analysis (Cox model), and non-parametric tests. Results 263 patients receiving IHT were propensity-score matched to 263 patients treated with IT with no statistical differences at baseline. The IHT group had significantly lower inpatient readmission rates (41.1% vs. 55.5%, p = 0.001), fewer inpatient readmissions (mean 1.72 vs. 2.02, p = 0.005), and fewer inpatient days (48.5 vs. 51.7, p = 0.003) compared to IT. Time to readmission was longer for IHT (median not reached vs. 610 days for IT, p = 0.001). Combined readmission rates (IHT + IT + day clinic) did not differ significantly (61.2% vs. 64.3%, p = 0.47). IHT patients were more likely to initiate for the first time a POD treatment (33.5% vs. 24.7%, p = 0.035) and had more IHT readmissions (mean 0.85 vs. 0.35, p < 0.001). Conclusions IHT demonstrates sustained long-term benefits, reducing inpatient readmissions and prolonging readmission-free periods over 36 months. While overall psychiatric service utilization was similar between groups, IHT facilitated greater engagement with outpatient rather than inpatient care. Findings support IHT as a viable, sustainable alternative to IT, particularly in urban settings, with potential to rebalance care toward community-based services. Limitations include restricted generalizability to rural areas and lack of clinical symptom data. Further multi-centre studies are needed to confirm these results regarding long-term effects across diverse healthcare systems. Trial registration: German Clinical Trials Register (DRKS), DRKS00036833. Registered Mai 21st 2025, https://www.drks.de/search/de/trial/DRKS00036833/details Intensive Home Treatment Propensity score matching Psychiatric service utilization Readmission rates Figures Figure 1 Background Intensive Home Treatment (IHT) approaches—such as crisis resolution teams—have been implemented in many mental health systems as effective alternatives to inpatient care for individuals experiencing acute psychiatric crises [ 1 ]. These services provide intensive, multidisciplinary psychiatric support directly in patients’ homes, aiming to reduce the need for hospital admissions. Over the years, findings have suggested that IHT can reduce inpatient service utilization [ 2 ]. However, earlier studies only partially addressed the broader use of psychiatric services—such as day clinics and outpatient support—which play a vital role in contemporary mental health care systems. More recently, a prospective quasi-experimental multicenter trial conducted across 10 sites in Germany [ 3 ], provided new evidence by examining the newly implemented German IHT model. First findings showed significantly lower inpatient and combined readmission—defined to include inpatient care, IHT, and day clinic utilization—for patients receiving IHT compared to those treated in inpatient settings [ 4 ], with IHT also expected to be cost-effective at a slightly higher acceptability probability than inpatient treatment[ 5 ]. Furthermore, a retrospective pilot study on the German IHT model with matched pairs showed an effect of significantly rising Number of first-time treatments in the Psychiatric Outpatient Department (POD) following the IHT treatment in comparison to inpatient treatment at a 12-month-follow-up [ 6 ]. This German specific form of IHT, known as inpatient equivalent home treatment (IEHT), was allowed to start in 2018 after legal regulation were clarified in 2016. Thus it was made available to German psychiatric hospitals through reimbursement by public health insurance. It shares several core features with established home treatment (HT) models like the British, Norwegian, Spanish, Swiss and Dutch [ 1 , 7 – 11 ], including regular home visits, small caseloads, comprehensive psychiatric and medical assessments conducted at home, shared responsibility for both medical and social care, intensive support, involvement of family members or carers, and the development of crisis plans Nevertheless, unlike most other HT models, IEHT operates under strict regulatory requirements [ 12 ]. This consistent standardization across sites creates favorable conditions for rigorous and high-quality evaluation of the IEHT model. This growing body of evidence supports IHT as a viable and effective alternative to inpatient treatment (IT), particularly when implemented in routine care. Nevertheless, most previous studies have examined relatively short follow-up periods—typically 6, 12 [ 7 ], or occasionally 24 months [ 11 ]. Data on long-term outcomes beyond the first year remain limited, especially concerning readmissions, cumulative treatment days, and the combined use of psychiatric services, including IT, IHT, and day clinic (DC). These outcomes are crucial for evaluating the sustainability and systemic effects of IHT. To help fill these gaps, the present study investigates the long-term effectiveness of IHT in routine care by analysing a large retrospective matched cohort over a 36-month follow-up period. Specifically, the study focuses on inpatient readmission rates as also on the broader utilization of psychiatric services in a real-world clinical setting, the inpatient and combined readmission rates, the total treatment days and the effect on the utilization of outpatient treatment services. Given that survival analysis offers a more comprehensive, flexible, and clinically meaningful framework for predicting and managing hospital readmissions compared to simple readmission rates, we also planned to assess the time to readmission. Methods Study Setting and Data Source This study is based on routine controlling data and electronic patient records from the Vivantes Departments of Psychiatry, Psychosomatics, and Psychotherapy at the “Am Urban” (KAU), “Neukölln” (KNK), and “Kaulsdorf” (KHD) hospitals. The data cover patients treated between January 1, 2020, and December 31, 2020. No direct interviews or surveys were conducted. All clinics are part of a state-owned hospital group, serving approximately 1.2 million residents across three districts of Berlin. Two of the main contributing centres—KNK and KAU—are comparable in structure and service delivery. Following the prior implementation and evaluation of HT and intensified outpatient care as part of a pilot project under § 64b SGB V, IHT was introduced in 2018 with an initial capacity of seven treatment slots. Both clinics offer a wide range of psychiatric treatment services, including specialized programs for young people in psychological crises [ 13 – 15 ], as well as job coaching based on the Individual Placement and Support (IPS) model [ 16 ], have been offering IHT since 2018 and maintained established IHT teams throughout the observation period. Though working in different models. In 2020, KNK operated approximately 14 IHT treatment places, while KAU initially had 14 places and increased to 20 places in November 2020. Regular IHT services at KHD officially began on October 6, 2020, with initially 7 places offered, bringing the total number of IHT cases in 2020 to 42. The KHD is comparable in size and structure to the KAU, and it is subspecialized and mandatory care clinic for the Berlin district of Marzahn-Hellersdorf. Intervention and control treatment IHT treatment is a psychiatric care delivered at the patient’s home by a multidisciplinary group—including psychiatrists, psychologists, psychiatric nurses, social workers, and other professionals. The treatment protocols for IHT in Germany, called inpatient equivalent home treatment (IEHT), have been thoroughly defined by the umbrella organization representing all German social health insurance providers and the German Hospital Federation [ 12 ]. To qualify for reimbursement by German statutory health insurers, certain criteria must be met: there must be a formal indication for inpatient treatment (i.e., a psychiatric crisis), a psychiatrist must evaluate the patient’s suitability for home treatment (including home environment and privacy), a written treatment plan must be established, the team must be available every day of the week—round the clock (outside regular hours, on-call psychiatrists at the emergency department cover nighttime), and at least one in-person contact must occur each day. The team must also hold weekly meetings to review each patient in detail, and every contact (with exact time and content) must be documented. The IHT team handles all psychiatric and physical health care needs—covering diagnostic assessments, medication management, psychotherapy, and social support. An individualized needs assessment is conducted during the initial days, which forms the backbone of a tailored treatment plan. This plan outlines goals and interventions, such as medication, psychotherapy, skills training, daily or therapeutic activities, and family or caregiver involvement. Interventions are adjusted daily to meet patient needs, and in-person contacts may occur at home, in the hospital, or in any location chosen by the patient. The inpatient care was conducted in accordance with the established quality and organizational standards for psychiatric hospitals in Germany. Study Sample This is a retrospective cohort follow-up study with a group receiving IHT and a matched group of IT users. The IHT group includes all patients who received IHT between January 1, 2020, and December 31, 2020, at KAU, KNK, or KHD. For each patient, the index treatment episode (i.e., the first IHT episode within the observation period) was identified, and the last day of this episode served as the starting point for a 36-month follow-up period. The IT group was drawn from patients who were admitted for full IT during the same period at the same clinics. Patients were excluded if they: Received care under the regulation of the German Social Code Book V, Section 64b model project due to insurance status Were private patients or self-payers Had an index treatment period shorter than five days Had no primary psychiatric diagnosis (F-code) according to ICD-10 Were not living in the catchment area of the reference hospital, as being an exclusion criterion for providing IHT from the reference hospitals in general Matching Procedure To ensure comparability between groups, a propensity score matching (PSM) approach was applied. Based on logistic regression analyses of data from the preceding year, a propensity score (PS) was calculated for each patient using the variables: age, gender, primary psychiatric diagnosis (FX), and the number of full IT or IHT received at the clinic within the last two years. Each IHT case was matched to a control case from the IT group within the same diagnostic group (FX) using the nearest neighbour method without caliper [ 17 ]. The order of IHT patients was randomized, and the pairing was defined by the smallest sum of squared PS differences. This resulted in two matched cohorts: 261 patients in the IHT group and 261 in the IT group. This matching approach was also used in the multicentre, prospective AKtiV study and demonstrated strong comparability in sociodemographic and clinical characteristics [ 18 ]. The matching process was carried out through the following steps: Stratified matching within diagnostic subgroups (FX) Nearest neighbour matching based on PS proximity Iterative pairing without replacement, with randomized order of IHT group patients Evaluation of matches by the mean PS difference across all pairs Selection of the matching set with the smallest total squared PS difference Outcomes Over a 36-month observation period following discharge from the index treatment, the following outcomes were analysed: IT readmission rate (primary outcome): Proportion of patients readmitted to IT psychiatric care after the initial treatment episode. Combined readmission rate (including IT, IHT, and DC settings): Proportion of patients readmitted to any structured psychiatric care setting, including IT, IHT, or DC treatment. Number of full inpatient treatment readmissions: Total number of times patients were readmitted to full inpatient psychiatric care during the follow-up period. Number of treatment days during IT readmissions: Total number of days patients spent in IT after being readmitted. Number of IHT readmissions: Total number of times patients were readmitted to IHT. Number of treatment days during IHT readmissions: Total number of days patients received IHT after being readmitted. Number of DC treatment readmissions: Total number of times patients were readmitted to DC treatment. Number of treatment days during DC readmissions: Total number of days patients spent in DC after being readmitted. Number of first-time treatments in the POD following the initial treatment: Number of patients who initiated treatment in the POD after completing their initial (index) treatment. Time to readmission: Time to readmission was defined as the number of days between the discharge date of the initial (index) admission and the date of the subsequent IT psychiatric readmission. These indicators offer a comprehensive evaluation of long-term healthcare utilization and support the assessment of sustained treatment effectiveness and service continuity in psychiatric care. The secondary outcomes “number of coercive measures”, “cumulative duration of coercive measures within 36 months after the end of the index treatment”, as well as “premature treatment termination during the index treatment”, as being detailed in the study protocol could not be assessed due to technical limitations in the hospital information systems across all participating clinics. These outcomes will therefore be reported in a separate publication focusing exclusively on the KAU site population. For the comparison of treatment days during the index stay as well as treatments after the index stay and for the number of readmissions (fully inpatient, inpatient-equivalent, or partial inpatient), the mean with standard deviation was calculated. The dichotomous (yes, no) variable of readmission (fully inpatient, inpatient-equivalent, or partial inpatient) was defined as one admission within 36 months after discharge from the index treatment into the corresponding treatment modality with a minimum length of stay of one day. The dichotomous (yes, no) variable