The relationships between need profiles, clinical symptoms, functioning and the well-being of inpatients with severe mental disorders

Perceived Unmet Need for Care and Barriers to Care Among Individuals with Mental Health Issues: A Meta-analysis

Unmet needs refer to the gap between the health services individuals require and what they receive. Individuals with mental health issues often face barriers preventing them from accessing the care they need. A meta-analysis was conducted to estimate the pooled prevalence of unmet needs for care and barriers to care among individuals with mental health issues. The databases PubMed, Scopus, Web of Science, and Cochrane Library were searched for relevant studies published from December 1, 1985 to August 1, 2024. Following the screening process, 204 included studies remained for meta-analysis. Individuals with mental health issues reported significant pooled prevalence rate of unmet care needs over the past year, with the most common being related to work/occupation (43%), dental care (41%), counseling (40%), social intervention (37%), mental health (34%), physical health needs (33%), skills training (32%), social network (32%), psychological distress (31%), information (27%), intimate relationships (27%), benefits (26%), harm reduction (25%), psychotic symptoms (24%), housing (24%), money and food (21%), education (20%), sexual expression (19%), home care (16%), safety (15%), self-care (15%), telephone support (9%), and child care (8%). The pooled prevalence rates of barriers to accessing care were motivational (38%), structural (37%), financial (31%), and stigmatization (25%). The findings indicated that patients with substance use disorders experienced a significantly higher prevalence of unmet care needs and barriers to accessing care compared to those with mental health disorders and homeless individuals. The results showed that unmet care needs were highest among those in established adulthood, while harm reduction was more common among adolescents and emerging adults. Physical health and food needs were most prevalent among midlife adults. Barriers to care were most common among adolescents and emerging adults, except for structural barriers, which were most frequent among midlife adults. To address the unmet employment needs of Individuals with mental health issues, comprehensive training in essential skills is recommended. Enhancing dentists' mental health understanding and fostering collaboration among healthcare providers is crucial. Government-funded, low-barrier service models for substance use disorder patients is suggested to enhance accessibility and effectiveness, while improving health service affordability and acceptability is essential.

Needs for care of residents with schizophrenia spectrum disorders and association with daily activities and mood monitored with experience sampling method: the DIAPASON study

AIMS

Care needs represent an essential paradigm in planning residential facility (RF) interventions. However, possible disagreements between users and staff are critical issues in service delivery. The Experience Sampling Method (ESM) tracks experiences in the real world and real time. This study aimed to evaluate the care needs of patients with schizophrenia spectrum disorder (SSD) in RFs and its association with daily activities and mood monitored using the ESM.

METHODS

As part of the DIAPASON project, 313 residents with SSD were recruited from 99 Italian RFs. Sociodemographic and clinical characteristics were recorded. Care needs, the severity of symptomatology and negative symptoms were assessed. Fifty-six residents were also assessed for 7 consecutive days using the mobile ESM. Descriptive, agreement, predictor and moderator analyses were conducted.

RESULTS

The staff rated a higher number of total and met needs than service users (p < 0.001). Only a slight agreement between users and staff on unmet needs was found in self-care (k = 0.106) and information (k = 0.100) needs, while a moderate agreement was found in accommodation (k = 0.484), food (k = 0.406), childcare (k = 0.530), physical health (k = 0.470), telephone (k = 0.458) and transport (k = 0.425) needs. Older age (-0.15; p < 0.01), longer SSD diagnosis (-0.16; p < 0.01), higher collaboration (-0.16; p < 0.01) and lower symptomatology (-0.16; p < 0.01) decreased the number of unmet needs, while being a female (0.27; p < 0.05) and a shorter length of stay in an RF (0.54; p < 0.001) increased the number of unmet needs. A higher number of unmet needs was associated with a lower amount of time spent in leisure activities or reporting a positive mood: on the contrary, more unmet needs were associated with a greater amount of time spent in religious or non-productive activities. The associations between unmet needs rated by staff and users and momentary mood as assessed using the ESM were not moderated by the severity of symptomatology.

CONCLUSIONS

Although care needs are fundamental in planning residential activities aimed at recovery-oriented rehabilitation, RF interventions did not fully meet users' needs, and some disagreements on unmet needs between users and staff were reported. Further efforts are necessary to overcome Italian RF limits in delivering rehabilitative interventions defined by real users' needs to facilitate users' productivity and progress towards personal recovery.

