Integrated Psychosomatic Care in General Hospital Medicine: An Observational Study of Outcomes in Medically Complex Inpatients.

BACKGROUND

Medically complex inpatients with severe somatic illness and comorbid mental disorders are rarely reached by standard psychiatric or psychosomatic services due to physical limitations and complex care needs. The Nuremberg Integrated Psychosomatic Acute Unit (NIPA)-an embedded, ward-based psychosomatic care model delivering multidisciplinary treatment-was developed to address this gap by providing proactive, individualized psychosomatic care directly within internal medicine wards.

OBJECTIVE

To describe symptom trajectories and hospitalization patterns associated with participation in the NIPA model under real-world conditions.

METHODS

We analyzed real-world clinical data from a retrospective cohort of 139 patients with gastrointestinal, respiratory, and oncological diseases treated by NIPA between 2018 and 2024. Depression (Patient Health Questionnaire 9), anxiety (Generalized Anxiety Disorder 7), and somatic symptom burden (Patient Health Questionnaire 15) were assessed at admission and discharge. Patient satisfaction was assessed using the Nuremberg Satisfaction with Treatement Questionnaire (ZUF-8). A postal follow-up survey was conducted 3 months postdischarge (response rate 25.2%). Hospitalization data for the 3 months before and after NIPA were obtained from hospital records and supplemented by follow-up self-reports.

RESULTS

Statistically significant improvements in depression (η2 = 0.30), anxiety (η2 = 0.37), and somatic symptoms (η2 = 0.19) were observed at discharge. At 3-month follow-up, sustained improvements were observed for anxiety (η2 = 0.36) and moderate improvements for depression (η2 = 0.17). Within 3 months of discharge, 26.2% of patients were rehospitalized; in only 8.2% of cases was readmission associated with the same psychosocial symptom constellation. Most readmissions were attributable to somatic deterioration or planned medical interventions. Among patients with frequent prior hospitalizations, mean inpatient days were observed to decrease from 8.4 to 3.2, and 64.6% were not readmitted.

CONCLUSIONS

Participation in the NIPA program was associated with clinically meaningful improvements in psychological distress and favorable hospitalization patterns among medically complex inpatients. These findings suggest that this kind of integrated proactive psychosomatic care is feasible for this underserved population and support the need for controlled studies to further evaluate its effectiveness.