of combined readmission was defined as one admission within 36 months after discharge from the index treatment either into a fully inpatient, inpatient-equivalent, or partial inpatient treatment with a minimum length of stay of one day. A first-time treatment in the POD of the clinic was defined as the utilization of POD services if no POD services of the clinic had been utilized in the previous two years. Time to readmission was calculated by subtracting the index discharge date from the IT readmission date, resulting in the total days until IT readmission. Data Analysis Sociodemographic and treatment-related data from all matched patients were extracted from the internal documentation system. Data were analysed using R, Version 4.3.0 [ 19 ]. Descriptive statistics for categorical variables are reported as absolute and relative frequencies (n, %), and continuous variables are reported as means (M) and standard deviations (SD). The Shapiro-Wilk test was used to assess normality of continuous variables. Group comparisons of continuous variables were conducted using the Mann-Whitney U test; categorical variables were compared using the chi-square test. To investigate the full inpatient readmission within 36 months, a sensitivity analysis in the form of a logistic regression was additionally performed, for the factors where was a significant difference between the groups. Furthermore, a survival analysis was planned to assess time to inpatient readmission. A Kaplan–Meier plot was used to visualize the time until inpatient readmission, showing the probability of remaining readmission-free over 36 months for both treatment groups. Group differences were evaluated using a Cox regression model. To formally test group differences in time to readmission, a Cox proportional hazards regression model was performed, with the treatment group included as a covariate. The null hypothesis was specified as the regression coefficient being equal to zero (β = 0), indicating no difference in the hazard rates of readmission between the groups. Although the data were drawn from multiple participating centres, we did not perform centre-specific analyses. The aim of this study was not to examine differences between individual sites, but rather to gain a comprehensive, system-level understanding of the effectiveness of IHT in real-world psychiatric care across a broader population. Sample size Calculation: The sample size in the retrospective data collection depends on the one hand, on the availability and completeness of the retrospective data and, on the other hand, on the expected effect size. A prospective study [ 4 ] with a 12-month follow-up and a sample size of 400 patients (200 per group) showed that IHT was associated with a significantly lower rate of full inpatient readmissions compared to traditional full inpatient treatment (31.12% vs. 49.74%; mean difference: 18%). However, for a planned 3-year follow-up, it is expected that the difference between the groups in terms of full inpatient readmission rates may be smaller. This suggests that a larger sample size than the 400 patients used in that study will be required to statistically detect even smaller differences over the longer observation period. A new sample size calculation was therefore necessary to account for the changed assumptions regarding a longer follow-up and a smaller effect size. Taking into account the possible available data in the hospital information system (HIS), a sample size of approximately 350 patients in the IHT group could be feasible. A comparable control group with 350 patients from the full inpatient treatment context will be selected using propensity score matching (PSM). With a sample size of 350 patients per group, a power of 80%, and a two-sided chi-square test with an alpha error of 5%, an effect size of up to 0.21 can be detected. This would correspond to a reduction in effect size of up to approximately 45% compared to the prospective 1-year follow-up study. Results Sample and Matching Procedure Between January 1, 2020, and December 31, 2020 a total of 314 patients were admitted to intensive home treatment (IHT) Of these, 51 patients (16%) were excluded because their index treatment duration was fewer than five days. No exclusions were made due to missing psychiatric (F-code) diagnoses or residency outside the hospital’s catchment area. Thus, 263 IHT patients (84%) were available for matching. During the same period, 5,241 patients received full inpatient psychiatric treatment. Of these, 2,757 patients (53%) were excluded: 76 (1.5%) due to missing F-code diagnoses, 1,694 (32.3%) due to treatment duration of fewer than five days, 881 (16.8%) due to residency outside the catchment area, and 106 (2.0%) due to duplicate records with participants from the group of the IHT patients. Consequently, 2,484 inpatient cases (47%) were eligible for propensity score matching Matching was conducted at a 1:1 ratio based on clinically relevant covariates using propensity scores. As no calliper was applied, the small number of matched pairs (n = 5 ) with a propensity score difference greater than 10 points were not excluded. All remaining matched pairs had differences below 0.8. In total, 263 matched pairs (n = 526 patients) were included in the final analysis. No statistically significant differences were found between the two groups regarding the variables relevant to the propensity score matching. The values of all variables relevant to the PSM procedure can be found in Table 1 . Table 1 Propensity score variables of the participants in the IHT compared to the participants in IT group at recruitment. Propensity score variables IHT group (n = 263) IT group (n = 263) p value Gender female; n (%) 162 (61.6) 150 (57.0) 0.3289 a Age in years; mean (SD) 47.30 (17.36) 48.22 (17.23) 0.469 b Number of IHT or IT in the 2 years prior to the start of the index treatment; mean (SD) 1.75 (2.26) 1.46 (2.21) 0.005 b Main diagnosis on admission to index treatment 1:1 matching 1.000 a F0X; n (%) 6 (2.3) 6 (2.3) F1X; n (%) 5 (1.9) 5 (1.9) F2X; n (%) 100 (38.0) 100 (38.0) F3X; n (%) 111 (42.2) 111 (42.2 F4X; n (%) 27 (10.3) 26 (9.9) F5X; n (%) 1 (0.4) 1 (0.4) F6X; n (%) 13 (4.9) 14 (5.3) IHT = intensive home treatment; IT = inpatient treatment; SD = standard deviation; n = frequency, a = chi-squared test; b = Wilcoxon test. Insert Table 1 around here Results of the Index Treatment and 36-Month Follow-Up The average duration of the index treatment was 31.80 days (SD = 24.18) in the IHT group and 33.02 days (SD = 35.30) in the IT group, with the difference being statistically significant (p = 0.016, Wilcoxon test). Within the 36 months following discharge, 108 participants in the IHT group (41.1%) experienced at least one full inpatient readmission. In contrast, 146 participants in the IT group (55.5%) were readmitted at least once. The inpatient readmission rate was significantly lower in the IHT group by approximately 14.4% (p = 0.001; Wilcoxon test), indicating a meaningful difference between groups. A sensitivity analysis using logistic regression for the primary outcome, including the only significant predictor—“duration of index treatment”—and group assignment (IHT vs. IT), showed that the effect of the treatment group remained significant even after adjusting for treatment duration (p = 0.00). The combined readmission rate within 36 months after discharge was 61.2% in the IHT group and 64.3% in the IT group Although the intervention group showed a lower readmission rate by about 4.2 percentage points, this difference was not statistically significant (p = 0.47; Wilcoxon test). The number of inpatient readmissions during the 36-month follow-up was also significantly higher in the IT group compared to the IHT group (IT M = 2.02, SD = 3.26; IHT: M = 1.72, SD = 3.70; p = 0.005; Wilcoxon test). Additionally, the number of inpatient treatment days during the follow-up period was significantly higher in the IT group (M = 51.66, SD = 94.44) than in the IHT group (M = 48.47, SD = 117.64; p = 0.003; Wilcoxon test). Participants in the IHT group were significantly more likely to be admitted to IHT again during the 36-month follow-up than those in the IT group (IHT group: M = 0.85, SD = 1.87; IT group: M = 0.35, SD = 1.31; p < 0.000; Wilcoxon Test). They also spent significantly more days in IHT (IHT group: M = 21.55, SD = 44.39; IT group: M = 7.41, SD = 31.65; p < 0.000; Wilcoxon Test). Participants in the IHT group were significantly more likely to receive first-time treatment in the hospital’s POD during the 36-month period following the index treatment. A total of 88 IHT group participants (33.5%) initiated new POD treatment, compared to 64 in the IT group (24.7%), representing a significantly higher rate of new POD treatment in the IHT group by nearly 12% (p = 0.035; chi-square test). No significant differences between the groups were observed regarding combined readmissions, the number of DC readmissions, or the number of DC treatment days during the 36 months following discharge from the index treatment. A detailed overview of the utilization psychiatric services within 36 months after initiation of the index treatment in the IHT group compared to the IT group G can be found in Table 2 . Table 2 Utilization of psychiatric services within 36 months after index treatment. IHT Group IT Group p value IT readmission rate; n (%) 108 (41.1%) 146 (55.5%) 0.001 a Total number of IT readmissions; mean (SD) 1.72 (3.70) 2.02 (3.26) 0.005 b Total number of IT treatment days follow-up cases; mean (SD) 48.47 (44.39) 51.66 (94.55) 0.003 b Combined readmission rate; n (%) 161 (61.2%) 169 (64.3%) 0.471 a Total number combined readmissions; mean (SD) 2.86 (5.27) 2.70 (4.40 0.741 b Total number combined treatment days follow-up cases; mean (SD) 81.60 (141.95) 70.74 (118.76) 0.950 b Number of IHT readmissions; mean (SD) 0.85 (1.87) 0.35 (1.31) 0.000 b Total IHT treatment days of follow-up cases; mean (SD) 21.55 (44.39) 7.41 (31.65) 0.000 b Number of DC readmissions; mean (SD) 0.29 (0.84) 0.33 (0.77) 0.133 b DC treatment days of follow-up cases; mean (SD) 11.59 (34.24) 11.67 (27.17) 0.223 b First-time treatment in the POD after the Index Treatment; n (%) 88 (33.5%) 65 (24.7%) 0.035 a IHT = intensive home treatment; IT = inpatient treatment; POD = Psychiatric Outpatient Department; DC = Day clinic; n = frequency; SD = standard deviation; a = chi-squared test; b = Wilcoxon test; combined treatment = inpatient treatment + intensive home treatment + day clinic treatment Insert Table 2 around here Participants in the IHT group showed a significantly longer time to IT readmission compared to the IT group over the 36-month (1,095-day) follow-up period. The log-rank test showed a significant difference between the groups (χ² (1) = 10.5, p = 0.001), indicating better survival (longer readmission-free time) in the IHT group. The median time to readmission in the IHT group was not reached within the 1,095-day follow-up period (median = 1,197 days; the upper confidence limit is not estimable), suggesting that more than half of the IHT group participants remained readmission-free at study end. In contrast, the IT group had a median time to readmission of 610 days (95% CI: 357 to 1,212 days), indicating that half of the IT group participants experienced readmission by approximately 20 months. The Kaplan-Meier survival curves (Fig. 1) show a consistently higher probability of avoiding full inpatient readmission over time for the IHT group compared to the IT group. Insert Fig. 1 here IHT = intensive home treatment; IT = inpatient treatment By the end of the follow-up period, the cumulative probability of remaining without readmission was markedly higher in the IHT group. Discussion Consistent with previous research [ 4 , 6 , 20 ] over a 12-months follow up, IHT was associated with significantly fewer inpatient readmissions, fewer inpatient days, and a reduced number of total inpatient episodes over a 36-month follow-up period. The significantly longer readmission-free survival in the IHT group, with the median time to readmission not being reached within the observation period, suggests a robust and lasting effect of IHT on relapse IT prevention. In contrast, the IT group reached the median time to readmission at 610 days, highlighting a substantially higher risk of rehospitalization over time. These results extend previous findings by demonstrating that the benefits of IHT are not limited to short-term outcomes but are sustained over the long term and provide robust evidence that IHT is an effective and sustainable alternative to conventional IT for individuals experiencing acute psychiatric crises [ 4 ]. Given that both groups did not statistically differ in terms of demographic and clinical variables—such as age, gender, primary psychiatric diagnosis, and the number of previous IT or IHT treatments in the past two years—it is plausible to attribute this difference primarily to the treatment modality of the index episode. There were significant differences in the duration of the index treatment, with substantially shorter treatment episodes for the IHT group compared to the IT group. This finding aligns with previous results on the German model of IHT from a monocentric study conducted in the same clinic [ 6 ] but not with outcomes from the multicentre study[ 18 ], which may reflect procedural differences in the study centres—located in a metropolitan area—compared to the multicentre sample, which also included rural areas and small towns. Nevertheless, a sensitivity analysis using logistic regression showed that the effect of the treatment group on the primary outcome remained significant even after adjusting for the only significant predictor, “duration of index treatment”. Despite earlier findings from a prospective non-randomized trial at the 12-month follow-up [ 4 ], the current study with a 36-month follow-up could not confirm that IHT leads to a sustained reduction in combined readmissions—including IT, IHT, and DC readmissions. However, participants in the IHT group utilized IHT significantly more often and spent more days in IHT during the 36 months following discharge compared