Needs of patients with early psychosis: A comparison of patient's and mental health care provider's perception

BACKGROUND

Needs define the capacity of a patient to benefit from health care services and a systematic assessment of needs allows planning and delivery of effective treatment to suit patients. This study aimed to understand the (a) needs felt by patients and those perceived by the care providers (CPs), (b) agreement between patients and CPs in the identified needs and (c) factors associated with unmet needs.

METHODS

Participants (N = 215) were recruited through convenience sampling from the Early Psychosis Intervention Programme (EPIP). Data was captured from patients and CPs using the Camberwell Assessment of Needs Short Appraisal Schedule (CANSAS).

RESULTS

Patients and CPs identified an average of 4.06 and 3.84 needs, respectively. The highest number of unmet needs were identified for the social (50% of patients and CPs) and health domains (31.13% of patients' vs. 28.30% of CPs). Company, intimate relationships, psychotic symptoms, money, sexual expression and psychological distress, information and benefits were the unmet needs identified by patients, whereas company, intimate relationships, physical health, and daytime activities were identified by CPs. The concordance between patients and CPs was low with majority of the items scoring slight to fair agreement (Cohen's kappa = 0-0.4). Older age, depression, severe anxiety and having Obsessive-Compulsive Disorder (OCD) were positively associated with unmet needs in patients.

CONCLUSION

While there was an overall consensus on the total needs and met needs between patients and CPs, the level of agreement between the two groups on various items were low. Different perceptions regarding unmet needs were noted between the groups. A holistic approach that takes into account different facets of the needs of patients together with strategic planning to address unmet needs might improve treatment outcomes and satisfaction.

A study on the feasibility of delivering a psychologically informed ward-based intervention on an acute mental health ward

Acute mental health inpatient wards have been criticized for being nontherapeutic. The study aimed to test the feasibility of delivering a psychologically informed intervention in these settings. This single-arm study evaluated the feasibility of clinical psychologists delivering a ward-based psychological service model over a 6-month period on two acute mental health wards. Data were gathered to assess trial design parameters and the feasibility of gathering patient/staff outcome data. Psychologists were able to deliver key elements of the intervention. Baseline staff and patient participant recruitment targets were met. However, there was significant patient attrition at follow-up, with incorrect contact details on discharge being the primary reason. Implementation of a ward-based psychological intervention appears feasible when implemented flexibly. It is feasible to recruit staff and patient participants and to collect staff outcome measures over a 6-month period. However, greater efforts need to be taken to trace patient movement following discharge.

The influence of romantic relationships on mental wellbeing for people who experience psychosis: A systematic review

PURPOSE

Whilst it is generally accepted that supportive relationships facilitate recovery from psychosis, much less is known about the role of romantic relationships in people with psychosis. This review aimed to synthesise quantitative literature regarding the impact of romantic relationships on the mental health and general wellbeing of people who experience psychosis.

METHOD

A systematic review of electronic databases (PsychINFO, PubMed, Web of Science) was carried out using search terms relating to psychosis and romantic relationships. Papers were selected for inclusion by independent reviewers. Quality assessment was completed and a narrative synthesis produced.

RESULTS

Fifty-eight studies reporting the association between romantic relationships and psychotic symptoms, depression, posttraumatic stress disorder, suicidality, quality of life, satisfaction with life and self-esteem were included. Results were mixed but indicated having a romantic partner may be associated with reduced positive and negative symptoms of psychosis, but increased depressive symptoms. Tentative explanations for these findings, such as functioning prior to onset of psychosis, social support and relationship quality are explored.

CONCLUSION

Findings highlight the importance of this often-overlooked area in clinical practice. Studies with robust design, which specifically aim to understand the relationship between romantic relationships and wellbeing for people who experience psychosis are needed.

Met and Unmet Needs in an Inpatient Psychiatry Setting in Spain

PURPOSE

Patients with severe mental disorder have health and social needs that require care. The aim of the study was to determine the main areas of perceived needs among inpatients with severe mental disorders and to identify risk factors of the group of patients with the greatest unmet needs.

PATIENTS AND METHODS

A total of 150 patients with severe mental illness were assessed during admission prior to discharge from the hospital. Camberwell Assessment of Needs was used as evaluation measure, in addition to clinical status (The Brief Psychiatric Rating Scale), social functioning (Personal and Social Performance) and sociodemographic variables. A descriptive and a multivariate logistic regression analysis were used to analyse variables related to the group of patients with the highest number of unmet needs (≥3).

