Needs for care among patients with schizophrenia in six European countries: a one-year follow-up study
Tóm tắt
This article compares needs for care among patients with schizophrenia across six European countries and examines how this relates to the diversity of psychiatric systems in Europe. A one-year prospective cohort study was set up. Inclusion criteria for patients were: a clinical lifetime diagnosis of schizophrenia according to ICD-10 (F20) diagnostic criteria for research, age between 18 and 65 years and at least one contact with mental health services in 1993. The patients were assessed for their clinical diagnosis and symptoms using the SCAN interview (Schedules for Clinical Assessment in Neuropsychiatry) and the interventions proposed to them were recorded through the systematic use of the NFCAS (Needs For Care Assessment Schedule). 438 patients were included and 391 were followed up. The mean age was 38 years, the mean age at onset was 22 years, and 59% were out-patients, 24% in day care and 15% hospitalized. The populations in the different centres were significantly different for almost all the variables: sociodemographic, clinical and social, and the problems identified remained relatively stable over the year. Comparisons highlighted cultural differences concerning the interventions that were proposed. Centres in Italy, Spain and Portugal proposed many interventions even though they were relatively deprived in terms of resources, and the tendency seems to be the reverse for the Northern European countries. On average, one in four patients suffered from needs that were not adequately met by the mental health service in their region. These needs (on average 6 per patient) varied from psychotic symptoms to managing their own affairs. The number of interventions was not correlated to the need status. The availability of community-based treatment, rehabilitation and residential care seems to predict smaller proportions of patients with unmet needs. There appeared to be a systematic relationship between the availability of community-based mental health care and the need status of schizophrenic patients: the fewer out-patient and rehabilitation services available, the more unmet needs there were.
Tài liệu tham khảo
Kovess V, Caldas de Almeida Jose M, Carta M, Dubuis J, Lacalmontie E, Pellet J, Roelandt JL, Moreno Kustner B, Walsh D, Wiersma D: Professional team's choices of intervention towards problems and needs of patients suffering from schizophrenia across six European countries. Eur Psychiatry. 2005, 20 (8): 521-528. 10.1016/j.eurpsy.2005.02.007.
Bachrach LL: Deinstitutionalisation: promises, problems and prospects. Mental health service evaluation. Edited by: Knudsen HC and Thornicroft G. 1996, Cambridge, Cambridge University Press
Marks I, Scott R: Mental health care delivery. Innovations, impediments and implementation. 1990, Cambridge, Cambridge University Press
Freeman H, Henderson JH: Evaluation of comprehensive care of the mentally ill. 1991, London, Gaskell
Thornicroft G, Brewin CR, Wing JK: Measuring mental health needs. 1992, London, Gaskell Royal College of Psychiatrists
Knudsen HC, Thornicroft G: Mental health service evaluation. 1996, Cambridge, Cambridge University Press
Mastroeni A, Bellotti C, Pellegrini E, Galletti F, Lai E, Falloon IR: Clinical and social outcomes five years after closing a mental hospital: a trial of cognitive behavioural interventions. Clin Pract Epidemol Ment Health. 2005, 1: 25-10.1186/1745-0179-1-25.
Henderson JH: Protocol for a multi-centre study of evaluation of comprehensive care of the mentally ill. 1992, Northampton, Planning Group on Mental Health Care in the European Countries
World Health Organization: The ICD-10 classification of mental and behavioural disorders. 1993, Geneva, World Health Organization
Wing JK, Babor T, Brugha T, Burke J, Cooper JE, Giel R, Jablenski A, Regier D, Sartorius N: SCAN. Schedules for Clinical Assessment in Neuropsychiatry. Arch Gen Psychiatry. 1990, 47 (6): 589-593.
Kovess V: Mental health services description. Prospects for the future. Epidemiologia e Psichiatria Sociale Monogr Suppl. 1997, 1: 91-104.
Wiersma D, Nienhuis FJ, Giel R, de Jong A, Slooff CJ: Assessment of the need for care 15 years after onset of a Dutch cohort of patients with schizophrenia, and an international comparison. Soc Psychiatry Psychiatr Epidemiol. 1996, 31 (3-4): 114-121. 10.1007/BF00785757.
Wiersma D: Reliability of the "Needs for Care Assessment Schedule" in a European context: an international comparison. Department of Social Psychiatry. 1996, Groningen, University of Groningen
Wiersma D, Nienhuis FJ, Slooff CJ, Giel R: Natural course of schizophrenic disorders: a 15-year followup of a Dutch incidence cohort. Schizophr Bull. 1998, 24 (1): 75-85.
Brewin CR, Wing JK: Manual of the MRC Needs for Care Assessment. Memo. 1989, London, MRC Social Psychiatry Unit
Brewin CR, Wing JK, Mangen SP, Brugha TS, MacCarthy B: Principles and practice of measuring needs in the long-term mentally ill: the MRC needs for care assessment. Psychol Med. 1987, 17 (4): 971-981.
Lesage AD, Mignoli G, Faccincani C, Tansella M: Standardized assessment of the needs for care in a cohort of patients with schizophrenic psychoses. Psychol Med Monogr Suppl. 1991, 19: 27-33.
Holloway F: Day care in an inner city. II. Quality of the services. Br J Psychiatry. 1991, 158: 810-816.
van Haaster I, Lesage AD, Cyr M, Toupin J: Problems and needs for care of patients suffering from severe mental illness. Soc Psychiatry Psychiatr Epidemiol. 1994, 29 (3): 141-148.
van Haaster I, Lesage AD, Cyr M, Toupin J: Further reliability and validity studies of a procedure to assess the needs for care of the chronically mentally ill. Psychol Med. 1994, 24 (1): 215-222.
Jablensky A, Sartorius N, Ernberg G, Anker M, Korten A, Cooper JE, Day R, Bertelsen A: Schizophrenia: manifestations, incidence and course in different cultures. A World Health Organization ten-country study. Psychol Med Monogr Suppl. 1992, 20: 1-97.