to participants in the IT group. Based on these results—and in the absence of further data on psychosocial functioning or symptom severity—it can be concluded that participants in both groups received psychiatric care to a comparable extent during the 36-month follow-up period. From a clinical perspective, this suggests an equivalent effectiveness of IHT and inpatient treatment in terms of relapse prevention, while from a healthcare resource perspective, there appears to be a preference for continued use of IHT among those who have previously utilized it. This finding is in line with results from a previous monocentric study [ 6 ] conducted in one of the participating study hospitals, suggesting that the observed patterns may be partly attributable to specific procedural characteristics of the study participating clinics, or of the psychiatric care in metropolitan areas and the specific catchment area of the study clinics [ 14 , 15 ]. In these settings, a broader range of alternative services to inpatient treatment is available, which may enable patients to substitute inpatient care with other forms of psychiatric service utilization, which are more self-determined and leave patients with more individual freedom than IT. This interpretation aligns with the above discussed findings regarding the shorter duration of index treatment in the IHT group, further reflecting structural and procedural differences between urban study centres and the more diverse settings—including rural areas—captured in previous multicentre studies. A particularly relevant finding of this study and a replication of findings on 12-months follow up [ 6 ] is the higher likelihood of patients in the IHT group to engage first time with outpatient psychiatric services—specifically the Psychiatric Outpatient Department (POD)—after the index treatment. IHT appears to function not only as a substitute for hospitalization during acute episodes but also as a facilitator of long-term engagement with community-based psychiatric services. This finding supports the hypothesis that home-based treatment may contribute to more continuous, less disruptive care trajectories by fostering stronger integration into outpatient treatment systems. The finding of equal utilization of alternatives to inpatient treatment—such as day clinics (DC), intensive home treatment (IHT), or psychiatric outpatient departments (POD)—between the two groups further supports the notion, consistent with health economic evaluations of other community-based acute psychiatric treatment approaches [ 5 ], of that IHT is associated with a shift in psychiatric treatment costs from inpatient care toward outpatient services with a rebalancing of costs within the psychiatric care system. This cost redistribution reflects the potential of IHT models to maintain clinical effectiveness while optimizing future resource use across the continuum of care. This not only allows for more individualized and needs-based patient care but also has the potential even to reduce healthcare costs. By decreasing reliance on costly inpatient stays—including the expenses of building and maintaining hospital beds and staff for the maintenance of the clinics—and increasing the use of more efficient outpatient options, IHT may offer a sustainable and cost-effective long-term approach to psychiatric care. Given that Germany had the second-highest number of psychiatric hospital beds in Europe in 2021, with 131 beds per 100,000 inhabitants [ 21 ], there is not only potential but indeed a necessity to implement such flexible and resource-optimizing treatment models like IHT to better address current and future demands on mental health services These findings demonstrate also that delivering psychiatric care directly in patients’ homes, even during severe crises, is not only feasible but also offers multiple benefits, not only by reducing the likelihood of future hospitalizations but additionally, the accessibility of the treatment team, collaborative communication on equal footing, and close coordination with other community-based services may play a key role in supporting sustained outpatient care. However, the effective implementation of IHT cannot stand alone; it requires being embedded within a pluralistic and flexible network of psychiatric services in the community. IHT should be integrated alongside a variety of alternative treatment options—such as outpatient clinics, day treatment programs, crisis services, and supported housing—allowing users to select the care best suited to their needs. This approach enhances therapeutic effectiveness while preserving patient autonomy and choice, essential for sustainable, person-centred mental health care. Conclusions The present results demonstrate that shifting psychiatric treatment into patients’ home environments—even during severe crises—is feasible and associated with various benefits. IHT appears to reduce the risk of inpatient readmissions and the number of inpatient treatment days also on long-term. It takes significantly more time until an inpatient readmission occurs, and over this period, the findings indicate that IHT can contribute to relieving inpatient structures in the medium to long term. Over a 36-month follow-up period after discharge from the index treatment, there is no significant difference in the overall utilization of psychiatric services between patients treated with IHT and those treated with IT. First-time engagement with outpatient psychiatric services (such as the POD) occurs more frequently following IHT than after inpatient treatment. These findings suggest that IHT may contribute, at least for population of urban areas as in this study, to a shift from inpatient to a utilization of broader spectrum psychiatric services. Limitations This study has certain limitations, particularly regarding the external validity of the results. It was conducted on the on hand in three centers, but moreover representing only a certain metropolitan urban area of, which means the findings can only be generalized to other area, like rural or small town, to a limited extent. Due to the retrospective nature of the study, certain criteria could not be verified for participants in the control group, even though these factors could theoretically have influenced the decision to admit a patient to IHT. These criteria include a suitable home environment for delivering IHT, consent from household members or caregivers, approval from the management of care facilities (if applicable), and the absence of child welfare concerns. Collecting such information could have provided a broader basis for assessing the comparability of the two groups. Despite our initial sample size calculation, which assumed the feasibility of including approximately 350 patients in the IHT group and an equivalent control group from inpatient treatment (total intended sample size n = 700), the final sample was smaller than expected. Several factors contributed to this reduction. Firstly, the IHT department in one center only commenced operations in October 2020, while in the other two centers, the IHT treatment capacity was not yet fully expanded during the observation period. Additionally, the year 2020 was marked by the onset of the COVID-19 pandemic, which likely impacted the availability of treatment capacities and the number of eligible patients, particularly in the newly established IHT services. Furthermore, a considerable proportion of patients had to be excluded based on predefined criteria. However, despite the smaller-than-planned sample size, the primary outcome—hospital readmission rate—still showed statistically significant results, indicating that IHT is an effective intervention for reducing hospital readmissions. Nevertheless, the negative or non-significant findings regarding secondary outcomes might be at least partially attributed to the reduced sample size, which was lower than planned in the initial power calculation. This should be taken into account when interpreting the secondary analyses. Additionally, no primary data were collected regarding quality of life, symptom severity, psychosocial functioning, or self-efficacy, as these parameters were not systematically assessed at admission. Consequently, it was not possible to compare the clinical improvement rates between the two treatment types. Another limitation was the restriction of the available data regarding the use of psychiatric and psychotherapeutic services to the hospital information system. As a result, it was only possible to estimate the initial use of outpatient psychiatric-psychotherapeutic services based on the utilization of POD services. To better evaluate the long-term effectiveness of IHT in routine clinical practice further research is needed. This should include larger sample sizes and address both clinically and health-economically relevant questions in multiple clinics, in rural, urban and metropolitan areas that offer IHT. Abbreviations IHT Intensive Home Treatment IEHT Inpatient Equivalent Home Treatment IT Inpatient Treatment HT Home Treatment DC Day Clinic POD Psychiatric Outpatient Department IPS Individual Placement and Support FX ICD-10 F-codes (psychiatric diagnoses) PSM Propensity Score Matching PS Propensity Score M Mean SD Standard Deviation HIS Hospital Information System KAU Krankenhaus Am Urban KNK Krankenhaus Neukölln KHD Krankenhaus Kaulsdorf Declarations Ethics approval and consent to participate The ethics committee of Charité – Universitätsmedizin Berlin granted full approval to the “StäB 36 PSR MK” trial on November 28, 2024 (EA2/203/24). The ethics boards of all study sites followed this approval. The trial followed current recommendations for implementation science and naturalistic study reporting standards. The trial was conducted in accordance with the Declaration of Helsinki, Good Clinical Practice guidelines, and the provisions of Good Epidemiological Practice. The study also complied with the German Federal Data Protection Act, Social Security Law Book , and the General Data Protection Regulation . All participant-related data were collected, stored, and published in anonymized form to ensure privacy. The data protection officer at Charité – Universitätsmedizin Berlin granted full approval for the data assurance concept of the trial. The data protection officers at all study sites followed this approval. Due to the nature of the retrospective analysis of routine control data, the Study Information and Consent form was not applicable in advance. To fulfil the informational requirement, even in a retrospective study (without obtaining consent), patients of the study sites will be informed about the analysis of clinical routine data for research purposes via a notice in the clinic or on the project’s website. Consent for publication Not applicable Availability of data and materials Study material and data will be available upon reasonable request. Competing interests All authors do declare not to have any competing interest. Funding Open Access funding was enabled and organized by the Publikationsfonds of Charité – Universitätsmedizin Berlin. The project was endorsed by the German Center for Mental Health (DZPG). The project was carried out in collaboration with the Department of Psychiatry, Psychotherapy, and Psychosomatics, incorporating FRITZ am Urban and Soulspace, Vivantes Hospital am Urban, and Vivantes Hospital im Friedrichshain, Berlin, Germany. Author contributions: KN and AB conceived and designed the study. Data were acquired by KN, SR, BJ, and JT. KN conducted the statistical analysis and was responsible for the integrity of the data. Interpretation of the data was carried out by KN and AB. KN drafted the initial version of the manuscript. The manuscript was critically reviewed for important intellectual content by OH, JT, CR, BJ, AB, and SR. AB obtained the funding for the study. Supervision was provided by AB and JT. Administrative, technical, or material support was contributed by OH, AB, and CR. All listed authors have read and approved the final manuscript. Acknowledgments We express our gratitude to Martin Mai and Pascal Gensicke from the Controlling department of the study clinics, who supported us throughout the course of the project by providing the routine data from the study clinics. We are also very thankful to Sebastian von Huene and Sascha Zapf, master students ate the Charité – Universitätsmedizin Berlin, the study departments and colleagues who supported us throughout the project for their openness toward our work, as well as for all the support and friendly advice we received during the project. References Johnson S. Crisis resolution and home treatment teams: an evolving model. Adv Psychiatr Treat. 2013;19(2):115–23. Murphy SM, Irving CB, Adams CE, Waqar M. Crisis intervention for people with severe mental illnesses. Cochrane Database Syst Reviews, 2015(12). Baumgardt J, et al. Implementation, efficacy, costs and processes of inpatient equivalent home-treatment in German mental health care (AKtiV): protocol of a mixed-method, participatory, quasi-experimental trial. BMC Psychiatry. 2021;21(1):1–13. Bechdolf A, et al. Utilization of Psychiatric Hospital Services Following Intensive Home Treatment: A Nonrandomized Clinical Trial. JAMA Netw Open. 2024;7(11):e2445042–2445042. Waldmann T, et al. Cost Utility of Intensive Home Treatment Compared With Acute Psychiatric Inpatient Admission. JAMA Netw Open. 2025;8(5):e2512465–2512465. Nikolaidis K, et al. Stationsäquivalente Behandlung (StäB) im Vergleich mit vollstationärer Behandlung: 12-Monats-Follow-up Ergebnisse einer mittels Propensity-Score gematchten retrospektiven Kohortenstudie. Psychiatr Prax. 2024;51(02):92–8. Cornelis J, et al. The effectiveness of intensive home treatment as a substitute for hospital admission in acute psychiatric crisis resolution in the Netherlands: a two-centre Zelen double-consent randomised controlled trial. Lancet Psychiatry. 