Needs for care of residents with schizophrenia spectrum disorders and association with daily activities and mood monitored with experience sampling method: the DIAPASON study

Abstract

Aims Care needs represent an essential paradigm in planning residential facility (RF) interventions. However, possible disagreements between users and staff are critical issues in service delivery. The Experience Sampling Method (ESM) tracks experiences in the real world and real time. This study aimed to evaluate the care needs of patients with schizophrenia spectrum disorder (SSD) in RFs and its association with daily activities and mood monitored using the ESM. Methods As part of the DIAPASON project, 313 residents with SSD were recruited from 99 Italian RFs. Sociodemographic and clinical characteristics were recorded. Care needs, the severity of symptomatology and negative symptoms were assessed. Fifty-six residents were also assessed for 7 consecutive days using the mobile ESM. Descriptive, agreement, predictor and moderator analyses were conducted. Results The staff rated a higher number of total and met needs than service users (p < 0.001). Only a slight agreement between users and staff on unmet needs was found in self-care (k = 0.106) and information (k = 0.100) needs, while a moderate agreement was found in accommodation (k = 0.484), food (k = 0.406), childcare (k = 0.530), physical health (k = 0.470), telephone (k = 0.458) and transport (k = 0.425) needs. Older age (−0.15; p < 0.01), longer SSD diagnosis (−0.16; p < 0.01), higher collaboration (−0.16; p < 0.01) and lower symptomatology (−0.16; p < 0.01) decreased the number of unmet needs, while being a female (0.27; p < 0.05) and a shorter length of stay in an RF (0.54; p < 0.001) increased the number of unmet needs. A higher number of unmet needs was associated with a lower amount of time spent in leisure activities or reporting a positive mood: on the contrary, more unmet needs were associated with a greater amount of time spent in religious or non-productive activities. The associations between unmet needs rated by staff and users and momentary mood as assessed using the ESM were not moderated by the severity of symptomatology. Conclusions Although care needs are fundamental in planning residential activities aimed at recovery-oriented rehabilitation, RF interventions did not fully meet users' needs, and some disagreements on unmet needs between users and staff were reported. Further efforts are necessary to overcome Italian RF limits in delivering rehabilitative interventions defined by real users' needs to facilitate users' productivity and progress towards personal recovery.

Addressing Challenges in Residential Facilities: Promoting Human Rights and Recovery While Pursuing Functional Autonomy

“…This is particularly noteworthy as patients demonstrated lower functional autonomy in these specific areas. This finding is consistent with previous research ( 28 , 34 ), as interventions targeting basic autonomy skills are comparatively easier to implement, as they typically involve practical and tangible tasks, and are often prioritized due to the challenges associated with motivating individuals with SMD to engage in self‐care practices ( 28 , 35 ).…”

“…Only a few studies explored whether RFs embrace the personal recovery approach and promote human rights ( 27 , 28 , 29 ). The objective of this study was to evaluate the effectiveness of Italian RFs in fostering human rights and user recovery while actively pursuing functional autonomy.…”

Positivity, daily time use, mood, and functioning in patients with schizophrenia spectrum disorders: Results from the diapason multicentric study

“…Interestingly, POS levels were associated with having a stronger support network, but they were not associated with other sociodemographic variables such as marital status, employment status, and living situation. These variables are typically recognized as important features of adulthood that relate to the roles individuals with psychosocial disabilities need to fulfill in order to achieve independence ( Goldstone, 2020 ; Martinelli et al, 2023 ). This observation suggests the importance of understanding the real needs of patients ( Rose & Glass, 2008 ) and evaluating whether patients develop a dependency on support networks provided by mental health services ( World Health Organization, 2010 ) and/or other caregivers ( Bonavigo et al, 2016 ; Martinelli et al, 2022 ).…”

Ecological monitoring of emotional intensity, variability, and instability in individuals with schizophrenia spectrum disorders: Results of a multicentre study

“…This multisite project (DiAPAson project ‐ Daily Activities, Physical Activities and Interpersonal relationships) (de Girolamo et al, 2020 ; Martinelli et al, 2022 ; Martinelli et al, 2023 ; Mayeli et al, 2023 ; Oliva et al, 2022 ; Zarbo et al, 2022 ; Zarbo, Rota, et al, 2023 ; Zarbo, Zamparini, Killaspy, et al, 2023 ; Zarbo, Zamparini, Nielssen, et al, 2023 ; Zarbo, Stolarski, et al, 2023 ) included 20 Departments of Mental Health (DMHs) and 98 Residential Facilities (RF) located in different Italian regions. Departments of Mental Health recruited both outpatient and residential patients, and RFs only residential patients.…”