Background: Few studies have considered the impact of demographic and clinical variables on help received respectively from services and relatives to satisfy needs of adults with severe mental disorders (SMD). Purposes: To identify major needs receiving help and, using the Andersen’s Behavioural Model of Health Service Use, to identify and compare predisposing, enabling and need factors associated with help given respectively by services and relatives. Me thods: 352 adults with SMD from Montreal (Ca nada) were interviewed using six standardized instruments. Clinical records were consulted. Multiple linear regression analyses were processed to measure level of help received from relatives and services. Results: Factors significantly associated with help from relatives were: higher number of perceived needs; fewer diag noses; better community functioning; being younger, and in a conjugal relationship; living autonomously; having social support and better quality of life; and, marginally, being an immigrant. Factors significantly associated with help from services were: higher number of perceived needs, better quality of life, supervised housing, adjustment disorder and schizophrenia. Con clusions: Help overall is insufficient to meet users’ needs. Services are more helpful than rela tives, in particular regarding health needs. Comparatively to help from services, help from relatives is associated with predisposing factors like age, marital status and nationality.
KeywordsHelp from RelativesHelp from ServicesNeeds AssessmentSevere Mental DisordersService Utilisation
Pitschel-Walz, G., Leutch, S., B?uml, J., Kissling, W. and Engel, R.R. (2001) The effect of family interventions on relapse and rehospitalization in schizophrenia—A meta analysis. Schizophrenia Bulletin, 27, 73-92. doi:10.1093/oxfordjournals.schbul.a006861
Anthony, W.A., Cohen, M. and Farkas, M. (1990) Psy chiatric rehabilitation. Boston University Centre for Psychiatric Rehabilitation, Boston.
Ward-Griffin, C., Scholfield, R., Vos, S. and Coatsworth Puspoky, R. (2005) Canadian families caring for members with mental illness: A vicious cycle. Journal of Family Nursing, 11, 140-161. doi:10.1177/1074840705275464
Ochoa, S., Haro, J.M., Autonell, J., Pendàs, A., Teba, F., Màrquez, M. and the NEDES Group (2003) Met and un met needs of schizophrenia patients in a Spanish sample. Schizophrenia Bulletin, 29, 201-210. doi:10.1093/oxfordjournals.schbul.a006998
Lam, J.A. and Rosenheck, R. (1999) Social support and service use among homeless persons with serious mental illness. International Journal of Social Psychiatry, 45, 13 28. doi:10.1177/002076409904500103
Snowden, L.R. (1998) Racial differences in informal help seeking for mental health problems. Journal of Community Psychology, 26, 429-438. doi:10.1002/(SICI)1520-6629(199809)26:5 3.0.CO;2-M
Horwitz, A.V. and Uttaro, T. (1998) Age and mental health services. Community Mental Health Journal, 34, 275-283. doi:10.1023/A:1018717808191
Pescosolido, B.A., Wright, E.R., Alegria, M. and Vera, M. (1998) Social networks and patterns of use among the poor with mental health problems in Puerto Rico. Medical Care, 36, 1057-1072. doi:10.1097/00005650-199807000-00012
Woodward, A.T., Taylor, R.J., Bullard, K.M., Neighbors, H.W., Chatters, L.M. and Jackson, J.S. (2008) Use of professional and informal support by African Americans and Caribbean blacks with mental disorders. Psychiatric Services, 59, 1292-1298. doi:10.1176/appi.ps.59.11.1292
Cedereke, M. and Ojehagen, A. (2007) Formal and informal help during the year after a suicide attempt: A one year follow-up. International Journal of Social Psychiatry, 53, 419-429. doi:10.1177/0020764007078345
Macpherson, R., Haynes, R., Summerfield, L., Foy, C. and Slade, M. (2003) From research to practice. A local mental health services needs assessment. Social Psychiatry and Psychiatric Epidemiology, 38, 276-281. doi:10.1007/s00127-003-0629-0