2022;9(8):625–35. Johnson S, Needle J, Bindman JP, Thornicroft G. Crisis resolution and home treatment in mental health. Volume 13. Cambridge University Press Cambridge; 2008. Giménez-Díez D, et al. Treating mental health crises at home: Patient satisfaction with home nursing care. J Psychiatr Ment Health Nurs. 2020;27(3):246–57. Sjølie H, Karlsson B, Kim H. Crisis resolution and home treatment: structure, process, and outcome–a literature review. J Psychiatr Ment Health Nurs. 2010;17(10):881–92. Stulz N, et al. Home treatment for acute mental healthcare: randomised controlled trial. Br J Psychiatry. 2020;216(6):323–30. GKV-Spitzenverband. Vereinbarung zur Stationsäquivalenten psychiatrischen Behandlung nach § 115d Abs. 2 SGB V vom 01.08.2017. Berlin; 2017. V.d.P.K. GKV-Spitzenverband, Deutsche Krankenhausgesellschaft, Editor. Bechdolf A, et al. soulspace–Implementierung eines niedrigschwelligen, spezifischen Behandlungs-und Frühinterventionsangebots für junge Erwachsene und Jugendliche in die Regelversorgung in Deutschland. Psychiatr Prax. 2019;46(05):243–6. Weinmann S, Rout S, Memarzadeh S, Bechdolf A. StäB in der Großstadt: Berlin . in Psychiatrische Krisenintervention zu Hause . Psychiatrie; 2020. Rout S, Ignatyev Y, Schwarz J, von Peter S. [Transition from Child and Adolescent to Adult Psychiatry in a German Metropolitan Region: An Explorative Cross-Sectional Study]. Psychiatr Prax, 2023. 50(5): pp. 234–240. Jäckel D, et al. Arbeitsbezogene Teilhabebeeinträchtigungen und Unterstützungsbedarf von Patienten in der (teil-) stationären psychiatrischen Versorgung. Psychiatr Prax. 2020;47(05):235–41. Austin PC. An Introduction to Propensity Score Methods for Reducing the Effects of Confounding in Observational Studies. Multivar Behav Res. 2011;46(3):399–424. Nikolaidis K, et al. StäB oder Station?–Erste Ergebnisse zur Studienpopulation und zur Behandlung im Rahmen der multizentrischen AKtiV-Studie zur stationsäquivalenten Behandlung. Psychiatr Prax. 2023;50(08):407–14. Team RC. R: A Language and Environment for Statistical Computing. R Foundation for Statistical Computing: Vienna, Austria; 2023. Johnson S, et al. Randomised controlled trial of acute mental health care by a crisis resolution team: the north Islington crisis study. BMJ. 2005;331(7517):599. Eurostat. Hospital beds by function and type of care. 2024 02.07.2025]; Available from: https://ec.europa.eu/eurostat/databrowser/view/hlth_rs_bds1__custom_12041857/default/table?lang=en Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7104562","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":495917451,"identity":"6768802f-8af1-4788-be7a-1a898153c7de","order_by":0,"name":"Konstantinos Nikolaidis","email":"data:image/png;base64,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","orcid":"","institution":"Vivantes Hospital Am Urban","correspondingAuthor":true,"prefix":"","firstName":"Konstantinos","middleName":"","lastName":"Nikolaidis","suffix":""},{"id":495917452,"identity":"66989501-d0ae-4eda-ad0e-adc4dc1145bb","order_by":1,"name":"Sandeep Rout","email":"","orcid":"","institution":"Vivantes Hospital Neukölln","correspondingAuthor":false,"prefix":"","firstName":"Sandeep","middleName":"","lastName":"Rout","suffix":""},{"id":495917453,"identity":"26058681-16d7-45af-84e8-95411942c10b","order_by":2,"name":"Olaf Hardt","email":"","orcid":"","institution":"Vivantes Hospital Neukölln","correspondingAuthor":false,"prefix":"","firstName":"Olaf","middleName":"","lastName":"Hardt","suffix":""},{"id":495917454,"identity":"df0f1600-e192-4f4a-8b61-faa01c371a29","order_by":3,"name":"Christoph Richter","email":"","orcid":"","institution":"Charité Universitätsmedizin Berlin","correspondingAuthor":false,"prefix":"","firstName":"Christoph","middleName":"","lastName":"Richter","suffix":""},{"id":495917455,"identity":"a99621d0-fa59-4cea-af5c-fe50d32cea03","order_by":4,"name":"Britta Janßen","email":"","orcid":"","institution":"Vivantes Hospital Kaulsdorf","correspondingAuthor":false,"prefix":"","firstName":"Britta","middleName":"","lastName":"Janßen","suffix":""},{"id":495917456,"identity":"78a858bb-9af0-4d83-9318-a0c1bb547a75","order_by":5,"name":"Jürgen Timm","email":"","orcid":"","institution":"University of Bremen","correspondingAuthor":false,"prefix":"","firstName":"Jürgen","middleName":"","lastName":"Timm","suffix":""},{"id":495917457,"identity":"c7743b97-e889-460e-bfe3-8a5ad42946c7","order_by":6,"name":"Andreas Bechdolf","email":"","orcid":"","institution":"Vivantes Hospital Am Urban","correspondingAuthor":false,"prefix":"","firstName":"Andreas","middleName":"","lastName":"Bechdolf","suffix":""}],"badges":[],"createdAt":"2025-07-11 21:23:30","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7104562/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7104562/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12888-026-08062-5","type":"published","date":"2026-04-16T15:59:09+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":88521866,"identity":"9f6db56a-cc6b-4bdc-8ad3-1b8016440d3d","added_by":"auto","created_at":"2025-08-07 09:53:34","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":8205997,"visible":true,"origin":"","legend":"\u003cp\u003eKaplan-Meier Estimator of inpatient readmission 36-months after the index treatment\u003c/p\u003e","description":"","filename":"Figure1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7104562/v1/553da9d004a53dd7206c4917.jpg"},{"id":107351484,"identity":"26372808-66d5-45b5-913c-ccbde3d92166","added_by":"auto","created_at":"2026-04-20 16:11:10","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":8540110,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7104562/v1/881018b4-45fa-46a1-94f2-4513876b7c1f.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Intensive Home Treatment compared to Inpatient Psychiatric Treatment: A 36-Month Follow-Up of a Propensity-Score Matched Retrospective Multicenter Cohort Study","fulltext":[{"header":"Background","content":"\u003cp\u003eIntensive Home Treatment (IHT) approaches\u0026mdash;such as crisis resolution teams\u0026mdash;have been implemented in many mental health systems as effective alternatives to inpatient care for individuals experiencing acute psychiatric crises [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. These services provide intensive, multidisciplinary psychiatric support directly in patients\u0026rsquo; homes, aiming to reduce the need for hospital admissions. Over the years, findings have suggested that IHT can reduce inpatient service utilization [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eHowever, earlier studies only partially addressed the broader use of psychiatric services\u0026mdash;such as day clinics and outpatient support\u0026mdash;which play a vital role in contemporary mental health care systems. More recently, a prospective quasi-experimental multicenter trial conducted across 10 sites in Germany [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e], provided new evidence by examining the newly implemented German IHT model. First findings showed significantly lower inpatient and combined readmission\u0026mdash;defined to include inpatient care, IHT, and day clinic utilization\u0026mdash;for patients receiving IHT compared to those treated in inpatient settings [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e], with IHT also expected to be cost-effective at a slightly higher acceptability probability than inpatient treatment[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Furthermore, a retrospective pilot study on the German IHT model with matched pairs showed an effect of significantly rising Number of first-time treatments in the Psychiatric Outpatient Department (POD) following the IHT treatment in comparison to inpatient treatment at a 12-month-follow-up [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThis German specific form of IHT, known as inpatient equivalent home treatment (IEHT), was allowed to start in 2018 after legal regulation were clarified in 2016. Thus it was made available to German psychiatric hospitals through reimbursement by public health insurance. It shares several core features with established home treatment (HT) models like the British, Norwegian, Spanish, Swiss and Dutch [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan additionalcitationids=\"CR8 CR9 CR10\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e], including regular home visits, small caseloads, comprehensive psychiatric and medical assessments conducted at home, shared responsibility for both medical and social care, intensive support, involvement of family members or carers, and the development of crisis plans Nevertheless, unlike most other HT models, IEHT operates under strict regulatory requirements [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. This consistent standardization across sites creates favorable conditions for rigorous and high-quality evaluation of the IEHT model.\u003c/p\u003e\u003cp\u003eThis growing body of evidence supports IHT as a viable and effective alternative to inpatient treatment (IT), particularly when implemented in routine care. Nevertheless, most previous studies have examined relatively short follow-up periods\u0026mdash;typically 6, 12 [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e], or occasionally 24 months [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Data on long-term outcomes beyond the first year remain limited, especially concerning readmissions, cumulative treatment days, and the combined use of psychiatric services, including IT, IHT, and day clinic (DC). These outcomes are crucial for evaluating the sustainability and systemic effects of IHT.\u003c/p\u003e\u003cp\u003eTo help fill these gaps, the present study investigates the long-term effectiveness of IHT in routine care by analysing a large retrospective matched cohort over a 36-month follow-up period. Specifically, the study focuses on inpatient readmission rates as also on the broader utilization of psychiatric services in a real-world clinical setting, the inpatient and combined readmission rates, the total treatment days and the effect on the utilization of outpatient treatment services. Given that survival analysis offers a more comprehensive, flexible, and clinically meaningful framework for predicting and managing hospital readmissions compared to simple readmission rates, we also planned to assess the time to readmission.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eStudy Setting and Data Source\u003c/p\u003e\u003cp\u003eThis study is based on routine controlling data and electronic patient records from the Vivantes Departments of Psychiatry, Psychosomatics, and Psychotherapy at the \u0026ldquo;Am Urban\u0026rdquo; (KAU), \u0026ldquo;Neuk\u0026ouml;lln\u0026rdquo; (KNK), and \u0026ldquo;Kaulsdorf\u0026rdquo; (KHD) hospitals. The data cover patients treated between January 1, 2020, and December 31, 2020. No direct interviews or surveys were conducted. All clinics are part of a state-owned hospital group, serving approximately 1.2\u0026nbsp;million residents across three districts of Berlin.\u003c/p\u003e\u003cp\u003eTwo of the main contributing centres\u0026mdash;KNK and KAU\u0026mdash;are comparable in structure and service delivery. Following the prior implementation and evaluation of HT and intensified outpatient care as part of a pilot project under \u0026sect;\u0026nbsp;64b SGB V, IHT was introduced in 2018 with an initial capacity of seven treatment slots. Both clinics offer a wide range of psychiatric treatment services, including specialized programs for young people in psychological crises [\u003cspan additionalcitationids=\"CR14\" citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e], as well as job coaching based on the Individual Placement and Support (IPS) model [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e], have been offering IHT since 2018 and maintained established IHT teams throughout the observation period. Though working in different models. In 2020, KNK operated approximately 14 IHT treatment places, while KAU initially had 14 places and increased to 20 places in November 2020. Regular IHT services at KHD officially began on October 6, 2020, with initially 7 places offered, bringing the total number of IHT cases in 2020 to 42. The KHD is comparable in size and structure to the KAU, and it is subspecialized and mandatory care clinic for the Berlin district of Marzahn-Hellersdorf.\u003c/p\u003e\u003cp\u003eIntervention and control treatment\u003c/p\u003e\u003cp\u003eIHT treatment is a psychiatric care delivered at the patient\u0026rsquo;s home by a multidisciplinary group\u0026mdash;including psychiatrists, psychologists, psychiatric nurses, social workers, and other professionals. The treatment protocols for IHT in Germany, called inpatient equivalent home treatment (IEHT), have been thoroughly defined by the umbrella organization representing all German social health insurance providers and the German Hospital Federation [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. To qualify for reimbursement by German statutory health insurers, certain criteria must be met: there must be a formal indication for inpatient treatment (i.e., a psychiatric crisis), a psychiatrist must evaluate the patient\u0026rsquo;s suitability for home treatment (including home environment and privacy), a written treatment plan must be established, the team must be available every day of the week\u0026mdash;round the clock (outside regular hours, on-call psychiatrists at the emergency department cover nighttime), and at least one in-person contact must occur each day. The team must also hold weekly meetings to review each patient in detail, and every contact (with exact time and content) must be documented.\u003c/p\u003e\u003cp\u003eThe IHT team handles all psychiatric and physical health care needs\u0026mdash;covering diagnostic assessments, medication management, psychotherapy, and social support. An individualized needs assessment is conducted during the initial days, which forms the backbone of a tailored treatment plan. This plan outlines goals and interventions, such as medication, psychotherapy, skills training, daily or therapeutic activities, and family or caregiver involvement. Interventions are adjusted daily to meet patient needs, and in-person contacts may occur at home, in the hospital, or in any location chosen by the patient.