title: Mediation analysis of severity of needs, service performance and outcomes for patients with mental disorders.
abstract: Needs and service performance assessment are key components in improving recovery among individuals with mental disorders.
  
  
  
  To test the role of service performance as a mediating factor between severity of patients' needs and outcomes.
  
  
  
  A total of 339 adults with mental disorders were interviewed. A mediation analysis between severity of needs, service performance (adequacy of help, continuity of care and recovery orientation of services) and outcomes (personal recovery and quality of life) was carried out using structural equation modelling.
  
  
  
  The structural equation model provided a good fit with the data. An increase in needs was associated with lower service performance and worse outcomes, whereas higher service performance was associated with better outcomes. Service performance partially mediated the effect of patient needs on outcomes.
  
  
  
  Poorer service performance has a negative impact on outcomes for patients with the highest needs. Ensuring more efficient services for patients with high needs may help improve their recovery and quality of life.
authors.affiliation: Paul Roux, MD, PhD, Department of Psychiatry, McGill University, Douglas Mental Health University Institute Research Centre, Montreal, Canada, Service Universitaire de Psychiatrie d'adultes, Centre Hospitalier de Versailles, Le Chesnay, Laboratoire HandiRESP, Université de Versailles Saint-Quentin-en-Yvelines, Montigny-le-Bretonneux and Fondation Fondamental, Créteil, France; Christine Passerieux, MD, PhD, Service Universitaire de Psychiatrie d'adultes, Centre Hospitalier de Versailles, Le Chesnay, Laboratoire HandiRESP, Université de Versailles Saint-Quentin-en-Yvelines, Montigny-le-Bretonneux and Fondation Fondamental, Créteil, France; Marie-Josée Fleury, PhD, Department of Psychiatry, McGill University, Douglas Mental Health University Institute Research Centre, Montreal, Canada paul.roux@uvsq.fr.
authors.forename: Paul
authors.initials: P
authors.lastname: Roux
authors.affiliation: Paul Roux, MD, PhD, Department of Psychiatry, McGill University, Douglas Mental Health University Institute Research Centre, Montreal, Canada, Service Universitaire de Psychiatrie d'adultes, Centre Hospitalier de Versailles, Le Chesnay, Laboratoire HandiRESP, Université de Versailles Saint-Quentin-en-Yvelines, Montigny-le-Bretonneux and Fondation Fondamental, Créteil, France; Christine Passerieux, MD, PhD, Service Universitaire de Psychiatrie d'adultes, Centre Hospitalier de Versailles, Le Chesnay, Laboratoire HandiRESP, Université de Versailles Saint-Quentin-en-Yvelines, Montigny-le-Bretonneux and Fondation Fondamental, Créteil, France; Marie-Josée Fleury, PhD, Department of Psychiatry, McGill University, Douglas Mental Health University Institute Research Centre, Montreal, Canada.
authors.forename: Christine
authors.initials: C
authors.lastname: Passerieux
authors.affiliation: Paul Roux, MD, PhD, Department of Psychiatry, McGill University, Douglas Mental Health University Institute Research Centre, Montreal, Canada, Service Universitaire de Psychiatrie d'adultes, Centre Hospitalier de Versailles, Le Chesnay, Laboratoire HandiRESP, Université de Versailles Saint-Quentin-en-Yvelines, Montigny-le-Bretonneux and Fondation Fondamental, Créteil, France; Christine Passerieux, MD, PhD, Service Universitaire de Psychiatrie d'adultes, Centre Hospitalier de Versailles, Le Chesnay, Laboratoire HandiRESP, Université de Versailles Saint-Quentin-en-Yvelines, Montigny-le-Bretonneux and Fondation Fondamental, Créteil, France; Marie-Josée Fleury, PhD, Department of Psychiatry, McGill University, Douglas Mental Health University Institute Research Centre, Montreal, Canada.
authors.forename: Marie-Josée
authors.initials: MJ
authors.lastname: Fleury
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D006301:Health Services Needs and Demand / Q000592:standards / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000628:therapy*; D008605:Mental Health Services / Q000592:standards / Q000706:statistics & numerical data*; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care / Q000592:standards / Q000706:statistics & numerical data*; D011792:Quebec