RESULTS

Mean number of needs was 7.93, being 4.61 the mean number of needs met and 3.32 the needs unmet. The highest proportion of unmet needs were intimate relationships (44.0%), company (40.7%) and daytime activities (38.7%). A relationship was also found between the presence of three or more unmet needs and the following variables: Brief Psychiatric Rating Scale score (p=0.004), Personal and Social Performance score (p = 0.013), marital status (p=0.018), employment status (p=0.009) and voluntary admission (p=0.032). The multivariate model explained 29.5% of the variance (Nagelkerke's R²: 0.295).

CONCLUSION

Treatments aimed at improving social relationships and daytime activities could be a good option for inpatients with many unmet needs.

Sexual Dysfunction in Chronically Medicated Male Inpatients With Schizophrenia: Prevalence, Risk Factors, Clinical Manifestations, and Response to Sexual Arousal

BACKGROUND

Sexual dysfunction is a common symptom in patients with schizophrenia, especially in chronically medicated patients. However, the relationship between sexual dysfunction and emotional response to sexual arousal in male patients with schizophrenia remains unclear. This study aimed to assess the incidence, risk factors of sexual dysfunction in males, and their clinical correlations to sexual arousal in male patients with schizophrenia in China.

METHODS

A total of 162 male patients, aged 18-50 years, with schizophrenia were recruited from a psychiatric hospital in Ganzhou. The clinical symptoms were assessed by the Positive and Negative Syndrome Scale (PANSS). The Arizona Sexual Experience Scale was utilized to evaluate sexual dysfunction. Erotic images were selected from International Affective Picture System (IAPS). Sixty-eight out of the 162 subjects completed the erotic pictures reactivity task.

RESULTS

Overall, 48 (29.6%) patients were measured as having global sexual dysfunction, 72 (44.4%) patients as having strength of sex drive dysfunction, 51 (31.5%) patients as having sexual arousal dysfunction, 55 (34.0%) patients as having penile erection dysfunction, 60 (37.0%) patients as having reached orgasm dysfunction, and 60 (37.0%) patients as having satisfaction with orgasm dysfunction. The sexual dysfunction patients had significantly higher scores on the negative symptoms of the PANSS. The only important predictor of sexual dysfunction was the severity of PANSS negative factor. The sense of pleasure and arousal post viewing erotic images in the sexual dysfunction group were lower compared to the non-sexual dysfunction group. The sense of pleasure and approach motivation were significantly negatively correlated with the severity of sexual dysfunction.

CONCLUSIONS

This study shows that nearly one-third of young and middle-aged chronically medicated male inpatients with schizophrenia suffer from sexual dysfunction. The negative factor of the PANSS can be regarded as the risk factor of sexual dysfunction. Schizophrenia patients with sexual dysfunction experienced lower pleasure and higher avoidance motivation than non-sexual dysfunction patients when exposed to erotic stimuli.

Predicting Predischarge Anhedonia Among Inpatients With Schizophrenia and Schizoaffective Disorders: A Large-scale Analysis

This study sought to evaluate predischarge anhedonia level and its predictors in 125 inpatients with schizophrenia and schizoaffective disorders. Consecutively admitted inpatients were assessed before discharge from the hospital using the Specific Loss of Interest and Pleasure Scale (SLIPS) and a battery of measures for clinical and psychosocial variables. When symptoms, distress, and social anhedonia scores were controlled, the SLIPS score inversely correlated with self-constructs, social support, quality of life, recovery, and unmet needs. Using two cutoff points of the data set of SLIPS, we identified three groups: 19 (15.2%) patients reported "no loss of pleasure"; 46 (36.8%), "some loss of pleasure"; and 60 (48.0%), "marked diminishment of pleasure." The SLIPS score is predicted by sensitivity, unmet needs, deficient interpersonal pleasure, poor quality of life, and friend support. The study underlines the importance of assessing anhedonia and related psychosocial factors in patients with serious mental illness.

