Patients' satisfaction with hospital health care: Identifying indicators for people with severe mental disorder.

BACKGROUND: Patients' perception of psychiatric healthcare is a critical indicator in measuring service quality. The aim of the study was to determine patient's level of satisfaction with the quality of health care delivered at the inpatient departments, and to identify the service quality factors that were important to patients. METHOD: The Satisfaction with Psychiatry Care Questionnaire-22 was administered to 125 consecutive inpatients with schizophrenia or schizoaffective disorder in a stable condition. Sociodemographic and background variables, illness and symptom severity, insight, social anhedonia, self-esteem, perceived social support, and satisfaction with quality of life were collected. RESULTS: Although the participants generally expressed satisfaction with the inpatient services, they indicated that the weakest aspects of the service were in the domains of 'personal experience', 'information' and 'activity'. Women were significantly more dissatisfied than men with 'staff', 'care', and by general satisfaction. Multiple regression analysis revealed that satisfaction with hospital health care was associated with five indicators: insight, satisfaction with physical health, self-efficacy, family support, and social anhedonia. CONCLUSION: Personality related factors rather than psychopathological symptoms were associated with a satisfaction with care of admitted patients with severe mental illness. These factors could be targets for interventions aimed to improve treatment and hospital services.

Assessment of health needs, satisfaction with care, and quality of life in compulsorily admitted patients with severe mental disorders.

This cross-sectional study compared the levels of needs, care satisfaction, quality of life, and social support of compulsory admitted patients with severe mental disorders to a comparable group of voluntary admitted patients. One hundred and twenty-five patients with schizophrenia and schizoaffective disorder were admitted to a hospital by district psychiatrist order (DPO), court observation order (COO), or voluntary (VA). Participants were assessed before discharge using questionnaires, and psychiatric rating scales. A linear discriminant analysis revealed eight variables that best differentiated the three groups. COO patients were significantly discriminated from the two other groups (DPO and VA) by severe negative symptoms, better satisfaction with both nursing staff and family support. COO subjects had more non-illness unmet needs, while reported better hedonic capacity for social and interpersonal pleasure - compared to VA patients. DPO patients were significantly indicated by poorer awareness to illness, but better satisfaction with subjective feelings. VA subjects were significantly discriminated from compulsory admitted patients by higher illness severity scores. Assessment of unmet needs, satisfaction with care, quality of life, hedonic capacity, and social support constitute the factors that differentiate compulsory admitted patients and could be targets for interventions aimed to reduce the negative effects of compulsory admissions.

Impaired cortico-limbic functional connectivity in schizophrenia patients during emotion processing.

Functional dysconnection is increasingly recognized as a core pathological feature in schizophrenia. Aberrant interactions between regions of the cortico-limbic circuit may underpin the abnormal emotional processing associated with this illness. We used a functional magnetic resonance imaging (fMRI) paradigm designed to dissociate the various components of the cortico-limbic circuit (i.e. a ventral automatic circuit that is intertwined with a dorsal cognitive circuit), in order to explore bottom-up appraisal as well as top-down control during emotion processing. In schizophrenia patients compared to healthy controls, bottom-up processes were associated with reduced interaction between the amygdala and both the anterior cingulate cortex (ACC) and the dorsolateral prefrontal cortex (DLPFC). Contrariwise, top-down control processes led to stronger connectivity between the ventral affective and the dorsal cognitive circuits, i.e. heightened interactions between the ventral ACC and the DLPFC as well as between dorsal and ventral ACC. These findings offer a comprehensive view of the cortico-limbic dysfunction in schizophrenia. They confirm previous results of impaired propagation of information between the amygdala and the prefrontal cortex and suggest a defective functional segregation in the dorsal cognitive part of the cortico-limbic circuit.

Childhood trauma and emotional processing circuits in schizophrenia: A functional connectivity study.

Childhood trauma strongly impacts emotional responses in schizophrenia. We have explored an association between early trauma and the amygdala functional connectivity using generalized psychophysiological interaction during an emotional task. Twenty-one schizophrenia patients and twenty-five controls were included. In schizophrenia patients, higher levels of sexual abuse and physical neglect during childhood were associated with decreased connectivity between the amygdala and the posterior cingulate/precuneus region. Additionally, patients showed decreased coupling between the amygdala and the posterior cingulate/precuneus region compared to controls. These findings suggest that early trauma could impact later connectivity in specific stress-related circuits affecting self-consciousness and social cognition in schizophrenia.

