Abstract
The current study tested the Integral Model of treatment motivation (IM) in a sample of 294 outpatients with severe mental illness, using structural equation modelling. The obtained structural model was not consistent with original theory, nor was the model invariant across time and patient groups (psychotic disorders and personality disorders). The patient’s perceived suitability of treatment, perceived costs of treatment and outcome expectancy were most strongly associated with motivation and treatment engagement. The model explained between 22 and 86% of variance in clinical outcomes, depending on the timing of the assessment. Currently, the IM does not constitute a robust framework for patterns through which patients become motivated to engage in treatment, but does explain substantial amounts of variance in clinical outcomes. The future potential of IM as a basis for interventions in the mental health care is discussed, including suggestions for subsequent research and potential alterations of the IM to improve its utility for application in clinical practice.
Highlights
Background and rationaleThe Integral Model of treatment motivation (IM) is a health behavior theory that was developed for application in mental health treatment to understand patients’ motivation for engaging in treatment (Drieschner et al 2004)
No education/elementary Secondary school Upper high school and over Comorbid substance use problemsb, n (% yes) Legal mandate, n (% yes) One or more previous admissions, n, (% yes) Problem recognition Mean (SD) Min to max Distress Mean (SD) Min to max External pressure Mean (SD) Min to max Perceived costs of treatment Mean (SD) Min to max Suitability of treatment Mean (SD) Min to max Outcome expectancy Mean (SD) Min to max Motivation to engage in treatment Mean (SD) Min to max Treatment engagement Median (IQR) Psychosocial functioning Median (IQR) Quality of life Median (IQR)
The final structural model was neither in line with original hypothesized theory as shown in Fig. 1 nor was it similar to the obtained empirical model which was previously found by Drieschner and Boomsma in a forensic psychiatric research population (2008b), in which the patient’s motivation for engaging in treatment mediated the relation between problem recognition and treatment engagement and which showed that suitability of treatment was directly related to treatment engagement and showed no effect of perceived costs of treatment
Summary
Background and rationaleThe Integral Model of treatment motivation (IM) is a health behavior theory that was developed for application in mental health treatment to understand patients’ motivation for engaging in treatment (Drieschner et al 2004). The Treatment Motivation Scales for forensic outpatient treatment (TMS-f) was developed by the founders of IM to assess the constructs in the theory (Drieschner and Boomsma 2008a). A series of studies using the TMS-f in a forensic psychiatric setting showed support for its hypothesized factorial structure and showed adequate reliability and validity(Drieschner and Boomsma 2008a, b). The studies found support for the general tenets of the IM, such that three out of six internal determinants were statistically significantly related to the patient’s motivation for engaging in treatment, which in turn was predictive of treatment engagement (Drieschner and Boomsma 2008a, b; Motivation and Emotion (2018) 42:816–830
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