\u003c/p\u003e\u003cp\u003eThe inpatient care was conducted in accordance with the established quality and organizational standards for psychiatric hospitals in Germany.\u003c/p\u003e\u003cp\u003eStudy Sample\u003c/p\u003e\u003cp\u003eThis is a retrospective cohort follow-up study with a group receiving IHT and a matched group of IT users. The IHT group includes all patients who received IHT between January 1, 2020, and December 31, 2020, at KAU, KNK, or KHD. For each patient, the index treatment episode (i.e., the first IHT episode within the observation period) was identified, and the last day of this episode served as the starting point for a 36-month follow-up period. The IT group was drawn from patients who were admitted for full IT during the same period at the same clinics.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003ePatients were excluded if they:\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eReceived care under the regulation of the German Social Code Book V, Section 64b model project due to insurance status\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eWere private patients or self-payers\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eHad an index treatment period shorter than five days\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eHad no primary psychiatric diagnosis (F-code) according to ICD-10\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eWere not living in the catchment area of the reference hospital, as being an exclusion criterion for providing IHT from the reference hospitals in general\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003eMatching Procedure\u003c/p\u003e\u003cp\u003eTo ensure comparability between groups, a propensity score matching (PSM) approach was applied. Based on logistic regression analyses of data from the preceding year, a propensity score (PS) was calculated for each patient using the variables: age, gender, primary psychiatric diagnosis (FX), and the number of full IT or IHT received at the clinic within the last two years.\u003c/p\u003e\u003cp\u003eEach IHT case was matched to a control case from the IT group within the same diagnostic group (FX) using the nearest neighbour method without caliper [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. The order of IHT patients was randomized, and the pairing was defined by the smallest sum of squared PS differences. This resulted in two matched cohorts: 261 patients in the IHT group and 261 in the IT group. This matching approach was also used in the multicentre, prospective AKtiV study and demonstrated strong comparability in sociodemographic and clinical characteristics [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe matching process was carried out through the following steps:\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eStratified matching within diagnostic subgroups (FX)\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eNearest neighbour matching based on PS proximity\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eIterative pairing without replacement, with randomized order of IHT group patients\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eEvaluation of matches by the mean PS difference across all pairs\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eSelection of the matching set with the smallest total squared PS difference\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003eOutcomes\u003c/p\u003e\u003cp\u003eOver a 36-month observation period following discharge from the index treatment, the following outcomes were analysed:\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eIT readmission rate (primary outcome): Proportion of patients readmitted to IT psychiatric care after the initial treatment episode.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eCombined readmission rate (including IT, IHT, and DC settings): Proportion of patients readmitted to any structured psychiatric care setting, including IT, IHT, or DC treatment.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eNumber of full inpatient treatment readmissions: Total number of times patients were readmitted to full inpatient psychiatric care during the follow-up period.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eNumber of treatment days during IT readmissions: Total number of days patients spent in IT after being readmitted.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eNumber of IHT readmissions: Total number of times patients were readmitted to IHT.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eNumber of treatment days during IHT readmissions: Total number of days patients received IHT after being readmitted.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eNumber of DC treatment readmissions: Total number of times patients were readmitted to DC treatment.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eNumber of treatment days during DC readmissions: Total number of days patients spent in DC after being readmitted.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eNumber of first-time treatments in the POD following the initial treatment: Number of patients who initiated treatment in the POD after completing their initial (index) treatment.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eTime to readmission: Time to readmission was defined as the number of days between the discharge date of the initial (index) admission and the date of the subsequent IT psychiatric readmission.\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003eThese indicators offer a comprehensive evaluation of long-term healthcare utilization and support the assessment of sustained treatment effectiveness and service continuity in psychiatric care.\u003c/p\u003e\u003cp\u003eThe secondary outcomes \u0026ldquo;number of coercive measures\u0026rdquo;, \u0026ldquo;cumulative duration of coercive measures within 36 months after the end of the index treatment\u0026rdquo;, as well as \u0026ldquo;premature treatment termination during the index treatment\u0026rdquo;, as being detailed in the study protocol could not be assessed due to technical limitations in the hospital information systems across all participating clinics. These outcomes will therefore be reported in a separate publication focusing exclusively on the KAU site population.\u003c/p\u003e\u003cp\u003eFor the comparison of treatment days during the index stay as well as treatments after the index stay and for the number of readmissions (fully inpatient, inpatient-equivalent, or partial inpatient), the mean with standard deviation was calculated.\u003c/p\u003e\u003cp\u003eThe dichotomous (yes, no) variable of readmission (fully inpatient, inpatient-equivalent, or partial inpatient) was defined as one admission within 36 months after discharge from the index treatment into the corresponding treatment modality with a minimum length of stay of one day.\u003c/p\u003e\u003cp\u003eThe dichotomous (yes, no) variable of combined readmission was defined as one admission within 36 months after discharge from the index treatment either into a fully inpatient, inpatient-equivalent, or partial inpatient treatment with a minimum length of stay of one day.\u003c/p\u003e\u003cp\u003eA first-time treatment in the POD of the clinic was defined as the utilization of POD services if no POD services of the clinic had been utilized in the previous two years.\u003c/p\u003e\u003cp\u003eTime to readmission was calculated by subtracting the index discharge date from the IT readmission date, resulting in the total days until IT readmission.\u003c/p\u003e\u003cdiv id=\"Sec2\" class=\"Section2\"\u003e\u003ch2\u003eData Analysis\u003c/h2\u003e\u003cp\u003eSociodemographic and treatment-related data from all matched patients were extracted from the internal documentation system. Data were analysed using R, Version 4.3.0 [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Descriptive statistics for categorical variables are reported as absolute and relative frequencies (n, %), and continuous variables are reported as means (M) and standard deviations (SD). The Shapiro-Wilk test was used to assess normality of continuous variables. Group comparisons of continuous variables were conducted using the Mann-Whitney U test; categorical variables were compared using the chi-square test. To investigate the full inpatient readmission within 36 months, a sensitivity analysis in the form of a logistic regression was additionally performed, for the factors where was a significant difference between the groups. Furthermore, a survival analysis was planned to assess time to inpatient readmission. A Kaplan\u0026ndash;Meier plot was used to visualize the time until inpatient readmission, showing the probability of remaining readmission-free over 36 months for both treatment groups. Group differences were evaluated using a Cox regression model. To formally test group differences in time to readmission, a Cox proportional hazards regression model was performed, with the treatment group included as a covariate. The null hypothesis was specified as the regression coefficient being equal to zero (β\u0026thinsp;=\u0026thinsp;0), indicating no difference in the hazard rates of readmission between the groups.\u003c/p\u003e\u003cp\u003eAlthough the data were drawn from multiple participating centres, we did not perform centre-specific analyses. The aim of this study was not to examine differences between individual sites, but rather to gain a comprehensive, system-level understanding of the effectiveness of IHT in real-world psychiatric care across a broader population.\u003c/p\u003e\u003cp\u003eSample size Calculation:\u003c/p\u003e\u003cp\u003eThe sample size in the retrospective data collection depends on the one hand, on the availability and completeness of the retrospective data and, on the other hand, on the expected effect size. A prospective study [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e] with a 12-month follow-up and a sample size of 400 patients (200 per group) showed that IHT was associated with a significantly lower rate of full inpatient readmissions compared to traditional full inpatient treatment (31.12% vs. 49.74%; mean difference: 18%).\u003c/p\u003e\u003cp\u003eHowever, for a planned 3-year follow-up, it is expected that the difference between the groups in terms of full inpatient readmission rates may be smaller. This suggests that a larger sample size than the 400 patients used in that study will be required to statistically detect even smaller differences over the longer observation period. A new sample size calculation was therefore necessary to account for the changed assumptions regarding a longer follow-up and a smaller effect size.\u003c/p\u003e\u003cp\u003eTaking into account the possible available data in the hospital information system (HIS), a sample size of approximately 350 patients in the IHT group could be feasible. A comparable control group with 350 patients from the full inpatient treatment context will be selected using propensity score matching (PSM). With a sample size of 350 patients per group, a power of 80%, and a two-sided chi-square test with an alpha error of 5%, an effect size of up to 0.21 can be detected. This would correspond to a reduction in effect size of up to approximately 45% compared to the prospective 1-year follow-up study.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eSample and Matching Procedure\u003c/p\u003e\n\u003cp\u003eBetween January 1, 2020, and December 31, 2020 a total of 314 patients were admitted to intensive home treatment (IHT) Of these, 51 patients (16%) were excluded because their index treatment duration was fewer than five days. No exclusions were made due to missing psychiatric (F-code) diagnoses or residency outside the hospital\u0026rsquo;s catchment area. Thus, 263 IHT patients (84%) were available for matching.\u003c/p\u003e\n\u003cp\u003eDuring the same period, 5,241 patients received full inpatient psychiatric treatment. Of these, 2,757 patients (53%) were excluded: 76 (1.5%) due to missing F-code diagnoses, 1,694 (32.3%) due to treatment duration of fewer than five days, 881 (16.8%) due to residency outside the catchment area, and 106 (2.0%) due to duplicate records with participants from the group of the IHT patients. Consequently, 2,484 inpatient cases (47%) were eligible for propensity score matching\u003c/p\u003e\n\u003cp\u003eMatching was conducted at a 1:1 ratio based on clinically relevant covariates using propensity scores. As no calliper was applied, the small number of matched pairs (n\u0026thinsp;=\u0026thinsp;5\u003cstrong\u003e)\u003c/strong\u003e with a propensity score difference greater than 10 points were not excluded. All remaining matched pairs had differences below 0.8. In total, 263 matched pairs (n\u0026thinsp;=\u0026thinsp;526 patients) were included in the final analysis.\u003c/p\u003e\n\u003cp\u003eNo statistically significant differences were found between the two groups regarding the variables relevant to the propensity score matching. The values of all variables relevant to the PSM procedure can be found in Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003ePropensity score variables of the participants in the IHT compared to the participants in IT group at recruitment.\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003ePropensity score variables\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eIHT group (n\u0026thinsp;=\u0026thinsp;263)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eIT group (n\u0026thinsp;=\u0026thinsp;263)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ep value\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eGender female; n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e162 (61.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e150 (57.