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

Social psychiatry - Tập 48 - Trang 313-323 - 2012
Muhammad A. Zahid1, J. U. Ohaeri2,3
1Department of Psychiatry, Faculty of Medicine, Health Sciences Centre, Kuwait University, Safat, Kuwait
2Department of Psychiatry, Psychological Medicine Hospital, Kuwait, Kuwait
3Department of Psychological Medicine, College of Medicine, University of Nigeria, Enugu State, Nigeria

Tóm tắt

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

Tài liệu tham khảo

American Psychiatry Association. Diagnostic and Statistical Manual of Mental Disorders IV 1994 Arvidsson H (2001) Needs assessed by patients and staff in a Swedish sample of severely mentally ill subjects. Nord J Psychiatry 55:311–317 Bengtsson-Tops A, Hansson L (1999) Clinical and social needs of schizophrenic outpatients living in the community: the relationship between needs and subjective quality of life. Soc Psychiatry Psychiatr Epidemiol 34:513–518 Brewin CR, Wing JK, Mangen SP et al (1987) Principles and practice of measuring need in the long-term mentally ill: the MRC Needs for care assessment. Psychol Med 17:971–981 Cleary M, Hunt GE, Walter G, Freeman A (2006) The patient’s view of need and caregiving consequences: a cross-sectional study of inpatients with severe mental illness. J Psychiatr Ment Health Nurs 13:506–514 de Weert-van Oene GH, Havenaar JM, Schrijvers AJ (2009) Self-assessment of need for help in patients undergoing psychiatric treatment. Psychiatry Res 167(3):221–230 El-Islam MF (1982) Rehabilitation of schizophrenics by the extended family. Acta Psychiatr Scand 65:112–119 El-Islam MF (1989) Collaboration with families for the rehabilitation of schizophrenic patients and the concept of expressed emotion. Acta Psychiatr Scand 79:303–307 Foldemo A, Bogren L (2002) Need assessment and quality of life in outpatients with schizophrenia: a 5-year follow-up study. Scand J Caring Sci 16:393–398 Freeman A, Malone J, Hunt GE (2004) A statewide survey of high-support services for people with chronic mental illness: assessment of needs for care, level of functioning and satisfaction. Aust N Z J Psychiatry 38:811–818 Gaite L, Vazquez-Barquero JL, Arrizabalaga AA, Schene A, Welcher B, Thornicroft G, Ruggeri M, Vazquez –Bourgon E, Retuerto MP, Leese M and the EPSILON study group (2000) Quality of life in schizophrenia: development, reliability and internal consistency of the Lancashire Quality of Life Profile – European version. Br J Psychiatry 177(Suppl 39):s49–s54 Grinshpoon A, Ponizovsky AM (2008) The relationships between need profiles, clinical symptoms, functioning and the well-being of inpatients with severe mental disorders. J Eval Clin Pract 14:218–225 Hansson L, Vinding HR, Mackeprang T, Sourander A, Werdelin G, Bengtsson-Tops A, Bjarnason O, Dybbro J, Nilsson L, Sandlund M, Sørgaard K, Middelboe T (2001) Comparison of key worker and patient assessment of needs in schizophrenic patients living in the community: a Nordic multicentre study. Acta Psychiatr Scand 103:45–51 Hansson L, Sandlund M, Bengtsson-Tops A, Bjarnason O, Karlsson H, Mackeprang T, Merinder L, Nilsson L, Sørgaard K, Vinding H, Middelboe T (2003) The relationship of needs and quality of life in persons with schizophrenia living in the community. A Nordic multi-center study. Nord J Psychiatry 57:5–11 Hayward M, Slade M, Moran PA (2006) Personality disorders and unmet needs among psychiatric inpatients. Psychiatr Serv 57:538–543 Jansson L, Wennström E, Wiesel FA (2005) The Need of Support and Service Questionnaire (NSSQ): a brief scale to assess needs in clients with long-term mental disabilities. Nord J Psychiatry 59:465–472 Joska JA, Flisher AJ (2007) Needs and services at an in-patient psychotherapy unit. Afr J Psychiatry (Johannesbg) 10:149–2156 Junca A, Ustun TB, Early TS, Sartorious N (1993) The ICD-10 Symptom Checklist: a comparison to the ICD-10 classification of mental and behavioural disorders. Soc Psychiatry Psychiatr Epidemiol 28:239–242 Kulhara P, Avasthi A, Grover S, Sharan P, Sharma P, Malhotra S, Gill S (2010) Needs of Indian schizophrenia patients: an exploratory study from India. Soc Psychiatry Psychiatr Epidemiol 45:809–818 Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33:159–174 