Physical and psychosocial needs of psychiatric patients undergoing discharge : a mixed methods study

Abstract

 Adequate understanding of the experiences and needs of psychiatric inpatients during discharge planning is important for the development of a person-centered mental health service. However, there has been limited research focusing on patients’ physical and psychosocial needs. A qualitative study was conducted followed by a quantitative study. The qualitative study explored the physical and psychosocial needs and experiences of psychiatric patients before hospital discharge. Individual semi-structured face-to-face interviews were conducted on 20 psychiatric patients with a mean age of 37.35 years (Range=18 to 67 years) when data saturation was attained. Five dominant themes were identified, including experience of taking psychiatric medications, experience of mental illness, perceived family support, worry of discrimination and worry about the future. Information collected in the qualitative study supported the lack of comprehensive assessment tool for needs assessment. In the quantitative study, Camberwell Assessment of Need (CAN) was adopted to assess comprehensive physical and psychosocial needs for psychiatric patients. The quantitative study was a cohort study with 1-month follow-up after discharge that examined the unmet needs of psychiatric patients undergoing discharge and 1 month after discharge. A total of 100 psychiatric inpatients were recruited and followed for 1 month after discharge. Prominent unmet needs at discharge were “accommodation” (n=100, 15%), followed by “psychological distress” (n=100, 14%) and “company” (n=100, 14%). At 1 month after discharge, 24 (24%) patients rated “company” as the highest unmet need, followed by “psychotic symptoms” (n =100, 18%) and “daytime activities” (n=100, 15%). Factors associated with unmet needs including symptoms severity, self-esteem, depression severity and quality of life, and which were the most significant physical and psychosocial factors were also explored. Schizophrenia (coefficient=1.02, 95% CI=0.61 to 1.98, p=0.037) and Brief Psychiatric Rating Scale (BPRS) (coefficient=0.14, 95% CI=0.04 to 0.25, p=0.007) showed significant association with unmet needs at discharge. At 1 month after discharge, a higher BPRS (coefficient=0.26, 95% CI=0.18 to 0.34, p<0.001) and having schizophrenia (coefficient=0.93, 95% CI=0.04 to 1.81, p=0.040) remained the most significant factors associated with more unmet needs. Moreover, factors associated with quality of life including symptoms severity, self-esteem, depression severity and unmet needs were examined. Centre For Epidemiologic Studies Depression Scale (CES-D) (coefficient=-0.72, 95% CI=-1.01 to -0.44, p<0.001), having depression (coefficient=8.57, 95% CI=1.09 to 16.05, p=0.025) and Rosenberg Self-Esteem Scale (RSES) (coefficient=1.23, 95% CI=0.59 to 1.87, p<0.001) were significantly associated with quality of life. Importantly, patient-rated unmet needs showed significant association with quality of life (coefficient=-3.05, 95% CI=-4.81 to -1.28, p=0.001) before discharge. At 1 month after discharge, both CES-D (coefficient=-0.40, 95% CI=-0.63 to -0.16, p=0.001) and RSES (coefficient=1.05, 95% CI=0.52 to 1.58, p<0.001) remained significantly associated with quality of life. In conclusion, this is the first study to examine physical and psychosocial needs and associated factors with unmet needs in psychiatric in patients undergoing discharge and at 1 month after discharge. To promote recovery, effective discharge planning in mental health service should incorporate a comprehensive needs assessment to address the needs from the patients’ perspective.