Research

Needs for care among patients with schizophrenia in six European countries: a one-year follow-up study

Viviane Kovess-Masféty¹, Durk Wiersma², Miguel Xavier³, José Miguel Caldas de Almeida³, Mauro G Carta⁴, Jacques Dubuis⁵, Elisabeth Lacalmontie⁶, Jacques Pellet⁷, Jean-Luc Roelandt⁸, Francisco Torres-Gonzalez⁹, Berta Moreno Kustner⁹ and Dermot Walsh¹⁰

¹  MGEN Foundation for Public Health, EA 4069 University of Paris 5, 3 square Max Hymans, 75748 Paris Cedex 15, France

²  The Department of Social Psychiatry; University Hospital Groningen, building 32, K5.21, PO Box 30001, 9700 Groningen, The Netherlands

³  Clinica Universitaria de Psiquiatria e Saude Mental, Faculdade de Ciências Medicas, calçada da Tapada, 155, 1300 Lisboa, Portugal

⁴  Istituto di Clinica Psichiatrica, Università degli Studi di Cagliari, viale Merello 22, 09123 Cagliari, Italy

⁵  CHS Le Vinatier, 95, boulevard Pinel, 69677 Bron Cedex, France

⁶  CHS La Verrière, 78321 Le Mesnil St Denis, France

⁷  Service Universitaire de Psychiatrie Adultes, CHU St Etienne, 42055 Saint Etienne Cedex 02, France

⁸  Clinique Jérôme Bosch, 104, rue du Général Leclerc, BP 10, 59487 Armentières Cedex, France

⁹  Departamento de Psiquiatria, Facultad de Medicina, avenida de Madrid, s/n, 18071 Granada, Spain

¹⁰  Health Research Board, Holbrook House, Holles Street, Dublin 2, Ireland

Clinical Practice and Epidemiology in Mental Health 2006, 2:22doi:10.1186/1745-0179-2-22

Published:	11 September 2006

Abstract

Background

This article compares needs for care among patients with schizophrenia across six European countries and examines how this relates to the diversity of psychiatric systems in Europe.

Methods

A one-year prospective cohort study was set up. Inclusion criteria for patients were: a clinical lifetime diagnosis of schizophrenia according to ICD-10 (F20) diagnostic criteria for research, age between 18 and 65 years and at least one contact with mental health services in 1993. The patients were assessed for their clinical diagnosis and symptoms using the SCAN interview (Schedules for Clinical Assessment in Neuropsychiatry) and the interventions proposed to them were recorded through the systematic use of the NFCAS (Needs For Care Assessment Schedule).

Results

438 patients were included and 391 were followed up. The mean age was 38 years, the mean age at onset was 22 years, and 59% were out-patients, 24% in day care and 15% hospitalized. The populations in the different centres were significantly different for almost all the variables: sociodemographic, clinical and social, and the problems identified remained relatively stable over the year. Comparisons highlighted cultural differences concerning the interventions that were proposed. Centres in Italy, Spain and Portugal proposed many interventions even though they were relatively deprived in terms of resources, and the tendency seems to be the reverse for the Northern European countries. On average, one in four patients suffered from needs that were not adequately met by the mental health service in their region. These needs (on average 6 per patient) varied from psychotic symptoms to managing their own affairs. The number of interventions was not correlated to the need status. The availability of community-based treatment, rehabilitation and residential care seems to predict smaller proportions of patients with unmet needs.

Conclusion

There appeared to be a systematic relationship between the availability of community-based mental health care and the need status of schizophrenic patients: the fewer out-patient and rehabilitation services available, the more unmet needs there were.