Abstract
Purpose
To investigate the pattern of associations between changes in unmet needs and treatment motivation in elderly patients with severe mental illness.
Methods
Observational longitudinal study in 70 patients treated by an assertive community treatment team for the elderly. Unmet needs and motivation for treatment were measured using the Camberwell assessment of needs for the elderly and the stages-of-change (SoC) scale, respectively, at baseline, after 9 and 18 months. SoC scores were dichotomized into two categories: motivated and unmotivated. Multinomial logistic regression analyses were conducted to determine whether changes in motivation were parallel to or preceded changes in unmet needs.
Results
The number of patients who were not motivated for treatment decreased over time (at baseline 71.4 % was not motivated, at the second measurement 51.4 %, and at 18 months 31.4 % of the patients were not motivated for treatment). A decrease in unmet needs, both from 0–9 to 0–18 months was associated with remaining motivated or a change from unmotivated to becoming motivated during the same observational period (parallel associations). A decrease in unmet needs from 0 to 9 months was also associated with remaining motivated or a change from unmotivated to motivated during the 9–18 months follow-up (sequential associations).
Conclusions
Our findings suggest that a decrease in unmet needs is associated with improvements in motivation for treatment.
Similar content being viewed by others
References
Torrey EF, Zdanowicz M (2001) Outpatient commitment: what, why, and for whom. Psychiatr Serv 52:337–341
Lehner R, Dopke C, Cohen K, Edstrom K, Maslar M, Slagg N, Yohanna Y (2007) Outpatient treatment adherence and serious mental illness: a review of interventions. Am J Rehabil 10:245–274
Sytema S, Wunderink L, Bloemers W, Roorda L, Wiersma D (2007) Assertive community treatment in the Netherlands: a randomized controlled trial. Acta Psychiatr Scand 116(2):105–112
Stobbe J, Wierdsma AI, Kok RM, Kroon H, Roosenschoon BJ, Depla M, Mulder CL (2014) The effectiveness of assertive community treatment for elderly patients with severe mental illness: a randomized controlled trial. BMC Psychiatry 14(1):42. doi:10.1186/1471U244XU14U42
Stein LI, Test MA (1980) Alternative to mental hospital treatment. I. Conceptual model, treatment program, and clinical evaluation. Arch Gen Psychiatry 37(4):392–397
Frank AF, Gunderson JG (1990) The role of the therapeutic alliance in the treatment of schizophrenia. Relationship to course and outcome. Arch Gen Psychiatry 47(3):228–236
McCabe R, Priebe S (2003) Are therapeutic relationships in psychiatry explained by patients’ symptoms? Factors influencing patient ratings. Eur Psychiatry 18(5):220–225
Lysaker PH, Davis LW, Buck KD, Outcalt S, Ringer JM (2011) Negative symptoms and poor insight as predictors of the similarity between client and therapist ratings of therapeutic alliance in cognitive behavior therapy for patients with schizophrenia. J Nerv Ment Dis 199(3):191–195. doi:10.1097/NMD.0b013e31820c73eb
Wittorf A, Jakobi U, Bechdolf A, Muller B, Sartory G, Wagner M, Wiedemann G, Wolwer W, Herrlich J, Buchkremer G, Klingberg S (2009) The influence of baseline symptoms and insight on the therapeutic alliance early in the treatment of schizophrenia. Eur Psychiatry 24(4):259–267. doi:10.1016/j.eurpsy.2008.12.015
Velligan DI, Weiden PJ, Sajatovic M, Scott J, Carpenter D, Ross R, Docherty JP (2009) The expert consensus guideline series: adherence problems in patients with serious and persistent mental illness. J Clin Psychiatry 70(Suppl 4):1–46
Stobbe J, Wierdsma AI, Kok RM, Kroon H, Depla M, Roosenschoon BJ, Mulder CL (2013) Lack of motivation for treatment associated with greater care needs and psychosocial problems. Aging Mental Health. doi:10.1080/13607863.2013.807422
Junghan UM, Leese M, Priebe S, Slade M (2007) Staff and patient perspectives on unmet need and therapeutic alliance in community mental health services. Br J Psychiatry 191:543–547
Kortrijk HE (2013) Use of routine outcome monitoring data for evaluating assertive community treatment. Erasmus University, Rotterdam
Prochaska JO, DiClemente CC (1983) Stages and processes of self-change of smoking: toward an integrative model of change. J Consult Clin Psychol 51(3):390–395
Corrigan PW, McCracken SG, Holmes EP (2001) Motivational interviews as goal assessment for persons with psychiatric disability. Community Ment Health J 37(2):113–122
Orrell M, Hancock GA (2004) The Camberwell assessment of need for the elderly (CANE). Gaskell, London
Reynolds T, Thornicroft G, Abas M, Woods B, Hoe J, Leese M, Orrell M (2000) Camberwell assessment of need for the elderly (CANE). Development, validity and reliability. Br J Psychiatry 176:444–452
van der Roest HG, Meiland FJ, van Hout HP, Jonker C, Droes RM (2008) Validity and reliability of the Dutch version of the Camberwell assessment of need for the elderly in community-dwelling people with dementia. Int Psychogeriatr 20(6):1273–1290. doi:10.1017/S1041610208007400
Jochems EC, Mulder CL, van Dam A, Duivenvoorden HJ (2011) A critical analysis of the utility and compatibility of motivation theories in psychiatric treatment. Curr Psychiatry Rev 7:298–312. doi:10.2174/157340011797928204
Broadbent E, Kydd R, Sanders D, Vanderpyl J (2008) Unmet needs and treatment seeking in high users of mental health services: role of illness perceptions. Aust N Z J Psychiatry 42(2):147–153
Tsemberis S, Gulcur L, Nakae M (2004) Housing first, consumer choice, and harm reduction for homeless individuals with a dual diagnosis. Am J Public Health 94(4):651–656
Collins SE, Malone DK, Larimer ME (2012) Motivation to change and treatment attendance as predictors of alcohol-use outcomes among project-based housing first residents. Addict Behav 37(8):931–939. doi:10.1016/j.addbeh.2012.03.029
Acknowledgments
This study was funded by BavoEuropoort, a department of Parnassia Psychiatric Institute, a Center for Mental Health Care, Rotterdam, the Netherlands. They had no role in the study design, collection of data, analysis, interpretation of data, or in the decision to submit the report for publication. JS, CLM, and RMK are employees of Parnassia Psychiatric Institute. All authors declare that they have no conflicts of interests and none of the authors received payments as a consequence of authorship for this manuscript. The authors thank David Alexander for his careful reading of the manuscript.
Conflict of interest
On behalf of all authors, the corresponding author states that there is no conflict of interest.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Stobbe, J., Wierdsma, A.I., Kok, R.M. et al. Decrease in unmet needs contributes to improved motivation for treatment in elderly patients with severe mental illness. Soc Psychiatry Psychiatr Epidemiol 50, 125–132 (2015). https://doi.org/10.1007/s00127-014-0918-9
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00127-014-0918-9