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.3289\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eAge in years; mean (SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e47.30 (17.36)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e48.22 (17.23)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.469\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eNumber of IHT or IT in the 2 years prior to the start of the index treatment; mean (SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e1.75 (2.26)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.46 (2.21)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.005\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003eMain diagnosis on admission to index treatment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e1:1 matching\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.000 \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eF0X; n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e6 (2.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6 (2.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eF1X; n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e5 (1.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5 (1.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eF2X; n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e100 (38.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e100 (38.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eF3X; n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e111 (42.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e111 (42.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eF4X; n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e27 (10.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e26 (9.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eF5X; n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e1 (0.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (0.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eF6X; n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e13 (4.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14 (5.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"6\"\u003e\n \u003cp\u003eIHT\u0026thinsp;=\u0026thinsp;intensive home treatment; IT\u0026thinsp;=\u0026thinsp;inpatient treatment; SD\u0026thinsp;=\u0026thinsp;standard deviation; n\u0026thinsp;=\u0026thinsp;frequency, a\u0026thinsp;=\u0026thinsp;chi-squared test; b\u0026thinsp;=\u0026thinsp;Wilcoxon test.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cem\u003eInsert\u003c/em\u003e Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e \u003cem\u003earound here\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eResults of the Index Treatment and 36-Month Follow-Up\u003c/p\u003e\n\u003cp\u003eThe average duration of the index treatment was 31.80 days (SD\u0026thinsp;=\u0026thinsp;24.18) in the IHT group and 33.02 days (SD\u0026thinsp;=\u0026thinsp;35.30) in the IT group, with the difference being statistically significant (p\u0026thinsp;=\u0026thinsp;0.016, Wilcoxon test).\u003c/p\u003e\n\u003cp\u003eWithin the 36 months following discharge, 108 participants in the IHT group (41.1%) experienced at least one full inpatient readmission. In contrast, 146 participants in the IT group (55.5%) were readmitted at least once. The inpatient readmission rate was significantly lower in the IHT group by approximately 14.4% (p\u0026thinsp;=\u0026thinsp;0.001; Wilcoxon test), indicating a meaningful difference between groups.\u003c/p\u003e\n\u003cp\u003eA sensitivity analysis using logistic regression for the primary outcome, including the only significant predictor\u0026mdash;\u0026ldquo;duration of index treatment\u0026rdquo;\u0026mdash;and group assignment (IHT vs. IT), showed that the effect of the treatment group remained significant even after adjusting for treatment duration (p\u0026thinsp;=\u0026thinsp;0.00).\u003c/p\u003e\n\u003cp\u003eThe combined readmission rate within 36 months after discharge was 61.2% in the IHT group and 64.3% in the IT group Although the intervention group showed a lower readmission rate by about 4.2 percentage points, this difference was not statistically significant (p\u0026thinsp;=\u0026thinsp;0.47; Wilcoxon test).\u003c/p\u003e\n\u003cp\u003eThe number of inpatient readmissions during the 36-month follow-up was also significantly higher in the IT group compared to the IHT group (IT M\u0026thinsp;=\u0026thinsp;2.02, SD\u0026thinsp;=\u0026thinsp;3.26; IHT: M\u0026thinsp;=\u0026thinsp;1.72, SD\u0026thinsp;=\u0026thinsp;3.70; p\u0026thinsp;=\u0026thinsp;0.005; Wilcoxon test).\u003c/p\u003e\n\u003cp\u003eAdditionally, the number of inpatient treatment days during the follow-up period was significantly higher in the IT group (M\u0026thinsp;=\u0026thinsp;51.66, SD\u0026thinsp;=\u0026thinsp;94.44) than in the IHT group (M\u0026thinsp;=\u0026thinsp;48.47, SD\u0026thinsp;=\u0026thinsp;117.64; p\u0026thinsp;=\u0026thinsp;0.003; Wilcoxon test).\u003c/p\u003e\n\u003cp\u003eParticipants in the IHT group were significantly more likely to be admitted to IHT again during the 36-month follow-up than those in the IT group (IHT group: M\u0026thinsp;=\u0026thinsp;0.85, SD\u0026thinsp;=\u0026thinsp;1.87; IT group: M\u0026thinsp;=\u0026thinsp;0.35, SD\u0026thinsp;=\u0026thinsp;1.31; p\u0026thinsp;\u0026lt;\u0026thinsp;0.000; Wilcoxon Test). They also spent significantly more days in IHT (IHT group: M\u0026thinsp;=\u0026thinsp;21.55, SD\u0026thinsp;=\u0026thinsp;44.39; IT group: M\u0026thinsp;=\u0026thinsp;7.41, SD\u0026thinsp;=\u0026thinsp;31.65; p\u0026thinsp;\u0026lt;\u0026thinsp;0.000; Wilcoxon Test).\u003c/p\u003e\n\u003cp\u003eParticipants in the IHT group were significantly more likely to receive first-time treatment in the hospital\u0026rsquo;s POD during the 36-month period following the index treatment. A total of 88 IHT group participants (33.5%) initiated new POD treatment, compared to 64 in the IT group (24.7%), representing a significantly higher rate of new POD treatment in the IHT group by nearly 12% (p\u0026thinsp;=\u0026thinsp;0.035; chi-square test).\u003c/p\u003e\n\u003cp\u003eNo significant differences between the groups were observed regarding combined readmissions, the number of DC readmissions, or the number of DC treatment days during the 36 months following discharge from the index treatment.\u003c/p\u003e\n\u003cp\u003eA detailed overview of the utilization psychiatric services within 36 months after initiation of the index treatment in the IHT group compared to the IT group G can be found in Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eUtilization of psychiatric services within 36 months after index treatment.\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eIHT Group\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eIT Group\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ep value\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIT readmission rate; n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e108 (41.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e146 (55.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.001\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTotal number of IT readmissions; mean (SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e1.72 (3.70)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.02 (3.26)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.005\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTotal number of IT treatment days follow-up cases; mean (SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e48.47 (44.39)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e51.66 (94.55)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.003\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCombined readmission rate; n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e161 (61.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e169 (64.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.471\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTotal number combined readmissions; mean (SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e2.86 (5.27)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.70 (4.40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.741\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTotal number combined treatment days follow-up cases; mean (SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e81.60 (141.95)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e70.74 (118.76)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.950\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNumber of IHT readmissions; mean (SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e0.85 (1.87)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.35 (1.31)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.000\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTotal IHT treatment days of follow-up cases; mean (SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e21.55 (44.39)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7.41 (31.65)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.000\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNumber of DC readmissions; mean (SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e0.29 (0.84)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.33 (0.77)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.133\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDC treatment days of follow-up cases; mean (SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e11.59 (34.24)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11.67 (27.17)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.223\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFirst-time treatment in the POD after the Index Treatment; n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e88 (33.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e65 (24.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.035\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"5\"\u003e\n \u003cp\u003eIHT\u0026thinsp;=\u0026thinsp;intensive home treatment; IT\u0026thinsp;=\u0026thinsp;inpatient treatment; POD\u0026thinsp;=\u0026thinsp;Psychiatric Outpatient Department; DC\u0026thinsp;=\u0026thinsp;Day clinic; n\u0026thinsp;=\u0026thinsp;frequency; SD\u0026thinsp;=\u0026thinsp;standard deviation; a\u0026thinsp;=\u0026thinsp;chi-squared test; b\u0026thinsp;=\u0026thinsp;Wilcoxon test; combined treatment\u0026thinsp;=\u0026thinsp;inpatient treatment\u0026thinsp;+\u0026thinsp;intensive home treatment\u0026thinsp;+\u0026thinsp;day clinic treatment\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cem\u003eInsert\u003c/em\u003e Table \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e \u003cem\u003earound here\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eParticipants in the IHT group showed a significantly longer time to IT readmission compared to the IT group over the 36-month (1,095-day) follow-up period. The log-rank test showed a significant difference between the groups (\u0026chi;\u0026sup2; (1)\u0026thinsp;=\u0026thinsp;10.5, p\u0026thinsp;=\u0026thinsp;0.001), indicating better survival (longer readmission-free time) in the IHT group. The median time to readmission in the IHT group was not reached within the 1,095-day follow-up period (median\u0026thinsp;=\u0026thinsp;1,197 days; the upper confidence limit is not estimable), suggesting that more than half of the IHT group participants remained readmission-free at study end. In contrast, the IT group had a median time to readmission of 610 days (95% CI: 357 to 1,212 days), indicating that half of the IT group participants experienced readmission by approximately 20 months. The Kaplan-Meier survival curves (Fig. 1) show a consistently higher probability of avoiding full inpatient readmission over time for the IHT group compared to the IT group.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eInsert Fig. 1 here\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eIHT\u0026thinsp;=\u0026thinsp;intensive home treatment; IT\u0026thinsp;=\u0026thinsp;inpatient treatment\u003c/p\u003e\n\u003cp\u003eBy the end of the follow-up period, the cumulative probability of remaining without readmission was markedly higher in the IHT group.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eConsistent with previous research [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e] over a 12-months follow up, IHT was associated with significantly fewer inpatient readmissions, fewer inpatient days, and a reduced number of total inpatient episodes over a 36-month follow-up period. The significantly longer readmission-free survival in the IHT group, with the median time to readmission not being reached within the observation period, suggests a robust and lasting effect of IHT on relapse IT prevention. In contrast, the IT group reached the median time to readmission at 610 days, highlighting a substantially higher risk of rehospitalization over time. These results extend previous findings by demonstrating that the benefits of IHT are not limited to short-term outcomes but are sustained over the long term and provide robust evidence that IHT is an effective and sustainable alternative to conventional IT for individuals experiencing acute psychiatric crises [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Given that both groups did not statistically differ in terms of demographic and clinical variables\u0026mdash;such as age, gender, primary psychiatric diagnosis, and the number of previous IT or IHT treatments in the past two years\u0026mdash;it is plausible to attribute this difference primarily to the treatment modality of the index episode.\u003c/p\u003e\u003cp\u003eThere were significant differences in the duration of the index treatment, with substantially shorter treatment episodes for the IHT group compared to the IT group. This finding aligns with previous results on the German model of IHT from a monocentric study conducted in the same clinic [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e] but not with outcomes from the multicentre study[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e], which may reflect procedural differences in the study centres\u0026mdash;located in a metropolitan area\u0026mdash;compared to the multicentre sample, which also included rural areas and small towns. Nevertheless, a sensitivity analysis using logistic regression showed that the effect of the treatment group on the primary outcome remained significant even after adjusting for the only significant predictor, \u0026ldquo;duration of index treatment\u0026rdquo;.