title: The motivation paradox: higher psychosocial problem levels in severely mentally ill patients are associated with less motivation for treatment.
abstract: OBJECTIVE
  Lack of motivation for treatment makes a subgroup of patients with severe mental illness (SMI) difficult to engage in psychiatric treatment. Such difficult-to-engage patients may also be the most in need of treatment. We hypothesized that the level of psychosocial problems would be inversely related to motivation for treatment.
  
  
  METHODS
  Cross-sectional study in two independent samples. The first sample (n = 294) included SMI patients who participated in a randomized controlled trial and were assessed using the Health of the Nation Outcome Scales (HoNOS) and self-rated and clinician-rated motivation-for-treatment scales. The second sample (n = 1,170) included SMI patients who were treated in Assertive Outreach Teams and were routinely assessed with the HoNOS and a motivation-for-treatment scale. In both samples, patients also self-rated their quality of life.
  
  
  RESULTS
  In both samples, patients with HoNOS scores of 16 and higher had lower motivation scores on all motivation scales than patients with lower HoNOS scores, and also a lower quality of life.
  
  
  CONCLUSIONS
  A motivation paradox seems inherent to this association between higher psychosocial problems levels, less motivation for treatment, and lower quality of life. Such a paradox has clinical relevance, as it may provide an ethical basis for outreach services which aim to engage marginally motivated SMI patients with severe psychosocial problems into mental health care.
authors.affiliation: Bavo-Europoort, Prins Constantijnweg 48-54, 3066 TA, Rotterdam, The Netherlands, niels.clmulder@wxs.nl.
authors.forename: Cornelis L
authors.initials: CL
authors.lastname: Mulder
authors.forename: E
authors.initials: E
authors.lastname: Jochems
authors.forename: H E
authors.initials: HE
authors.lastname: Kortrijk
mesh_terms: D000328:Adult; D000368:Aged; D001242:Assertiveness; D001521:Behavior Therapy / Q000379:methods*; D003156:Community Mental Health Services; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000523:psychology* / Q000628:therapy*; D028642:Persons with Psychiatric Disorders / Q000523:psychology*; D008875:Middle Aged; D009042:Motivation; D009426:Netherlands; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data; D011788:Quality of Life; D057566:Self Report; D012720:Severity of Illness Index; D012944:Social Support; D016896:Treatment Outcome