Sexual Dysfunction Among Patients With Schizophrenia in Southwest Nigeria

Sexual functioning has received little attention as an important aspect of patient care for those suffering from schizophrenia. In Nigeria, cultural and religious factors often prevent patients from talking with their clinician about their sexual life. The aim of our study was to assess the frequency and nature of sexual dysfunction in patients with schizophrenia and assess the determinants of sexual dysfunction in such patients. Sexual dysfunction was assessed with the Arizona Sexual Experience Scale in 90 patients with schizophrenia. Demographic and clinical characteristics including quality of life, the severity of schizophrenia, and perceived stigma were recorded using a standardized protocol and data collection. The prevalence of sexual dysfunction was 36.7%. Higher scores on the negative subscale of the Positive and Negative Syndrome Scale (PANSS), the general subscale of the PANSS, the total scores on the PANSS, and a family history of mental illness were significantly associated with sexual dysfunction. The only significant predictor of sexual dysfunction was the severity of the negative subscale of the PANSS. This study highlights the high prevalence of sexual dysfunction among patients with schizophrenia. Efforts should be made to identify and address this problem.

Health-care needs of remitted patients with bipolar disorder: A comparison with schizophrenia

AIM

To investigate health-care needs and their correlates among patients with remitted bipolar disorder (BD) compared to patients with remitted schizophrenia.

METHODS

Outpatients with BD (n = 150) and schizophrenia (n = 75) meeting clearly defined remission criteria were included in the study along with their relatives. Diagnostic ascertainment was carried out using the Mini International Neuropsychiatric Interview. Demographic and clinical details were recorded using structured formats. Residual symptoms were assessed using standardized scales. Health-care needs were assessed on two separate scales. The principal instrument employed to assess health-care needs was the Camberwell Assessment of Need-Research version (CAN-R). To further evaluate health-care needs we felt that an additional instrument, which was more relevant for Indian patients and treatment-settings and designed to cover those areas of needs not specifically covered by the CAN-R was required. This instrument with a structure and scoring pattern similar to the CAN-R was used for additional evaluation of needs. Patients’ level of functioning was assessed using the Global Assessment of Functioning Scale and their quality of life (QOL) using the World Health Organization Quality Of Life-BREF version in Hindi.

RESULTS

An average of 6-7 needs was reported by patients with BD as well as their relatives. Commonly reported needs were in the areas of economic and welfare needs, informational needs, social needs and the need for treatment. According to the CAN-R, both patients and relatives reported that more than 60% of the total needs were being met. However, over 90% of the needs covered by the additional evaluation were unmet according to patients and relatives. Needs in the areas of economic and welfare-benefits, information, company, daytime activities and physical health-care were largely unmet according to patients and relatives. Total, met and unmet needs were significantly higher for schizophrenia, but the most common types of needs were quite similar to BD. Relatives reported more needs than patients with certain differences in the types of needs reported. Level of patients’ functioning was the principal correlate of greater total and unmet needs in both groups. Significant associations were also obtained with residual symptoms and QOL.

CONCLUSION

The presence of unmet needs in remitted patients with BD was an additional marker of the enduring psychosocial impairment characteristic of the remitted phase of BD.

Indian Psychiatric Society multicentric study on assessment of health-care needs of patients with severe mental illnesses as perceived by their family caregivers and health-care providers

AIM

To study the health-care needs of the patients with severe mental disorders as perceived by their family caregivers and the treating psychiatrists.

MATERIALS AND METHODS

Caregivers of patients with severe mental disorders and their treating psychiatrists were assessed using Camberwell Assessment of Need-Research Version (CAN-R) scale and indigenously designed Supplementary Assessment of Needs Scale (SNAS).

RESULTS

The study included 1494 patients recruited from 15 centers. The mean needs as per the CAN-R, perceived by the caregivers were 7.8 and treating psychiatrists were 8.1. About one-third of needs were unmet. On SNAS, both caregivers and treating psychiatrists reported a mean of 7.9 needs, of which more than half were unmet as per the caregivers. As per the treating psychiatrists, 45.5% of the needs as assessed on SNAS were unmet. There was a high level of correlation between needs perceived by the patients, caregivers and the treating psychiatrists. On CAN-R, main domains of needs as reported by the caregivers were those of money, relief of psychological distress, information about the illness and treatment, welfare benefits, transport, company and food. As per the treating psychiatrists, the most common total needs identified were those of relief of psychological distress, welfare benefits, information about the illness and treatment, money, transport, company self-care and physical health. The most common domains of needs as assessed on SNAS as per the caregivers were those of free treatment, medical reimbursement, psychoeducation, financial help, social support, insurance, more time from the clinicians and travel concession. The treating psychiatrists identified dealing with caregiver's stress as the most common need.

