Observational Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Psychiatr. Dec 22, 2016; 6(4): 431-441
Published online Dec 22, 2016. doi: 10.5498/wjp.v6.i4.431
Health-care needs of remitted patients with bipolar disorder: A comparison with schizophrenia
Rajarshi Neogi, Subho Chakrabarti, Sandeep Grover
Rajarshi Neogi, Subho Chakrabarti, Sandeep Grover, Department of Psychiatry, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India
Author contributions: All authors contributed equally to this work; Neogi R was involved in the planning of the study, carrying out the assessments, data analysis and writing the initial draft; Chakrabarti S and Grover S were involved in planning the study, supervision of assessments, data analysis and preparing the final draft of the paper; all authors have approved the final version of the submission.
Institutional review board statement: The study was reviewed and approved by Postgraduate Institute of Medical Education and Research Institutional Review Board.
Informed consent statement: All involved persons (patients and their relatives) gave their written informed consent prior to study inclusion. Anonymity of study-participants has been maintained.
Conflict-of-interest statement: Conflict of interest statement in proper format has been submitted.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at subhochd@yahoo.com. Participants gave informed consent for data sharing. Supplementary data is available from the corresponding author.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Subho Chakrabarti, Professor, Department of Psychiatry, Postgraduate Institute of Medical Education and Research (PGIMER), Sector 12, Chandigarh 160012, India.subhochd@yahoo.com
Telephone: +91-172-2756808 Fax: +91-172-2744401
Received: August 17, 2016
Peer-review started: August 19, 2016
First decision: September 6, 2016
Revised: September 18, 2016
Accepted: October 17, 2016
Article in press: October 18, 2016
Published online: December 22, 2016
Processing time: 124 Days and 20.5 Hours
Abstract
AIM

To investigate health-care needs and their correlates among patients with remitted bipolar disorder (BD) compared to patients with remitted schizophrenia.

METHODS

Outpatients with BD (n = 150) and schizophrenia (n = 75) meeting clearly defined remission criteria were included in the study along with their relatives. Diagnostic ascertainment was carried out using the Mini International Neuropsychiatric Interview. Demographic and clinical details were recorded using structured formats. Residual symptoms were assessed using standardized scales. Health-care needs were assessed on two separate scales. The principal instrument employed to assess health-care needs was the Camberwell Assessment of Need-Research version (CAN-R). To further evaluate health-care needs we felt that an additional instrument, which was more relevant for Indian patients and treatment-settings and designed to cover those areas of needs not specifically covered by the CAN-R was required. This instrument with a structure and scoring pattern similar to the CAN-R was used for additional evaluation of needs. Patients’ level of functioning was assessed using the Global Assessment of Functioning Scale and their quality of life (QOL) using the World Health Organization Quality Of Life-BREF version in Hindi.

RESULTS

An average of 6-7 needs was reported by patients with BD as well as their relatives. Commonly reported needs were in the areas of economic and welfare needs, informational needs, social needs and the need for treatment. According to the CAN-R, both patients and relatives reported that more than 60% of the total needs were being met. However, over 90% of the needs covered by the additional evaluation were unmet according to patients and relatives. Needs in the areas of economic and welfare-benefits, information, company, daytime activities and physical health-care were largely unmet according to patients and relatives. Total, met and unmet needs were significantly higher for schizophrenia, but the most common types of needs were quite similar to BD. Relatives reported more needs than patients with certain differences in the types of needs reported. Level of patients’ functioning was the principal correlate of greater total and unmet needs in both groups. Significant associations were also obtained with residual symptoms and QOL.

CONCLUSION

The presence of unmet needs in remitted patients with BD was an additional marker of the enduring psychosocial impairment characteristic of the remitted phase of BD.

Keywords: Health-care needs; Bipolar disorder; Schizophrenia; Remission; Patients; Relatives

Core tip: Health-care needs, functioning and quality of life (QOL) were assessed in 150 outpatients with remitted bipolar disorder (BD) and 75 with remitted schizophrenia. A high number of needs were found in BD; economic, welfare and information needs were mostly unmet. Total, met and unmet needs were significantly higher for schizophrenia, but the pattern of needs was similar to BD. Relatives reported more needs than patients with differences in the types of needs. Patient-functioning, residual symptoms and QOL were associated with higher needs. Unmet needs in remitted patients with BD were indicative of the enduring psychosocial impairment during remission.