Simons, L. and Petch, A. (2002) Needs assessment and discharge: A Scottish perspective. Journal of Psychiatric and Mental Health Nursing, 9, 435-445. doi:10.1046/j.1365-2850.2002.00506.x
Sch?lzel-Dorenbos, C.J., Meeuwsen, E.J. and Olde-Rik kert, M.G. (2010) Integrating unmet needs into dementia health-related quality of life research and care: Introduc tion of the hierarchy model of needs in dementia. Aging & Mental Health, 14, 113-119. doi:10.1080/13607860903046495
Hansson, L., Bj?rkman, T. and Svensson, B. (1995) The assessment of needs in psychiatric patients. Interrater re liability of the Swedish version of the Camberwell assessment of needs instrument and results from a cross sectional study. Acta Psychiatrica Scandinavica, 92, 285 293. doi:10.1111/j.1600-0447.1995.tb09584.x
Bengtsson-Tops, A. and Hansson, L. (1999) Clinical and social needs of schizophrenic outpatients living in the community: The relationship between needs and subjective quality of life. Social Psychiatry and Psychiatric Epidemiology, 34, 513-518. doi:10.1007/s001270050169
Middleboe, T., Mackeprang, T., Hansson, L., Werdelin, G., Karlsson, H., Bjarnason, O., Bengtsson-Tops, A., Dybbro, J., Nilsson, L.L., Sandlund, M. and S?rgaard, K.W. (2001) The Nordic study on schizophrenic patients living in the community. Subjective needs and perceived help. European Psychiatry, 16, 207-214. doi:10.1016/S0924-9338(01)00566-1
Fleury, M.J., Grenier, G., Caron, J. and Lesage, A. (2008) Patient’s report of help provided by relatives and services to meet their needs. Community Mental Health Journal, 44, 271-281. doi:10.1007/s10597-008-9127-x
Cummings, S.M. and Kropf, N.P. (2009) Formal and in formal support for older adults with severe mental illness. Aging & Mental Health, 13, 619-627. doi:10.1080/13607860902774451
Kulhara, P., Avashthi, A., Grover, S., Sharan, P., Sharma, P., Malhotra, S. and Gill, S. (2010) Needs of Indian schizophrenia patients: An exploratory study from India. Social Psychiatry and Psychiatric Epidemiology, 45, 809 818. doi:10.1007/s00127-009-0126-1
Andersen, R.M. (1995) Revisiting the behavioral model and access to medical care: Does it matter? Journal of Health and Social Behavior, 36, 1-10. doi:10.2307/2137284
Phelan, M., Slade, M., Thornicroft, G., Dunn, G., Hollo way, F., Wykes, T., Strathdee, G., Loftus, L., McCrone, P. and Hayward, P. (1995) The Camberwell assessment of need: The validity and reliability of an instrument to assess the needs of people with severe mental illness. British Journal of Psychiatry, 167, 589-595. doi:10.1192/bjp.167.5.589
Corbière, M., Zaniboni, S., Lecomte, T., Bond, G.R., Gilles, P.Y., Lesage, A. and Goldner, E. (2011) Job acquisition for people with severe mental illness enrolled in supported employment programs: A theoretically grounded empirical study. Journal of Occupational Rehabilitation, 21, 342-354. doi:10.1007/s10926-011-9315-3
Schulze, B. and Angermeyer, M.C. (2003) Subjective experiences of stigma. A focus group study of schizo phrenic patients, their relatives and mental health professionals. Social Science & Medicine, 56, 299-312. doi:10.1016/S0277-9536(02)00028-X
Stuart, H. (2003) Stigma and the daily news: Evaluation of a newspaper intervention. Canadian Journal of Psychiatry, 48, 651-656.
Pruessner, M., Iyer, S.N., Faridi, K., Joober, R. and Malla, A.K. (2011) Stress and protective factors in individuals at ultra-high risk for psychosis, first episode psychosis and healthy controls. Schizophrenia Research, 129, 29-35. doi:10.1016/j.schres.2011.03.022
Piat, M., Sabetti, J. and Bloom, D. (2010) The transformation of mental health services to a recovery-oriented system of care: Canadian decision maker perspectives. International Journal of Social Psychiatry, 56, 168-177. doi:10.1177/0020764008100801
Accietto, C. (2003) La validation d'une version fran?aise du questionnaire A.U.D.I.T. Alcohol use identification test. Ph.D. Thesis, Geneva University, Geneva.