CONCLUSIONS

According to the family caregivers and treating psychiatrists, about one-third of the needs of the patients as assessed using CAN-R and about half of the needs as assessed using SNAS are unmet.

Indian Psychiatric Society multicentric study on assessment of health-care needs of patients with severe mental illnesses

AIM

To assess the health-care needs of the patients with severe mental disorders.

MATERIALS AND METHODS

Patients with the diagnosis of a severe mental disorder (schizophrenia and related psychotic disorders, bipolar disorder, recurrent depressive disorder, major depressive disorder and obsessive compulsive disorder) were assessed using Camberwell Assessment of Need-Research version (CAN-R) Scale and indigenously designed Supplementary Needs Assessment Scale (SNAS).

RESULTS

The study included 1494 patients recruited from 15 centers. The most common diagnostic group was that of affective disorders (55.3%), followed by psychotic disorders (37.6%). The mean number of total needs as perceived by the patients was 7.6 on the CAN-R. About two-third of the needs as assessed on CAN-R were met, and one-third were unmet. On CAN-R, main domains of needs as reported by patients were those of money, welfare benefits, transport, information about the illness and treatment, relief of psychological distress, company, household skills and intimate relationships. On SNAS, the mean number of total needs as perceived by the patients was 7.6 of which 4.1 were met needs. The most common domains of needs as assessed on SNAS were those of financial help, medical reimbursement, psychoeducation, free treatment, certification of mental illness, flexible work/job timings, addressing the caregiver stress and legal aid.

CONCLUSION

About two-third of the needs, of the patients with severe mental disorders are met as assessed using CAN-R. However, higher percentages of unmet needs are identified on SNAS. In view of the commonly reported needs, a change in the orientation of services offered to people with mental disorders is very much called for. At the government level, desired policies must be formulated to support the patients with mental disorders.

Living in supportive housing for people with serious mental illness: a paradoxical everyday life

Since the closure of large psychiatric institutions, various types of community-based supportive housing for people with serious mental illness (SMI) have been developed. There is currently limited knowledge about users' experiences of living in supportive housing. The aim of the present study was to describe user experiences of living in supportive housing for people with SMI. Twenty-nine people living in such facilities participated in open, qualitative interviews. Data were subjected to latent content analysis. Three main themes emerged from this analysis: (i) having a nest, which included the subthemes of a place to rest and having someone to attach to; (ii) being part of a group, with the subthemes of being brought together and a community spirit; and (iii) leading an oppressive life, including the subthemes of questioning one's identity, sense of inequality, and a life of gloom. It could be concluded that user experiences of living in supportive housing are complex and paradoxical. In order to provide supportive housing, staff need to recognize and work within social group processes, and perform continual and structural evaluations of users' social and emotional needs.

Lack of motivation for treatment associated with greater care needs and psychosocial problems

OBJECTIVE

To compare the care needs and severity of psychosocial problems in older patients with severe mental illness (SMI) between those who were and were not motivated for treatment.

METHODS

Cross-sectional study in which we enrolled 141 outpatients with SMI aged 55 and older. Needs were measured using the Camberwell Assessment of Needs for the Elderly, and psychosocial problems with the Health of the Nation Outcome Scale 65+. Motivation for treatment was assessed using a motivation-for-change scale. Parametric and non-parametric tests were used to analyze differences between motivated and non-motivated patients. Explorative logistic regression analyses were used to establish, which unmet needs were associated with motivation.

RESULTS

Less-motivated patients had greater unmet care needs and more psychosocial problems than those who were motivated. Logistic regression analyses showed that lack of motivation was associated with greater unmet needs regarding daytime activities, psychotic symptoms, behavioral problems, and addiction problems.

CONCLUSIONS

Lack of treatment motivation was associated with more unmet needs and more severe psychosocial problems. Further research will be needed to identify other factors associated with motivation in older people with SMI and to investigate whether this group of patient benefits from interventions such as assertive outreach, integrated care or treatment-adherence therapy.

The mediating role of self-stigma and unmet needs on the recovery of people with schizophrenia living in the community

PURPOSE

For people with schizophrenia living in the community and receiving outpatient care, the issues of stigma and discrimination and dearth of recovery-oriented services remain barriers to recovery and community integration. The experience of self-stigma and unmet recovery needs can occur regardless of symptom status or disease process, reducing life satisfaction and disrupting overall well-being. The present study examined the mediating role of self-stigma and unmet needs in the relationship between psychiatric symptom severity and subjective quality of life.