Lasalvia A, Bonetto C, Salvi G, Bissoli S, Tansella M, Ruggeri M (2007) Predictors of changes in needs for care in patients receiving community psychiatric treatment: a 4-year follow-up study. Acta Psychiatr Scand Suppl 437:31–41 Leucht S, Kane JM, Kissling W, Hamann J, Etschel E, Engel R (2005) Clinical implications of brief psychiatric rating scale scores. Br J Psychiatry 187:366–371 Lukoff D, Neuchterlien K, Ventura J (1986) Manual for the expanded brief psychiatric rating scale. Schizophr Bull 13:261–276 Macpherson R, Varah M, Summerfield L, Foy C, Slade M (2003) Staff and patient assessments of need in an epidemiologically representative sample of patients with psychosis—staff and patient assessments of need. Soc Psychiatry Psychiatr Epidemiol 38:662–667 MacPherson R, Gregory N, Slade M, Foy C (2007) Factors associated with changing patient needs in an assertive outreach team. Int J Soc Psychiatry 53:389–396 McCann E (2010) The sexual and relationship needs of people who experience psychosis: quantitative findings of a UK study. J Psychiatr Ment Health Nurs 17(4):295–303 McCrone P, Leese M, Thornicroft G, Schene AH, Knudsen HC, Vázquez-Barquero JL, Lasalvia A, Padfield S, White IR, Griffiths G (2000) Reliability of the Camberwell assessment of need–European version. EPSILON Study 6. European psychiatric services: inputs linked to outcome domains and needs. Br J Psychiatry Suppl 39:s34–s40 McCrone P, Leese M, Thornicroft G, Schene A, Knudsen HC, Vázquez-Barquero JL, Tansella M, Becker T (2001) A comparison of needs of patients with schizophrenia in five European countries: the EPSILON Study. Acta Psychiatr Scand 103:370–379 Meijer K, Schene A, Koeter M, Knudsen HC, Becker T, Thornicroft G, Vázquez-Barquero JL, Tansella M (2004) Needs for care of patients with schizophrenia and the consequences for their informal caregivers: results from the EPSILON multi centre study on schizophrenia. Soc Psychiatry Psychiatr Epidemiol 39:251–258 Middelboe T, Mackeprang T, Hansson L, Werdelin G, Karlsson H, Bjarnason O, Bengtsson-Tops A, Dybbro J, Nilsson LL, Sandlund M, Sörgaard KW (2001) The Nordic Study on schizophrenic patients living in the community. Subjective needs and perceived help. Eur Psychiatry 16:207–214 Ochoa S, Haro JM, Autonell J, Pendàs A, Teba F, Màrquez M, NEDES Group (2003) Met and unmet needs of schizophrenia patients in a Spanish sample. Schizophr Bull 29:201–210 Phelan M, Slade M, Thornicroft G, Dunn G, Holloway F, Wykes T, Strathdee G, Loftus L, McCrone P, Hayward P (1995) The camberwell assessment of need (CAN): the validity and reliability of an instrument to assess the needs of the seriously mentally ill. Br J Psychiatry 167:589–595 Rosales Varo C, Torres González F, Luna-Del-Castillo J, Baca Baldomero E, Martínez Montes G (2002) Assessment of needs in schizophrenia patients. Actas Esp Psiquiatr 30:182–188 Ruggeri M, Leese M, Slade M, Bonizzato P, Fontecedro L, Tansella M (2004) Demographic, clinical, social and service variables associated with higher needs for care in community psychiatric service patients. The South Verona outcome project 8. Soc Psychiatry Psychiatr Epidemiol 39:60–68 Tansella M (2010) Alternatives to standard acute in-patient care for people with mental disorders: from systematic description to evaluative research. Br J Psychiatry 197(Suppl 53):s1–s3 Trauer T, Tobias G (2004) The camberwell assessment of need and behaviour and symptom identification scale as routine outcome measures in a psychiatric disability rehabilitation and support service. Community Ment Health J 40:211–221 Wennström E, Sörbom D, Wiesel FA (2004) Factor structure in the camberwell assessment of need. Br J Psychiatry 185:505–510 Wiersma D (2006) Needs of people with severe mental illness. Acta Psychiatr Scand 113(Suppl. 429):115–119 Yeh HS, Luh RL, Liu HJ, Lee YC, Slade M (2006) Reliability of the Camberwell assessment of need (Chinese version) for patients with schizophrenia at a daycare center of Taiwan. Soc Psychiatry Psychiatr Epidemiol 41:75–80 Zahid MA, Ohaeri JU, Elshazli AS, Basiouny MA, Hamoda MA, Varghese R (2010) Correlates of quality of life in an Arab schizophrenia sample. Soc Psychiatry Psychiatr Epidemiol 45:875–887