Carey, K.B., Carey, M.P. and Chandra, P.S. (2003) Psy chometric evaluation of the Alcohol Use Disorders Identi fication Test and Short Drug Abuse Screening Test with psychiatric patients in India. Journal of Clinical Psychia try, 64, 767-774. doi:10.4088/JCP.v64n0705
Caron, J. (1996) L’échelle de provisions sociales: Une va lidation québécoise. Santé mentale au Québec, 21, 158 180. doi:10.7202/032403ar
Caron, J., Mercier, C. and Tempier, R. (1997) Une validation québécoise du satisfaction with life Domains Scale. Santé mentale au Québec, 17, 195-218. doi:10.7202/032422ar
Hendryx, M.S., Dyck, D.G., McBride, D. and Whitbeck, J. (2001) A test of the reliability and validity of the Multnomah Community Ability Scale. Community Mental Health Journal, 37, 157-168. doi:10.1023/A:1002713816110
Fleury, M.J., Grenier, G., Bamvita, J.M. and Tremblay, J. (2013) Factors associated with needs of users with severe mental disorders. Psychiatric Quarterly.
Babor, T.F., Higgins-Biddle, J.C., Saunders, J.B. and Monteiro, M. (2001) Audit. The Alcohol Use Disorders Identification Test guidelines for use in primary care. 2nd Edition, Department of Mental Health and Substance Dependence, World Health Organization, Geneva.
Slade, M., Phelan, M. and Thornicroft, G. (1998) A comparison of needs assessed by staff and by an epidemi ologically representative sample of patients with psycho sis. Psychological Medicine, 28, 543-550. doi:10.1017/S0033291798006564
Slade, M., Leese, M., Cahill, S., Thornicroft, G. and Kuipers, E. (2005) Patient-rated mental health needs and quality of life improvement. British Journal of Psychiatry, 187, 256-261. doi:10.1192/bjp.187.3.256
Wennstr?m, E., S?rbom, D. and Wiesel, F.A. (2004) Factor structure in the Camberwell Assessment of Need. British Journal of Psychiatry, 185, 505-510. doi:10.1192/bjp.185.6.505
McCrone, P., Leese, M., Thornicroft, G., Schene, A., Knudsen, H.C., Vàzquez-Barquero, J.L., Tansella, M. and Becker, T. (2001) A comparison of needs of patients with schizophrenia in five European countries: The EPSILON study. Acta Psychiatrica Scandinavica, 103, 370-379. doi:10.1034/j.1600-0447.2001.00207.x
Wiersma, D., van den Brink, R., Wolters, K., McCabe ,R., Bullenkamp, J., Hansson, L., Lauber, C., Martinez-Leal, R., R?ssler, W., Salize, H., Bj?rkman, T., Torres-Gonzales, F., Wright, D.J. and Priebe, S. (2009) Individual unmet needs for care: Are they sensitive as outcome criterion for the effectiveness of mental health services interventions? Social Psychiatry and Psychiatric Epidemiology, 44, 317 324. doi:10.1007/s00127-008-0432-z
McCann, E. (2010) The sexual and relationship needs of people who experience psychosis: Quantitative findings of a UK study. Journal of Psychiatric and Mental Health Nursing, 17, 295-303. doi:10.1111/j.1365-2850.2009.01522.x
Slade, M. (1996) Assessing the needs of the severely mentally ill: Cultural and professional differences. Inter national Journal of Social Psychiatry, 42, 1-9. doi:10.1177/002076409604200101
Andrews, G., Issakidis, C. and Carter, G. (2001) Shortfall in mental health service utilisation. British Journal of Psychiatry, 179, 417-425. doi:10.1192/bjp.179.5.417