\u003c/p\u003e\u003cp\u003eDespite earlier findings from a prospective non-randomized trial at the 12-month follow-up [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e], the current study with a 36-month follow-up could not confirm that IHT leads to a sustained reduction in combined readmissions\u0026mdash;including IT, IHT, and DC readmissions. However, participants in the IHT group utilized IHT significantly more often and spent more days in IHT during the 36 months following discharge compared to participants in the IT group. Based on these results\u0026mdash;and in the absence of further data on psychosocial functioning or symptom severity\u0026mdash;it can be concluded that participants in both groups received psychiatric care to a comparable extent during the 36-month follow-up period. From a clinical perspective, this suggests an equivalent effectiveness of IHT and inpatient treatment in terms of relapse prevention, while from a healthcare resource perspective, there appears to be a preference for continued use of IHT among those who have previously utilized it. This finding is in line with results from a previous monocentric study [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e] conducted in one of the participating study hospitals, suggesting that the observed patterns may be partly attributable to specific procedural characteristics of the study participating clinics, or of the psychiatric care in metropolitan areas and the specific catchment area of the study clinics [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. In these settings, a broader range of alternative services to inpatient treatment is available, which may enable patients to substitute inpatient care with other forms of psychiatric service utilization, which are more self-determined and leave patients with more individual freedom than IT. This interpretation aligns with the above discussed findings regarding the shorter duration of index treatment in the IHT group, further reflecting structural and procedural differences between urban study centres and the more diverse settings\u0026mdash;including rural areas\u0026mdash;captured in previous multicentre studies.\u003c/p\u003e\u003cp\u003eA particularly relevant finding of this study and a replication of findings on 12-months follow up [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e] is the higher likelihood of patients in the IHT group to engage first time with outpatient psychiatric services\u0026mdash;specifically the Psychiatric Outpatient Department (POD)\u0026mdash;after the index treatment. IHT appears to function not only as a substitute for hospitalization during acute episodes but also as a facilitator of long-term engagement with community-based psychiatric services. This finding supports the hypothesis that home-based treatment may contribute to more continuous, less disruptive care trajectories by fostering stronger integration into outpatient treatment systems.\u003c/p\u003e\u003cp\u003eThe finding of equal utilization of alternatives to inpatient treatment\u0026mdash;such as day clinics (DC), intensive home treatment (IHT), or psychiatric outpatient departments (POD)\u0026mdash;between the two groups further supports the notion, consistent with health economic evaluations of other community-based acute psychiatric treatment approaches [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e], of that IHT is associated with a shift in psychiatric treatment costs from inpatient care toward outpatient services with a rebalancing of costs within the psychiatric care system.\u003c/p\u003e\u003cp\u003eThis cost redistribution reflects the potential of IHT models to maintain clinical effectiveness while optimizing future resource use across the continuum of care. This not only allows for more individualized and needs-based patient care but also has the potential even to reduce healthcare costs. By decreasing reliance on costly inpatient stays\u0026mdash;including the expenses of building and maintaining hospital beds and staff for the maintenance of the clinics\u0026mdash;and increasing the use of more efficient outpatient options, IHT may offer a sustainable and cost-effective long-term approach to psychiatric care. Given that Germany had the second-highest number of psychiatric hospital beds in Europe in 2021, with 131 beds per 100,000 inhabitants [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e], there is not only potential but indeed a necessity to implement such flexible and resource-optimizing treatment models like IHT to better address current and future demands on mental health services\u003c/p\u003e\u003cp\u003eThese findings demonstrate also that delivering psychiatric care directly in patients\u0026rsquo; homes, even during severe crises, is not only feasible but also offers multiple benefits, not only by reducing the likelihood of future hospitalizations but additionally, the accessibility of the treatment team, collaborative communication on equal footing, and close coordination with other community-based services may play a key role in supporting sustained outpatient care.\u003c/p\u003e\u003cp\u003eHowever, the effective implementation of IHT cannot stand alone; it requires being embedded within a pluralistic and flexible network of psychiatric services in the community. IHT should be integrated alongside a variety of alternative treatment options\u0026mdash;such as outpatient clinics, day treatment programs, crisis services, and supported housing\u0026mdash;allowing users to select the care best suited to their needs. This approach enhances therapeutic effectiveness while preserving patient autonomy and choice, essential for sustainable, person-centred mental health care.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThe present results demonstrate that shifting psychiatric treatment into patients\u0026rsquo; home environments\u0026mdash;even during severe crises\u0026mdash;is feasible and associated with various benefits. IHT appears to reduce the risk of inpatient readmissions and the number of inpatient treatment days also on long-term. It takes significantly more time until an inpatient readmission occurs, and over this period, the findings indicate that IHT can contribute to relieving inpatient structures in the medium to long term. Over a 36-month follow-up period after discharge from the index treatment, there is no significant difference in the overall utilization of psychiatric services between patients treated with IHT and those treated with IT. First-time engagement with outpatient psychiatric services (such as the POD) occurs more frequently following IHT than after inpatient treatment. These findings suggest that IHT may contribute, at least for population of urban areas as in this study, to a shift from inpatient to a utilization of broader spectrum psychiatric services.\u003c/p\u003e\u003cp\u003e\u003cb\u003eLimitations\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThis study has certain limitations, particularly regarding the external validity of the results. It was conducted on the on hand in three centers, but moreover representing only a certain metropolitan urban area of, which means the findings can only be generalized to other area, like rural or small town, to a limited extent.\u003c/p\u003e\u003cp\u003eDue to the retrospective nature of the study, certain criteria could not be verified for participants in the control group, even though these factors could theoretically have influenced the decision to admit a patient to IHT. These criteria include a suitable home environment for delivering IHT, consent from household members or caregivers, approval from the management of care facilities (if applicable), and the absence of child welfare concerns. Collecting such information could have provided a broader basis for assessing the comparability of the two groups.\u003c/p\u003e\u003cp\u003eDespite our initial sample size calculation, which assumed the feasibility of including approximately 350 patients in the IHT group and an equivalent control group from inpatient treatment (total intended sample size \u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;700), the final sample was smaller than expected. Several factors contributed to this reduction. Firstly, the IHT department in one center only commenced operations in October 2020, while in the other two centers, the IHT treatment capacity was not yet fully expanded during the observation period. Additionally, the year 2020 was marked by the onset of the COVID-19 pandemic, which likely impacted the availability of treatment capacities and the number of eligible patients, particularly in the newly established IHT services. Furthermore, a considerable proportion of patients had to be excluded based on predefined criteria. However, despite the smaller-than-planned sample size, the primary outcome\u0026mdash;hospital readmission rate\u0026mdash;still showed statistically significant results, indicating that IHT is an effective intervention for reducing hospital readmissions. Nevertheless, the negative or non-significant findings regarding secondary outcomes might be at least partially attributed to the reduced sample size, which was lower than planned in the initial power calculation. This should be taken into account when interpreting the secondary analyses.\u003c/p\u003e\u003cp\u003eAdditionally, no primary data were collected regarding quality of life, symptom severity, psychosocial functioning, or self-efficacy, as these parameters were not systematically assessed at admission. Consequently, it was not possible to compare the clinical improvement rates between the two treatment types.\u003c/p\u003e\u003cp\u003eAnother limitation was the restriction of the available data regarding the use of psychiatric and psychotherapeutic services to the hospital information system. As a result, it was only possible to estimate the initial use of outpatient psychiatric-psychotherapeutic services based on the utilization of POD services.\u003c/p\u003e\u003cp\u003eTo better evaluate the long-term effectiveness of IHT in routine clinical practice further research is needed. This should include larger sample sizes and address both clinically and health-economically relevant questions in multiple clinics, in rural, urban and metropolitan areas that offer IHT.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eIHT\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eIntensive Home Treatment\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eIEHT\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eInpatient Equivalent Home Treatment\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eIT\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eInpatient Treatment\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eHT\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eHome Treatment\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eDC\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eDay Clinic\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003ePOD\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003ePsychiatric Outpatient Department\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eIPS\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eIndividual Placement and Support\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eFX\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eICD-10 F-codes (psychiatric diagnoses)\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003ePSM\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003ePropensity Score Matching\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003ePS\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003ePropensity Score\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eM\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eMean\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eSD\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eStandard Deviation\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eHIS\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eHospital Information System\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eKAU\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eKrankenhaus Am Urban\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eKNK\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eKrankenhaus Neuk\u0026ouml;lln\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eKHD\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eKrankenhaus Kaulsdorf\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"Declarations","content":"\u003ch3\u003eEthics approval and consent to participate\u003c/h3\u003e\n\u003cp\u003eThe ethics committee of Charité – Universitätsmedizin Berlin granted full approval to the “StäB 36 PSR MK” trial on November 28, 2024 (EA2/203/24). The ethics boards of all study sites followed this approval.\u003c/p\u003e\n\u003cp\u003eThe trial followed current recommendations for implementation science and naturalistic study reporting standards. The trial was conducted in accordance with the Declaration of Helsinki, Good Clinical Practice guidelines, and the provisions of Good Epidemiological Practice. The study also complied with the German Federal Data Protection Act, Social Security Law Book , and the General Data Protection Regulation . All participant-related data were collected, stored, and published in anonymized form to ensure privacy. The data protection officer at Charité – Universitätsmedizin Berlin granted full approval for the data assurance concept of the trial. The data protection officers at all study sites followed this approval.\u003c/p\u003e\n\u003cp\u003eDue to the nature of the retrospective analysis of routine control data, the Study Information and Consent form was not applicable in advance. To fulfil the informational requirement, even in a retrospective study (without obtaining consent), patients of the study sites will be informed about the analysis of clinical routine data for research purposes via a notice in the clinic or on the project’s website.