Abstract
Knowledge about the needs of psychiatric patients is essential for mental health care planning. However, research on met and unmet needs is still scarce, particularly in low- and middle-income countries. This study aimed to describe the patients' needs (met and unmet) at least four years after their first psychiatric hospitalization and to verify the role of demographic and clinical features as possible predictors of these needs. Patients who had their first psychiatric admission between January 1, 2006 and December 31, 2007 at an inpatient unit in the city of Ribeirão Preto, Brazil, were eligible to participate in the study. Patients were contacted and face-to-face interviews were conducted by psychologists using the Camberwell Assessment of Need. Data were analyzed using zero-inflated negative binomial regression model. Of 933 eligible patients, 333 were interviewed. The highest level of needs was related to welfare benefits (32.4%, unmet=25.5%), followed by household skills (30.3%, unmet=3.0%), psychotic symptoms (29.4%, unmet=9.0%), psychological distress (27.6%, unmet=8.4%), physical health (24.3%, unmet=5.4%), daytime activities (19.5%, unmet=16.5%), and money (16.8%, unmet=9.0%). Fewer years of schooling, living with relatives, and unemployment at the moment of the first admission were significantly associated with a higher number of both met and unmet needs in the follow-up. Unmet needs were also more often reported by patients living alone. In conclusion, socioeconomic indicators were the best predictors of needs. The unmet needs related to welfare benefits point to the need for specific social and health policies.
Highlights
In Brazil, the high prevalence of mental disorders [1,2,3] contrasts with the mental health expenditure, which is less than 1% of the national health budget [4], with the implementation of effective community-oriented mental health care still an ongoing process [5]
A comprehensive assessment of needs provides relevant information that allows to develop personalized care plans and evaluate the ability of health services in providing effective care [8,9,10], which are important for people with mental disorders, that frequently present non-psychiatric diseases and social barriers for adequate care [11,12]
Among people with mental disorders, higher rates of needs seem to be related to the male sex, unemployment, lower economic level [13,14], diagnosis of severe mental disorders [15,16], psychotic symptoms severity [17], and more frequent contact with community-based mental health services [18]
Summary
In Brazil, the high prevalence of mental disorders [1,2,3] contrasts with the mental health expenditure, which is less than 1% of the national health budget [4], with the implementation of effective community-oriented mental health care still an ongoing process [5]. A comprehensive assessment of needs provides relevant information that allows to develop personalized care plans and evaluate the ability of health services in providing effective care [8,9,10], which are important for people with mental disorders, that frequently present non-psychiatric diseases and social barriers for adequate care [11,12]. Among people with mental disorders, higher rates of needs seem to be related to the male sex, unemployment, lower economic level [13,14], diagnosis of severe mental disorders (affective disorders, schizophrenia, and substance abuse-related disorders) [15,16], psychotic symptoms severity [17], and more frequent contact with community-based mental health services [18]. There is an association between unmet needs and worse quality of life for these people [19], with the reduction of unmet needs predicting an improvement of the quality of life [18]
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Schedule a callMore From: Brazilian journal of medical and biological research = Revista brasileira de pesquisas medicas e biologicas
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