Tempier, R., Meadows, G.N., Vasiliadis, H.M., Mosier, K.E., Lesage, A., Stiller, A., Graham, A. and Lepnurm, M. (2009) Mental disorders and mental health care in Canada and Australia: Comparative epidemiological findings. Social Psychiatry and Psychiatric Epidemiology, 44, 63-72. doi:10.1007/s00127-008-0409-y
Leese, M., Johnson, S., Slade, M., Parkman, S., Kelly, F., Phelan, M. and Thornicroft, G. (1998) User perspective on needs and satisfaction with mental health services. PRiSM psychosis study. 8. British Journal of Psychiatry, 173, 409-415. doi:10.1192/bjp.173.5.409
Fleury, M.J., Piat, M., Grenier, G., Bamvita, J.M., Boyer, R., Lesage, A. and Tremblay, J. (2010) Components associated with adequacy of help for consumers with severe mental disorders. Administration and Policy in Mental Health and Mental Health Services Research, 37, 497 508. doi:10.1007/s10488-010-0292-1
Song, L. and Singer, M. (2001) The social functioning of persons with chronic mental illness: An empirical typology of consumers and correlates of social functioning. International Journal of Social Psychiatry, 47, 36-51. doi:10.1177/002070400104700104
Carta, M.G., Balestrieri, M., Murru, A. and Hardoy, M.C. (2009) Adjustment disorder: Epidemiology, diagnosis and treatment. Clinical Practice and Epidemiology in Mental Health, 5, 15. doi:10.1186/1745-0179-5-15
Jones, R., Yates, W.R., Williams, S., Zhou, M. and Hardman, L. (1999) Outcome for adjustment disorder with depressed mood: Comparison with other mood disorders. Journal of Affective Disorders, 55, 55-61. doi:10.1016/S0165-0327(98)00202-X
Casey, P. (2001) Adult adjustment disorder: A review of its current diagnostic status. Journal of Psychiatric Practice, 7, 32-40. doi:10.1097/00131746-200101000-00004
Nyer, M., Kascow, J., Fellows, I., Lawrence, E.C., Gol shan, S., Solorzano, E. and Zisook, S. (2010) The relationship of marital status and clinical characteristics in middle-aged and older patients with schizophrenia and depressive symptoms. Annals of Clinical Psychiatry, 22, 172-179.
Drake, R.E., Goldman, H.H., Leff, H.S., Lehman, F., Dixon, L., Mueser, K.T. and Torrey, W.C. (2001) Implementing evidence-based practices in routine mental health service settings. Psychiatric Services, 52, 903-910. doi:10.1176/appi.ps.52.2.179
Holmes, A.M. and Deb, P. (1998) Factors influencing in formal care-giving. Journal of Mental Health Policy and Economics, 1, 77-87. doi:10.1002/(SICI)1099-176X(199807)1:2 3.0.CO;2-5
Ruggeri, M., Dall’Agnola, C., Agostini, C. and Bisoffi, G. (1994) Acceptability, sensitivity and content validity of the VESC and VSSS in measuring expectations and satisfaction in psychiatric patient and their relatives. Social Psychiatry and Psychiatric Epidemiology, 29, 265-276. doi:10.1007/BF00802049
Doornbos, M.M. (2002) Family caregivers and the mental health care system: Reality and dreams. Archives of Psychatric Nursing, 16, 39-46. doi:10.1053/apnu.2002.30541
Perreault, M., Tardif, H., Provencher, H., Paquin, G., Des marais, J. and Pawliuk, N. (2005) The role of relatives in discharge planning from psychiatric hospitals: The perspective of patients and their relatives. Psychiatric Quarterly, 76, 297-315. doi:10.1007/s11126-005-4964-z
Jeon, Y.H., Brodaty, H. and Chesterson, J. (2005) Respite care for caregivers and people with severe mental illness: Literature review. Journal of Advanced Nursing, 49, 297 306. doi:10.1111/j.1365-2648.2004.03287.x