Determinants of patient satisfaction with hospital health care in psychiatry: results based on the SATISPSY-22 questionnaire.

BACKGROUND: The aim of our study was to identify patient- and care-related factors that are associated with patients' satisfaction with psychiatric hospital care, using a specific, self-administered questionnaire based exclusively on the patient's point of view: the Satisfaction with Psychiatry Care Questionnaire-22 (SATISPSY-22). METHODS: This cross-sectional study was conducted in the psychiatric departments of two French public university teaching hospitals. The data collected included sociodemographic information, clinical characteristics, care characteristics, and the SATISPSY-22. A multivariate analysis using multiple linear regressions was performed to determine the variables potentially associated with satisfaction levels. RESULTS: Two hundred seventy patients were enrolled in our study. Only one moderate association was found between satisfaction and sociodemographic characteristics: the personal experience dimension with age (ß=0.15). Clinical improvement was moderately associated with higher global satisfaction (ß=-0.15), higher satisfaction with quality of care (ß=-0.19), and higher satisfaction with food (ß=-0.18). Stronger associations with satisfaction were found for care characteristics, particularly the therapeutic alliance with all of the satisfaction dimensions (ß, 0.20-0.43) except food, and for seclusion with global satisfaction (ß=-0.33) and personal experience (ß=-0.32). Patients with previous hospitalization also had a higher level of satisfaction with quality of care compared with patients who were admitted for the first time (ß=-0.15). CONCLUSION: This study has identified a number of potential determinants of satisfaction. The therapeutic relationship and seclusion were the most important features associated with a patient's satisfaction. These factors might be amenable through intervention, which, in turn, might be expected to improve satisfaction, patients' management, and health outcomes in psychiatric hospitals.

Challenges in measuring outcomes for caregivers of people with mental health problems.

Patient-reported outcomes (PROs) are increasingly important in health care and mental health research. Furthermore, caregivers become partners in care for patients with mental disorders, and health workers are more attentive to the expectations and needs of caregivers. A number of outcomes for caregivers are measured and used in daily practice in order to promote actions to improve health care systems and progress in research on the impact of mental disorders on their caregivers. This paper proposes an inventory of the different outcomes and different measurement tools used to assess the impact of disorders, raising a number of methodological and conceptual issues that limit the relevance of measurement tools and complicate their use. Finally, we propose some recommendations promoting the development of relevant outcome measures for caregivers and their integration into current systems of care.

Los resultados percíbidos por el paciente (PROs) son cada vez más importantes tanto en clínica como en investigación en salud mental. Además, los cuidadores se convierten en socios de los pacientes con trastornos mentales que atienden, y los trabajadores de la salud están más atentos a las expectativas y necesidades de los cuidadores. En la práctica díaria se mide y utiliza una serie de resultados para los cuidadores con el fin de promover accíones que mejoren los sistemas de atención de salud y los progresos en la investigación acerca del impacto de los trastornos mentales en los cuidadores. Este artículo propone un listado de los diferentes resultados y las diversas herramientas de medición utilizadas para evaluar el impacto de los trastornos, planteando una serie de temas metodológicos y conceptuales que limitan la ímportancia de las herramientas de medición ycomplican su empleo. Finalmente se proponen algunas recomendaciones que promueven el desarrollo de medicíones pertinentes de resultados para los cuidadores y su integración en los sistemas actuates de atencíón.

Les résultats rapportés par les patients (Patient Reported Outcomes, PROs) prennent une place grandissante en matière de soins et de recherche en santé mentale. Parallèlement les soignants se montrent plus attentifs aux attentes et besoins des aidants devenus partenaires des soins aux patients souffrant de troubles mentaux. Un certains nombre de résultats pour les aidants sont utilisés et mesurés en pratique quotidienne dans le but de promouvoir des actions d'amélioration des systèmes de soins et de progresser dans les recherches sur les répercussions des troubles mentaux sur leurs aidants. Ce travail propose un inventaire des différents résultats et des différents outils de mesure utilisés pour l'évaluation de l'impact des troubles, en relevant un certain nombre de difficultés méthodologiques et conceptuelles qui limitent la pertinence des outils de mesure et compliquent leur usage. Enfin sont proposées quelques recommandations favorisant le développement de mesures de résultats pertinentes pour les populations aidantes et leur intégration courante dans les systèmes de soins.