Indian Psychiatric Society multicentric study on assessment of health-care needs of patients with severe mental illnesses as perceived by their family caregivers and health-care providers

Abstract

Aim:To study the health-care needs of the patients with severe mental disorders as perceived by their family caregivers and the treating psychiatrists.Materials and Methods:Caregivers of patients with severe mental disorders and their treating psychiatrists were assessed using Camberwell Assessment of Need-Research Version (CAN-R) scale and indigenously designed Supplementary Assessment of Needs Scale (SNAS).Results:The study included 1494 patients recruited from 15 centers. The mean needs as per the CAN-R, perceived by the caregivers were 7.8 and treating psychiatrists were 8.1. About one-third of needs were unmet. On SNAS, both caregivers and treating psychiatrists reported a mean of 7.9 needs, of which more than half were unmet as per the caregivers. As per the treating psychiatrists, 45.5% of the needs as assessed on SNAS were unmet. There was a high level of correlation between needs perceived by the patients, caregivers and the treating psychiatrists. On CAN-R, main domains of needs as reported by the caregivers were those of money, relief of psychological distress, information about the illness and treatment, welfare benefits, transport, company and food. As per the treating psychiatrists, the most common total needs identified were those of relief of psychological distress, welfare benefits, information about the illness and treatment, money, transport, company self-care and physical health. The most common domains of needs as assessed on SNAS as per the caregivers were those of free treatment, medical reimbursement, psychoeducation, financial help, social support, insurance, more time from the clinicians and travel concession. The treating psychiatrists identified dealing with caregiver's stress as the most common need.Conclusions:According to the family caregivers and treating psychiatrists, about one-third of the needs of the patients as assessed using CAN-R and about half of the needs as assessed using SNAS are unmet.

Health-care needs of remitted patients with bipolar disorder: A comparison with schizophrenia

“…Though comparison with other studies was difficult because of differences in patient-samples, methodology and assessment instruments, the mean number of total needs among patients with BD of the present study was quite similar to previous reports of patients with either BD[23-25], or severe mental illnesses including BD[9,18,22,26-28]. Combining the findings of the CAN-R and the scale for additional evaluation of needs suggested that needs were most frequently expressed in three or four broad clusters.…”

“…The additional evaluation also confirmed that economic, welfare and information needs were the ones most likely to remain unmet. The proportion of met vs unmet needs and the types of unmet needs in this study were very similar to several Indian studies, which have assessed health-care needs among patients with severe mental illnesses including schizophrenia and BD[18,22,25,29-31]. The pattern of primacy of economic and welfare needs in Indian studies is also quite unlike the pattern of needs reported in Western studies, where a greater amount of help and benefits are usually received from health-care services; therefore, social needs are more often unmet than economic, welfare or treatment needs[7,24,32-35].…”

“…The average number of total needs reported by the patients themselves on the CAN-R was about six, which fell within the range of 4 to 10 needs reported by patients with severe mental illnesses on the CAN-R[18,20-22]. Though comparison with other studies was difficult because of differences in patient-samples, methodology and assessment instruments, the mean number of total needs among patients with BD of the present study was quite similar to previous reports of patients with either BD[23-25], or severe mental illnesses including BD[9,18,22,26-28].…”

“…The pattern of primacy of economic and welfare needs in Indian studies is also quite unlike the pattern of needs reported in Western studies, where a greater amount of help and benefits are usually received from health-care services; therefore, social needs are more often unmet than economic, welfare or treatment needs[7,24,32-35]. These differences clearly reflect the inadequate support that patients receive from formal health-care services in India, which forces them to turn to their family and friends to fulfil their needs[18,22,26]. They also emphasize the fact that socio-cultural factors such as the pre-eminence of the family in providing care, and the limited reach of the local health-care services probably have a greater bearing on the pattern of needs, particularly unmet ones, than other factors such as the type of psychiatric disorder[20,36,37].…”

Needs of Patients with Schizophrenia and Their Predictors

“…2001, Ochao ve ark. 2003, Rosales 1999, Hosakova ve Hosak 2015, Ganesh ve Gupta 2017, Grover ve ark. 2015.…”