METHODS

Structural equation modeling and mediation analyses were conducted based on a community sample of 400 mental health consumers with schizophrenia spectrum disorders in Hong Kong.

RESULTS

The model of self-stigma and unmet needs as mediators between symptom severity and subjective quality of life had good fit to the data (GFI = .93, CFI = .93, NNFI = .92, RMSEA = .06, χ(2)/df ratio = 2.62). A higher level of symptom severity was significantly associated with increased self-stigma (R (2) = .24) and a greater number of unmet needs (R (2) = .53). Self-stigma and unmet needs were in turn negatively related to subjective quality of life (R (2) = .45).

CONCLUSIONS

It is essential that service providers and administrators make greater efforts to eliminate or reduce self-stigma and unmet recovery needs, which are associated with the betterment of the overall quality of life and long-term recovery. Both incorporating empowerment and advocacy-based interventions into recovery-oriented services and providing community-based, person-centered services to people based on personally defined needs are important directions for future recovery-oriented efforts.

The CANSAS self-report for screening of needs in outpatients with schizophrenia and schizoaffective disorders

The importance of needs assessment for service development has been widely recognized. In this study we examined the agreement between the Camberwell Assessment of Need Short Appraisal Schedule self-report version (CANSAS-P) and the Camberwell Assessment of Need interview-based scale in 100 outpatients with schizophrenia and schizoaffective disorders. We found equivalent number of met, unmet, and no needs for most of the domains of the two instruments. Both intraclass correlations and Kappa reliability coefficients were high for most need domains. The high agreement between the two instruments suggests that the CANSAS-P can be used as a screening tool to detect unmet needs in both clinical routine practice and research surveys in mental health outpatient settings.

Clinical and psychosocial factors associated with needs for care: an Arab experience with a sample of treated community-dwelling persons with schizophrenia

OBJECTIVES

To (1) highlight the profile of the needs for care among a sample of persons with schizophrenia, using the Camberwell Assessment of Needs (CAN-EU), in comparison with the international data; (2) assess the association of patients' needs with socio-demographics, clinical characteristics and objective quality of life (QOL); and (3) compare the perceptions of patients with those of the staff.

METHOD

Consecutive outpatients in stable condition were interviewed with the CAN-EU and measures of QOL and psychopathology.

RESULTS

There were 130 patients (68.5% men, mean age 36.8). The highest frequency of unmet needs was for money (29.2%). About a fifth of the subjects expressed unmet needs for six other items, including accommodation. The mean total needs was 8.67(7.1), the total met needs was 5.29 and total unmet needs was 3.38. The dimension with the highest frequency (40%) of unmet needs (functioning) is constituted by items that are related to family care at home. Staff identified significantly more needs than patients. Higher levels of needs were significantly associated with severity of psychopathology and negative affect, and not participating in outdoor activities. The mean number of needs was similar to reports from developing countries and higher than those from European countries. The met/unmet need ratio was similar to European data.

CONCLUSION

Despite free health services and family support, a number of our treated community-dwelling persons with schizophrenia had problems meeting basic and health-care needs. The findings call for a consideration of techniques for enhancing the capability of families to cope with the care of patients.

Factor structure in the Camberwell Assessment of Need-Patient Version: the correlations with dimensions of illness, personality and quality of life of schizophrenia patients

AIM

To investigate the factor structure underlying the Camberwell Assessment of Need-Patient Version (CANSAS-P) items in schizophrenia and schizoaffective disorder.

METHOD

Factor, correlation and regression analyses were performed for dimensions of CANSAS-P, illness, personality and quality of life (QOL) related variables in 95 stabilized patients with chronic schizophrenia and schizoaffective disorder.

RESULTS

Exploratory factor analysis revealed a four-factor model that explains 50.4% of the total variance of the 20 CANSAS-P items. The factors 'Social disability', 'Information processing disability', 'Emotional processing disability', and 'Coping disability' showed acceptable internal consistency (Cronbach's α coefficient 0.67-0.77). The CANSAS-P subscale scores positively correlated with severity of symptoms, distress (r ranged from 0.34 to 0.45), while negatively associated with general functioning (r = -0.34), friend (r = -0.46) and family support (r = -0.41), satisfaction with medicine (r = -0.35), general activities (r = -0.40), and general QOL (r = -0.35) (all P < 0.001). Severity of illness, symptoms, emotional distress and emotion-oriented coping were positive predictors; friend support, QOL general activities, life satisfaction and satisfaction with medicine were negative predictors of the CANSAS-P subscale scores. The effect size (f(2)) for these predictors ranged from medium to quite large (f(2) = 0.28-1.13), and they explain from 23% to 46% of the variability in CANSAS-P subscales.

