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Social Psychiatry and Psychiatric Epidemiology

, Volume 50, Issue 1, pp 125–132 | Cite as

Decrease in unmet needs contributes to improved motivation for treatment in elderly patients with severe mental illness

  • Jolanda StobbeEmail author
  • André I. Wierdsma
  • Rob M. Kok
  • Hans Kroon
  • Marja Depla
  • Cornelis L. Mulder
Original Paper

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.

Keywords

Assertive outreach CANE Needs Elderly Severe mental illness Treatment motivation 

Notes

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.

References

  1. 1.
    Torrey EF, Zdanowicz M (2001) Outpatient commitment: what, why, and for whom. Psychiatr Serv 52:337–341PubMedCrossRefGoogle Scholar
  2. 2.
    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 10:245–274CrossRefGoogle Scholar
  3. 3.
    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):105–112PubMedCrossRefGoogle Scholar
  4. 4.
    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
  5. 5.
    Stein LI, Test MA (1980) Alternative to mental hospital treatment. I. Conceptual model, treatment program, and clinical evaluation. Arch Gen Psychiatry 37(4):392–397PubMedCrossRefGoogle Scholar
  6. 6.
    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):228–236PubMedCrossRefGoogle Scholar
  7. 7.
    McCabe R, Priebe S (2003) Are therapeutic relationships in psychiatry explained by patients’ symptoms? Factors influencing patient ratings. Eur Psychiatry 18(5):220–225PubMedCrossRefGoogle Scholar
  8. 8.
    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 PubMedCrossRefGoogle Scholar
  9. 9.
    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 PubMedCrossRefGoogle Scholar
  10. 10.
    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):1–46PubMedGoogle Scholar
  11. 11.
    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
  12. 12.
    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 191:543–547PubMedCrossRefGoogle Scholar
  13. 13.
    Kortrijk HE (2013) Use of routine outcome monitoring data for evaluating assertive community treatment. Erasmus University, RotterdamGoogle Scholar
  14. 14.
    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):390–395PubMedCrossRefGoogle Scholar
  15. 15.
    Corrigan PW, McCracken SG, Holmes EP (2001) Motivational interviews as goal assessment for persons with psychiatric disability. Community Ment Health J 37(2):113–122PubMedCrossRefGoogle Scholar
  16. 16.
    Orrell M, Hancock GA (2004) The Camberwell assessment of need for the elderly (CANE). Gaskell, LondonGoogle Scholar
  17. 17.
    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 176:444–452PubMedCrossRefGoogle Scholar
  18. 18.
    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 PubMedCrossRefGoogle Scholar
  19. 19.
    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 CrossRefGoogle Scholar
  20. 20.
    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):147–153PubMedCrossRefGoogle Scholar
  21. 21.
    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):651–656PubMedCentralPubMedCrossRefGoogle Scholar
  22. 22.
    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 PubMedCentralPubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Jolanda Stobbe
    • 1
    • 2
    Email author
  • André I. Wierdsma
    • 1
  • Rob M. Kok
    • 3
  • Hans Kroon
    • 4
  • Marja Depla
    • 5
  • Cornelis L. Mulder
    • 1
    • 2
  1. 1.Department of Psychiatry, Epidemiological and Social Psychiatric Research InstituteErasmus University Medical CenterRotterdamThe Netherlands
  2. 2.Department BavoEuropoort, Centre for Mental Health CareParnassia Psychiatric InstituteRotterdamThe Netherlands
  3. 3.Department Parnassia, Centre for Mental Health CareParnassia Psychiatric InstituteThe HagueThe Netherlands
  4. 4.Trimbos InstituteNetherlands Institute of Mental Health and AddictionUtrechtThe Netherlands
  5. 5.Department of General Practice and Elderly Care Medicine, EMGO Institute for Health and Care ResearchVU University Medical CenterAmsterdamThe Netherlands

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