Introduction: Long-acting injectable antipsychotics (LAIs) are widely recommended to enhance treatment adherence and reduce relapse among individuals with psychotic disorders; however, real-world evidence from community-based services in middle-income countries remains limited. This study examined the clinical characteristics, treatment patterns, and hospitalization outcomes associated with LAI use within Community Mental Health Centers (CMHCs) in Türkiye.
Methods: Using a retrospective observational cohort design with a mirror-image analytic approach, we evaluated 365 patients with schizophrenia, schizoaffective disorder, or atypical psychosis. Person-time-adjusted psychiatric hospitalization rates before and after LAI initiation were compared. Predictors of the transition time from diagnosis to LAI initiation were examined using a General Linear Model (GLM) with 1000-sample bootstrap confidence intervals.
Results: A total of 315 patients were eligible for mirror-image analysis. Median hospitalization rates decreased from 0.273 to 0.000 admissions per person-year following LAI initiation. Person-time-adjusted cohort-level rates decreased from 0.335 to 0.039 admissions per person-year, representing an 88.5% relative reduction (rate ratio: 0.115). This reduction was statistically significant (Z=-13.664, p <0.001) with a large effect size (r ≈ 0.83). In GLM analysis, older age, a higher number of previous hospitalizations, and high school education were significantly associated with longer delays in LAI initiation. Among LAI formulations, risperidone was associated with significantly later initiation compared with haloperidol (B=7.680, p=0.036). The model explained a substantial proportion of variance in LAI initiation timing (R²=0.521).Conclusions: These findings indicate a substantial reduction in hospitalization burden following LAI initiation in real-world community settings. The results support reconsidering the tendency to reserve LAIs for later stages of treatment and suggest that earlier use within community-based care may deserve greater consideration. Integrating LAIs within structured CMHC frameworks may create a complementary effect that supports continuity of care and may contribute to long-term outcomes.
Keywords: Community mental health services; hospitalization; long-acting