CONCLUSIONS

A four-factor structure mode, including social and cognitive functioning, emotion responsivity and coping with daily challenges, appears to fit CANSAS-P items. These subscales may contribute to research and improve treatment of psychiatric patients.

Measuring patient-reported outcomes in psychosis: conceptual and methodological review

BACKGROUND

There are calls to use patient-reported outcomes (PROs) routinely across mental health services. However, the use of PROs in patients with psychosis has been questioned.

AIMS

To examine the concepts and measures of four widely used PROs: treatment satisfaction, subjective quality of life, needs for care and the quality of the therapeutic relationship.

METHOD

We conducted a literature search of academic databases on concepts, characteristics and psychometric properties of the four PROs in patients with psychosis.

RESULTS

Although numerous concepts and measures have been published, evidence on the methodological quality of existing PROs is limited. Measures designed to assess distinct PROs showed a considerable conceptual, operational and empirical overlap, and some of them also included specific aspects. The impact of symptoms and cognitive deficits appears unlikely to be of clinical significance.

CONCLUSIONS

The popularity of PROs has not been matched with progress in their conceptualisation and measurement. Based on current evidence, some recommendations can be made. Distinct and short measures with clinical relevance and sufficient psychometric properties should be preferred. Future research should optimise the validity and measurement precision of PROs, while reducing assessment burden.

Self-perceived needs are related to violent behavior among schizophrenia outpatients

This study assessed the relationship between self-perceived clinical and social needs and aggressive behavior in outpatients with schizophrenia. A total of 895 outpatients with schizophrenia were enrolled. The presence of aggressive episodes was assessed using the Modified Overt Aggression Scale. Self-perceived needs were assessed using the Camberwell Assessment of Need in six areas of needs (food, household skills, self-care, daytime activities, psychotic symptoms, satisfaction with treatment, and company). The most common areas of needs were "psychotic symptoms" (81.6%), "daytime activities" (60.6%), and "household skills" (57.5%). More needs were expressed by patients who had more severe illnesses (p < 0.001) and more aggressive behavior (p < 0.001). Multivariate analysis showed that, in schizophrenia outpatients, self-perceived needs were associated with aggressive behavior (adjusted odds ratio, 11.43; 95% confidence interval, 5.11 to 25.56). Appropriate compliance with antipsychotic treatment was related with lower aggressive behavior (p < 0.001).

Patient-centered care in affective, non-affective, and schizoaffective groups: patients' opinions and attitudes

An outcome evaluation was conducted to obtain psychiatric inpatients' perspectives on acute care mental health treatment and services. The applicability of diagnostic categories based on affective, non-affective, and schizoaffective disorder were considered in the predictability of responses to treatment regimens and the related services provided in an inpatient psychiatric unit. A multidimensional approach was used to survey patients, which included the DAI-30, the BMQ, the SERVQUAL, and the CSQ-8. Overall, findings indicate that inpatient satisfaction could be improved with tailoring treatment to suit their respective symptoms. Furthermore, this exploratory study demonstrates some preliminary support for the inclusion of patients with a diagnosis of schizoaffective disorder as a separate group toward improving acute mental health care while hospitalized.

Needs of Indian schizophrenia patients: an exploratory study from India

BACKGROUND

Although there are many studies from the West, no study has evaluated the needs of schizophrenia patients in Indian setting.

METHODOLOGY

100 consecutive patients of schizophrenia were assessed on Camberwell Assessment of Needs questionnaire. Same questionnaire was also administered to the caregiver to assess their perception about the needs of the patients.

RESULTS

Patients and their caregivers reported 8.12 and 7.13 needs, respectively, more than two-third of which were unmet. The most commonly reported needs by both patients and their caregivers were need for welfare benefits. Besides the welfare benefits, the four most common areas in which patients had needs and required help were-psychotic symptoms, psychological distress, information about the condition and money, whereas four most commonly reported area of needs reported by the caregivers were psychological distress, money, company and intimate relationships. Help provided by the government or non-governmental organizations was negligible.

CONCLUSIONS

Most of needs of schizophrenia patients are unmet.