Satisfaction with mental health services in a Latin American community of carers of patients with schizophrenia

Evidence for an Interaction Between NEDD4 and Childhood Trauma on Clinical Characters of Schizophrenia With Family History of Psychosis

Background: Neural precursor cell-expressed developmentally downregulated 4 (NEDD4) polymorphisms and childhood trauma (CT) are associated with schizophrenia. However, whether NEDD4 interacts with CT on symptoms of schizophrenia remains unknown. This study aimed to investigate the gene-environment interaction effect. Methods: We recruited 289 schizophrenia patients and 487 controls and genotyped rs2303579, rs3088077, rs7162435, rs11550869, and rs62043855 in their NEDD4 gene. Results: We found significant differences in the rs2303579 and rs3088077 between the two groups. Patients with the rs2303579 CC genotype had higher scores compared with other genotype (P = 0.026) in the test of positive schizophrenia syndrome scores, whereas patients with the rs3088077 TT (P = 0.037) and rs7162435 CC genotypes (P = 0.009) had higher scores compared with the other genotypes in the test of excitement factor. Patients with a family history of psychosis (FH+) reported higher negative scores (P = 0.012) than those without. Patients exposed to physical abuse (PA) reported a lower language learning and memory score (P = 0.017) and working memory score (P = 0.047) than those not. Patients exposed to sexual abuse (SA) reported a lower reasoning and problem-solving skills score (P = 0.025); those exposed to emotional neglect (EN) reported a lower social cognition score (P = 0.044); and those exposed to physical neglect reported a lower social cognition score (P = 0.036) but higher visual learning and memory score (P = 0.032). Rs3088077 could interact with EN to increase risk for schizophrenia. Optimal model rs62043855 × EA, rs3088077 × rs7162435 × rs11550869 × SA × EN and rs2303579 × rs7162435 × rs11550869 × rs62043855 × EA × PA could explain positive symptom, excitement symptom and working memory, respectively, in FH+ group. Conclusion: The study highlighted that the combined interaction of NEDD4 and CT may be associated with symptoms of schizophrenia especially for those with FH+.

Evaluation of family caregiver satisfaction with a mental health inpatient service

OBJECTIVE

To evaluate the satisfaction of family caregivers with a mental health inpatient service in Brazil.

METHODS

This was a cross-sectional study with a quantitative approach. A sample of 80 caretaking family members answered the abbreviated version of the Brazilian Mental Health Services' Family Satisfaction scale (SATIS-BR) and a sociodemographic questionnaire. Categorical variables were expressed as frequencies and percentages and quantitative variables as means and standard deviations. Interactions among variables and indexes of the scale were analyzed using the Student's t test, Pearson correlation coefficient and analysis of variance.

RESULTS

The results showed a high mean overall satisfaction score when considering the categorization of the items of the scale, with higher satisfaction indexes in the 'Treatment results' subscale and lower ones in the 'Reception and competence of staff' and 'Privacy and confidentiality' subscales. In the comparison of the samples studied, greater scores were observed in general satisfaction and in factors in the medical residency care model than in the attending psychiatrist model. There were no significant differences in terms of family member satisfaction in relation to sociodemographic variables.

CONCLUSION

Family member satisfaction was high. The need for improvement in aspects related to the infrastructure of services was evident. This paper underlines the importance of continuous and regular evaluations of the services provided, focusing on the satisfaction of users and family members in order to better understand the factors that contribute towards the quality of care provided.

Patient satisfaction with mental health services based on Andersen's Behavioral Model

OBJECTIVE

The purpose of this article was to assess the satisfaction of adult patients who received mental health services (MHS) in healthcare networks staffed by multidisciplinary professionals and offering a range of MHS, and to identify variables associated with patient satisfaction.

METHODS

This cross-sectional study included 325 patients with mental disorders (MDs) among 4 Quebec health service networks. Data were collected using 9 standardized instruments and participant medical records. A 3-factor conceptual framework (predisposing, enabling, and needs-related factors) based on Andersen's Behavioral Model was used, integrating sociodemographic, clinical, needs-related, service utilization, social support, and quality-of-life (QOL) variables. An adjusted multiple linear regression model was performed.

RESULTS

The global mean score for patient satisfaction was 4.11 (minimum: 2.0; maximum: 5.0). Among the enabling factors, continuity of care, having a case manager, and help received from services were positively associated with patient satisfaction, whereas being hospitalized was negatively associated. Among the needs-related factors, the number of needs was negatively associated with satisfaction.

CONCLUSIONS

Findings demonstrated higher levels of satisfaction among patients who received good continuity of care and well-managed, frequent services in relation to their needs. Dissatisfaction was higher for patients with serious unmet needs or those hospitalized, which underlines the importance of taking these particular variables into account in the interest of improving MHS delivery and patient recovery.

Systematic review of feasibility and acceptability of psychosocial interventions for schizophrenia in low and middle income countries

BACKGROUND

In low and middle income countries there is evidence to suggest effectiveness of community-based psychosocial interventions for schizophrenia. Many psychosocial interventions have however been conceptualized in high income countries and assessing their feasibility and acceptability in low and middle income countries is pertinent and the objective of this review.

