title: Individual unmet needs for care: are they sensitive as outcome criterion for the effectiveness of mental health services interventions?
abstract: BACKGROUND
  Mental health interventions should demonstrate an effect on patients' functioning as well as his/her needs, in particular on unmet needs whose assessment depends on the perspective of either the patient or the clinician. However, individual met and unmet needs appear to change over time, qualitatively and quantitatively, raising questions about their sensitivity to change and about the association between level of needs and treatment.
  
  
  METHODS
  Data on baseline and follow-up need assessment in community mental health services in four European countries in the context of a cluster randomised trial on a novel mental health service intervention were used, which involved 102 clinicians with key worker roles and 320 patients with schizophrenia or related psychotic disorders. Need assessment was performed with the Camberwell assessment of needs short appraisal schedule (CANSAS) among patients as well as clinicians. Focus is the sensitivity to change in unmet needs over time as well as the concordance between patient and clinician ratings and their relationship with treatment condition.
  
  
  RESULTS
  At follow-up 294 patients (92%) had a full need assessment, while clinician rated needs were available for 302 patients (94%). Generally, the total number of met needs remained quite stable, but unmet needs decreased significantly over time, according to patients as well as to clinicians. Sensitivity to change of unmet needs is quite high: about two third of all unmet needs made a transition to no or met need, and more than half of all unmet needs at follow-up were new. Agreement between patient and clinician on unmet needs at baseline as well as follow-up was rather low, without any indication of a specific treatment effect.
  
  
  CONCLUSIONS
  Individual unmet needs appear to be quite sensitive to change over time but as yet less suitable as outcome criterion of treatment or specific interventions.
authors.affiliation: Dept. of Psychiatry, University Medical Center Groningen, University of Groningen, P.O. Box 30.001, Groningen 9700 RB, The Netherlands. durk.wiersma@med.umcg.nl
authors.forename: Durk
authors.initials: D
authors.lastname: Wiersma
authors.forename: Rob
authors.initials: R
authors.lastname: van den Brink
authors.forename: Kerstin
authors.initials: K
authors.lastname: Wolters
authors.forename: Rosemarie
authors.initials: R
authors.lastname: McCabe
authors.forename: Jens
authors.initials: J
authors.lastname: Bullenkamp
authors.forename: Lars
authors.initials: L
authors.lastname: Hansson
authors.forename: Christoph
authors.initials: C
authors.lastname: Lauber
authors.forename: Rafael
authors.initials: R
authors.lastname: Martinez-Leal
authors.forename: Wulf
authors.initials: W
authors.lastname: Rössler
authors.forename: Hans
authors.initials: H
authors.lastname: Salize
authors.forename: Tommy
authors.initials: T
authors.lastname: Björkman
authors.forename: Francisco
authors.initials: F
authors.lastname: Torres-Gonzales
authors.forename: Donna J
authors.initials: DJ
authors.lastname: Wright
authors.forename: Stefan
authors.initials: S
authors.lastname: Priebe
mesh_terms: D000328:Adult; D003156:Community Mental Health Services / Q000592:standards*; D017598:Efficiency, Organizational; D005060:Europe; D005260:Female; D006301:Health Services Needs and Demand; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D016032:Randomized Controlled Trials as Topic
references.citation: Soc Psychiatry Psychiatr Epidemiol. 2005 Mar;40(3):223-32
references.pmid: 15742228
references.citation: Soc Psychiatry Psychiatr Epidemiol. 2001 Jan;36(1):1-12
references.pmid: 11320802
references.citation: Soc Psychiatry Psychiatr Epidemiol. 1996 Jun;31(3-4):114-21
references.pmid: 8766456
references.citation: Psychol Med. 1987 Nov;17(4):971-81
references.pmid: 3124155
references.citation: Br J Psychiatry. 1995 Nov;167(5):589-95
references.pmid: 8564313
references.citation: Eur Psychiatry. 1999 Jul;14(4):186-8
references.pmid: 10787278
references.citation: Psychol Med. 1998 May;28(3):543-50
references.pmid: 9626711
references.citation: Schizophr Bull. 1987;13(2):261-76
references.pmid: 3616518
references.citation: Int J Soc Psychiatry. 1999 Spring;45(1):7-12
references.pmid: 10443245
references.citation: Acta Psychiatr Scand. 1999 Aug;100(2):149-57
references.pmid: 10480201
references.citation: Soc Psychiatry Psychiatr Epidemiol. 2006 Sep;41(9):728-33
references.pmid: 16775754
references.citation: Acta Psychiatr Scand. 1999 Nov;100(5):328-34
references.pmid: 10563449
references.citation: Eval Program Plann. 1983;6(3-4):299-313
references.pmid: 10267258
references.citation: Soc Psychiatry Psychiatr Epidemiol. 2008 Sep;43(9):705-13
references.pmid: 18438596
references.citation: Soc Psychiatry Psychiatr Epidemiol. 2006 Mar;41(3):208-14
references.pmid: 16435079
references.citation: Acta Psychiatr Scand. 2001 Jan;103(1):45-51
references.pmid: 11202128
references.citation: Arch Gen Psychiatry. 1991 Aug;48(8):764-70
references.pmid: 1883262
references.citation: Br J Psychiatry. 1999 May;174:404-8
references.pmid: 10616605
references.citation: Soc Psychiatry Psychiatr Epidemiol. 2004 Jan;39(1):60-8
references.pmid: 15022048
references.citation: Tijdschr Psychiatr. 2007;49(5):305-14
references.pmid: 17492581
references.citation: Clin Pract Epidemiol Ment Health. 2006 Sep 11;2:22
references.pmid: 16965621
references.citation: J Adv Nurs. 1999 Dec;30(6):1408-15
references.pmid: 10583652
references.citation: Br J Psychiatry Suppl. 2000;(39):s34-40
references.pmid: 10945076
references.citation: Int J Soc Psychiatry. 2007 Sep;53(5):389-96
references.pmid: 18018661
references.citation: Acta Psychiatr Scand. 2000 Nov;102(5):366-75
references.pmid: 11098809
references.citation: Soc Psychiatry Psychiatr Epidemiol. 1996 Jun;31(3-4):109-13
references.pmid: 8766455
references.citation: Acta Psychiatr Scand Suppl. 2006;(429):115-9
references.pmid: 16445493
references.citation: Psychol Med. 1995 May;25(3):605-17
references.pmid: 7480440
references.citation: Acta Psychiatr Scand. 1995 Oct;92(4):285-93
references.pmid: 8848954
references.citation: Soc Psychiatry Psychiatr Epidemiol. 2008 May;43(5):410-7
references.pmid: 18163188
references.citation: Soc Psychiatry Psychiatr Epidemiol. 2005 Jul;40(7):529-39
references.pmid: 16088372