\u003c/p\u003e\n\u003ch3\u003eConsent for publication\u003c/h3\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003ch3\u003eAvailability of data and materials\u003c/h3\u003e\n\u003cp\u003eStudy material and data will be available upon reasonable request.\u003c/p\u003e\n\u003ch3\u003eCompeting interests\u003c/h3\u003e\n\u003cp\u003eAll authors do declare not to have any competing interest.\u003c/p\u003e\n\u003ch3\u003eFunding\u003c/h3\u003e\n\u003cp\u003eOpen Access funding was enabled and organized by the Publikationsfonds of Charité – Universitätsmedizin Berlin. The project was endorsed by the German Center for Mental Health (DZPG). The project was carried out in collaboration with the Department of Psychiatry, Psychotherapy, and Psychosomatics, incorporating FRITZ am Urban and Soulspace, Vivantes Hospital am Urban, and Vivantes Hospital im Friedrichshain, Berlin, Germany.\u003c/p\u003e\n\u003ch3\u003eAuthor contributions:\u003c/h3\u003e\n\u003cp\u003eKN and AB conceived and designed the study. Data were acquired by KN, SR, BJ, and JT. KN conducted the statistical analysis and was responsible for the integrity of the data. Interpretation of the data was carried out by KN and AB. KN drafted the initial version of the manuscript. The manuscript was critically reviewed for important intellectual content by OH, JT, CR, BJ, AB, and SR. AB obtained the funding for the study. Supervision was provided by AB and JT. Administrative, technical, or material support was contributed by OH, AB, and CR. All listed authors have read and approved the final manuscript.\u003c/p\u003e\n\u003ch3\u003eAcknowledgments\u003c/h3\u003e\n\u003cp\u003eWe express our gratitude to Martin Mai and Pascal Gensicke from the Controlling department of the study clinics, who supported us throughout the course of the project by providing the routine data from the study clinics. We are also very thankful to Sebastian von Huene and Sascha Zapf, master students ate the Charité – Universitätsmedizin Berlin, the study departments and colleagues who supported us throughout the project for their openness toward our work, as well as for all the support and friendly advice we received during the project.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eJohnson S. Crisis resolution and home treatment teams: an evolving model. Adv Psychiatr Treat. 2013;19(2):115\u0026ndash;23.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMurphy SM, Irving CB, Adams CE, Waqar M. Crisis intervention for people with severe mental illnesses. Cochrane Database Syst Reviews, 2015(12).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBaumgardt J, et al. Implementation, efficacy, costs and processes of inpatient equivalent home-treatment in German mental health care (AKtiV): protocol of a mixed-method, participatory, quasi-experimental trial. BMC Psychiatry. 2021;21(1):1\u0026ndash;13.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBechdolf A, et al. Utilization of Psychiatric Hospital Services Following Intensive Home Treatment: A Nonrandomized Clinical Trial. JAMA Netw Open. 2024;7(11):e2445042\u0026ndash;2445042.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWaldmann T, et al. Cost Utility of Intensive Home Treatment Compared With Acute Psychiatric Inpatient Admission. JAMA Netw Open. 2025;8(5):e2512465\u0026ndash;2512465.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNikolaidis K, et al. Stations\u0026auml;quivalente Behandlung (St\u0026auml;B) im Vergleich mit vollstation\u0026auml;rer Behandlung: 12-Monats-Follow-up Ergebnisse einer mittels Propensity-Score gematchten retrospektiven Kohortenstudie. Psychiatr Prax. 2024;51(02):92\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCornelis J, et al. The effectiveness of intensive home treatment as a substitute for hospital admission in acute psychiatric crisis resolution in the Netherlands: a two-centre Zelen double-consent randomised controlled trial. Lancet Psychiatry. 2022;9(8):625\u0026ndash;35.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eJohnson S, Needle J, Bindman JP, Thornicroft G. Crisis resolution and home treatment in mental health. Volume 13. Cambridge University Press Cambridge; 2008.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGim\u0026eacute;nez-D\u0026iacute;ez D, et al. Treating mental health crises at home: Patient satisfaction with home nursing care. J Psychiatr Ment Health Nurs. 2020;27(3):246\u0026ndash;57.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSj\u0026oslash;lie H, Karlsson B, Kim H. Crisis resolution and home treatment: structure, process, and outcome\u0026ndash;a literature review. J Psychiatr Ment Health Nurs. 2010;17(10):881\u0026ndash;92.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eStulz N, et al. Home treatment for acute mental healthcare: randomised controlled trial. Br J Psychiatry. 2020;216(6):323\u0026ndash;30.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGKV-Spitzenverband. Vereinbarung zur Stations\u0026auml;quivalenten psychiatrischen Behandlung nach \u0026sect; 115d Abs. 2 SGB V vom 01.08.2017. Berlin; 2017. V.d.P.K. GKV-Spitzenverband, Deutsche Krankenhausgesellschaft, Editor.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBechdolf A, et al. soulspace\u0026ndash;Implementierung eines niedrigschwelligen, spezifischen Behandlungs-und Fr\u0026uuml;hinterventionsangebots f\u0026uuml;r junge Erwachsene und Jugendliche in die Regelversorgung in Deutschland. Psychiatr Prax. 2019;46(05):243\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWeinmann S, Rout S, Memarzadeh S, Bechdolf A. \u003cem\u003eSt\u0026auml;B in der Gro\u0026szlig;stadt: Berlin\u003c/em\u003e. in \u003cem\u003ePsychiatrische Krisenintervention zu Hause\u003c/em\u003e. Psychiatrie; 2020.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRout S, Ignatyev Y, Schwarz J, von Peter S. \u003cem\u003e[Transition from Child and Adolescent to Adult Psychiatry in a German Metropolitan Region: An Explorative Cross-Sectional Study].\u003c/em\u003e Psychiatr Prax, 2023. 50(5): pp. 234\u0026ndash;240.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eJ\u0026auml;ckel D, et al. Arbeitsbezogene Teilhabebeeintr\u0026auml;chtigungen und Unterst\u0026uuml;tzungsbedarf von Patienten in der (teil-) station\u0026auml;ren psychiatrischen Versorgung. Psychiatr Prax. 2020;47(05):235\u0026ndash;41.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAustin PC. An Introduction to Propensity Score Methods for Reducing the Effects of Confounding in Observational Studies. Multivar Behav Res. 2011;46(3):399\u0026ndash;424.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNikolaidis K, et al. St\u0026auml;B oder Station?\u0026ndash;Erste Ergebnisse zur Studienpopulation und zur Behandlung im Rahmen der multizentrischen AKtiV-Studie zur stations\u0026auml;quivalenten Behandlung. Psychiatr Prax. 2023;50(08):407\u0026ndash;14.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eTeam RC. R: A Language and Environment for Statistical Computing. R Foundation for Statistical Computing: Vienna, Austria; 2023.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eJohnson S, et al. Randomised controlled trial of acute mental health care by a crisis resolution team: the north Islington crisis study. BMJ. 2005;331(7517):599.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eEurostat. Hospital beds by function and type of care. 2024 02.07.2025]; Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://ec.europa.eu/eurostat/databrowser/view/hlth_rs_bds1__custom_12041857/default/table?lang=en\u003c/span\u003e\u003cspan address=\"https://ec.europa.eu/eurostat/databrowser/view/hlth_rs_bds1__custom_12041857/default/table?lang=en\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-psychiatry","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bpsy","sideBox":"Learn more about [BMC Psychiatry](http://bmcpsychiatry.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bpsy/default.aspx","title":"BMC Psychiatry","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Intensive Home Treatment, Propensity score matching, Psychiatric service utilization, Readmission rates","lastPublishedDoi":"10.21203/rs.3.rs-7104562/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7104562/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground:\u003c/h2\u003e\u003cp\u003eIntensive Home Treatment (IHT) has emerged as an effective alternative to inpatient care for acute psychiatric crises, reducing hospital admissions in the short term. However, long-term outcomes beyond 12 months remain understudied, particularly regarding readmissions, cumulative treatment days, and broader psychiatric service utilization. This study evaluates the 36-month effectiveness of IHT compared to inpatient treatment (IT) in routine care, focusing on readmission rates, treatment days, and outpatient service engagement\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eA retrospective matched cohort study was conducted using electronic health records from three psychiatric hospitals in Berlin, Germany. Patients receiving IHT were propensity-score matched (1:1) to IT patients based on age, gender, diagnosis, and prior service use. Outcomes included inpatient/combined readmissions, treatment days, time to readmission, and first-time us of the Psychiatric Outpatient Department (POD) over 36 months. Statistical analyses employed logistic regression, survival analysis (Cox model), and non-parametric tests.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003e263 patients receiving IHT were propensity-score matched to 263 patients treated with IT with no statistical differences at baseline. The IHT group had significantly lower inpatient readmission rates (41.1% vs. 55.5%, p\u0026thinsp;=\u0026thinsp;0.001), fewer inpatient readmissions (mean 1.72 vs. 2.02, p\u0026thinsp;=\u0026thinsp;0.005), and fewer inpatient days (48.5 vs. 51.7, p\u0026thinsp;=\u0026thinsp;0.003) compared to IT. Time to readmission was longer for IHT (median not reached vs. 610 days for IT, p\u0026thinsp;=\u0026thinsp;0.001). Combined readmission rates (IHT\u0026thinsp;+\u0026thinsp;IT\u0026thinsp;+\u0026thinsp;day clinic) did not differ significantly (61.2% vs. 64.3%, p\u0026thinsp;=\u0026thinsp;0.47). IHT patients were more likely to initiate for the first time a POD treatment (33.5% vs. 24.7%, p\u0026thinsp;=\u0026thinsp;0.035) and had more IHT readmissions (mean 0.85 vs. 0.35, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003eIHT demonstrates sustained long-term benefits, reducing inpatient readmissions and prolonging readmission-free periods over 36 months. While overall psychiatric service utilization was similar between groups, IHT facilitated greater engagement with outpatient rather than inpatient care. Findings support IHT as a viable, sustainable alternative to IT, particularly in urban settings, with potential to rebalance care toward community-based services. Limitations include restricted generalizability to rural areas and lack of clinical symptom data. Further multi-centre studies are needed to confirm these results regarding long-term effects across diverse healthcare systems.\u003c/p\u003e\u003ch2\u003eTrial registration:\u003c/h2\u003e\u003cp\u003eGerman Clinical Trials Register (DRKS), DRKS00036833. Registered Mai 21st 2025, \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.drks.de/search/de/trial/DRKS00036833/details\u003c/span\u003e\u003cspan address=\"https://www.drks.de/search/de/trial/DRKS00036833/details\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e","manuscriptTitle":"Intensive Home Treatment compared to Inpatient Psychiatric Treatment: A 36-Month Follow-Up of a Propensity-Score Matched Retrospective Multicenter Cohort Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-07 09:53:17","doi":"10.21203/rs.3.rs-7104562/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-09-23T19:14:38+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-09-22T13:53:11+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-09-16T23:27:39+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"131786277365239287860723927376325550688","date":"2025-09-08T17:50:30+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-09-07T02:11:42+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"16660561464121253995387121392678483137","date":"2025-09-04T15:29:18+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"184063364563815772690469125762601285943","date":"2025-09-04T12:38:04+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"206661366646346492700890994455490313226","date":"2025-09-04T12:03:19+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"260961525398003612401881214083059131285","date":"2025-09-02T22:08:49+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"52621306821639940047271077819032995281","date":"2025-09-02T05:54:47+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-08-03T06:42:55+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-07-23T12:28:55+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-07-22T11:25:23+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-07-22T11:24:07+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Psychiatry","date":"2025-07-11T21:08:02+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-psychiatry","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bpsy","sideBox":"Learn more about [BMC Psychiatry](http://bmcpsychiatry.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bpsy/default.aspx","title":"BMC Psychiatry","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"6b4565ec-bacc-4ceb-9690-a129846a3ff1","owner":[],"postedDate":"August 7th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-04-20T16:08:43+00:00","versionOfRecord":{"articleIdentity":"rs-7104562","link":"https://doi.org/10.1186/s12888-026-08062-5","journal":{"identity":"bmc-psychiatry","isVorOnly":false,"title":"BMC Psychiatry"},"publishedOn":"2026-04-16 15:59:09","publishedOnDateReadable":"April 16th, 2026"},"versionCreatedAt":"2025-08-07 09:53:17","video":"","vorDoi":"10.1186/s12888-026-08062-5","vorDoiUrl":"https://doi.org/10.1186/s12888-026-08062-5","workflowStages":[]},"version":"v1","identity":"rs-7104562","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7104562","identity":"rs-7104562","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}