METHODS

Six databases were searched using search terms (i) "Schizophrenia"; (ii) "Low and middle income or developing countries" and (iii) "Psychosocial interventions". Abstracts identified were extracted to an EndNote Database. Two authors independently reviewed abstracts according to defined inclusion and exclusion criteria. Full papers were accessed of studies meeting these criteria, or for which more information was needed to include or exclude them. Data were extracted from included studies using a predesigned data extraction form. Qualitative synthesis of qualitative and quantitative data was conducted.

RESULTS

14 037 abstracts were identified through searches. 196 full articles were reviewed with 17 articles meeting the inclusion criteria. Little data emerged on feasibility. Barriers to feasibility were noted including low education levels of participants, unavailability of caregivers, and logistical issues such as difficulty in follow up of participants. Evidence of acceptability was noted in high participation rates and levels of satisfaction with interventions.

CONCLUSIONS

While there is preliminary evidence to suggest acceptability of community-based psychosocial interventions for schizophrenia in low and middle income countries, evidence for overall feasibility is currently lacking. Well-designed intervention studies incorporating specific measures of acceptability and feasibility are needed.

Avaliação da satisfação dos pacientes e familiares em um serviço de saúde mental na cidade de Rio Branco, Acre

Objetivo Avaliar a satisfação dos pacientes e familiares atendidos em um serviço ambulatorial de saúde mental da cidade de Rio Branco, Acre. Métodos Foi realizado um estudo transversal com uma amostra de 160 pacientes e 160 familiares. Para coleta de dados, foram utilizadas as versões abreviadas das Escalas de Satisfação com os Serviços de Saúde Mental – SATIS-BR para pacientes e familiares, e um questionário sociodemográfico e clínico. Foram feitos análises estatísticas descritivas, cálculos das médias e desvios-padrão dos escores de satisfação global e das subescalas, e análises bivariadas utilizando o programa SPSS, versão 17. Resultados Os resultados da média de satisfação global dos pacientes e familiares revelaram que eles estão satisfeitos com o serviço de saúde mental. As subescalas dos pacientes: competência e compreensão da equipe e acolhida da equipe e ajuda recebida foram elevadas. No entanto, a subescala condições físicas e conforto do serviço apresentou uma menor média de satisfação. Também apresentaram um elevado nível de satisfação as subescalas para os familiares: resultados do tratamento, acolhida e competência da equipe e privacidade e confidencialidade. Foi identificado que pacientes mais velhos e que não tinham tido crises estavam mais satisfeitos. Assim como os familiares mais jovens também tinham maior nível de satisfação. Conclusão Os resultados apontam para necessidades de melhorias nos aspectos relacionados a infraestrutura, conforto e aparência dos serviços, bem como a criação de estratégias que favoreçam maior participação do familiar no tratamento do paciente.

Quality of life among caregivers of patients with schizophrenia: a cross-cultural comparison of Chilean and French families

BACKGROUND

To our knowledge, no study has examined quality of life (QoL) among caregivers of individuals with schizophrenia between a developing and a developed country. The aim of this study was to assess QoL of the caregivers of individuals with schizophrenia in two countries characterized by different social, economic and cultural conditions, namely Chile and France.

METHODS

Data were collected from public mental health outpatient services in Arica (Chile), and in Marseille (France). QoL was measured with the short-form health survey scale - 36 items (SF36). QoL of 41 Chilean caregivers was firstly compared with 245 French caregivers. Univariate and multivariate analyses using linear regression were then performed to determine variables potentially related to QoL scores.

RESULTS

The caregivers were primarily mothers in the two groups, but Chilean caregivers were younger, and lived more frequently with the individual with schizophrenia than French caregivers. The SF36 scores were globally low in the two groups, especially on the mental QoL scores. Chilean caregivers reported lower physical SF36 scores than French caregivers. In the multivariate analysis, being mother and Chilean caregivers were the most regular features associating to a lower QoL.

CONCLUSION

Despite differences between Chile and France, especially in terms of quality and quantity of mental health services and economic supports, caregivers' QoL levels remain particularly low for both countries. Future support programmes should address the specific needs of caregivers.

Attitudes and burden in relatives of patients with schizophrenia in a middle income country

Background

Most studies of family attitudes and burden have been conducted in developed countries. Thus it is important to test the generalizability of this research in other contexts where social conditions and extended family involvement may be different. The aim of this study was to assess the relationship between the attitudes of caregivers and the burden they experience in such a context, namely Arica, a town located in the northernmost region of Chile, close to the border with Peru and Bolivia.

Methods

We assessed attitudes towards schizophrenia (including affective, cognitive and behavioural components) and burden (including subjective distress, rejection and competence) in 41 main caregivers of patients with schizophrenia, all of whom were users of Public Mental Health Services in Arica.

Results

Attitude measures differed significantly according to socio-demographic variables, with parents (mainly mothers) exhibiting a more negative attitude towards the environment than the rest of the family (t = 4.04; p = 0.000).This was also the case for caregivers with a low educational level (t = 3.27; p < 0.003), for the oldest caregivers (r = 0.546; p = 0.000) and for those who had spent more time with the patient (r = 0.377; p = 0.015). Although attitudes had significant association with burden, their explanatory power was modest (R² = .104, F = 4,55; p = .039).

Conclusions

Similar to finding developed countries, the current study revealed a positive and significant relationship between the attitudes of caregivers and their burden. These findings emphasize the need to support the families of patients with schizophrenia in this social context.