Introduction
Methods
Design and participants
Measures
Analysis
Likert-score (perceived difficulty 1 = low, 7 = high) | Number of selected patients (%) |
---|---|
1 | 10 (2.1) |
2 | 74 (15.8) |
3 | 165 (35.2) |
4 | 83 (17.7) |
5 | 100 (21.3) |
6 | 29 (6.2) |
7 | 4 (9) |
465 (99.1)a
|
Results
n = 469 (%) | |
---|---|
Sex | |
Female | 248 (52.9) |
Age | |
Mean (sd) | 46.9 (7.3) |
20–29 | 10 (2.1) |
30–39 | 53 (11.3) |
40–49 | 225 (48.0) |
50–59 | 175 (37.3) |
>60 | 6 (1.3) |
Education | |
CPN | 412 (87.8) |
CPN+ | 204 (43.5) |
CPN + Master | 11 (2.3) |
Mean years of CPN-experience (sd) [range] | 11.4 (8.6) [0–35] |
Work setting | |
Mental health services | 411 (87.6) |
Addiction services | 35 (7.5) |
Private practice | 34 (7.2) |
Forensic psychiatry | 10 (0.6) |
General hospital or academic psychiatry | 6 (1.3) |
Otherwise | 15 (3.1) |
Type of care | |
Emergency services | 133 (28.4) |
Community-based < 2 years | 301 (64.2) |
Community-based ≥ 2 years | 307 (65.5) |
Partial hospital | 17 (3.6) |
Inpatient < 2 years | 21 (4.5) |
Inpatient ≥ 2 years | 9 (1.9) |
Evidence-based practice | |
Mean hours of supervision (sd) [range] | 1.5 (1.15) [0.2–8] |
Method described in the work setting | 202 (43.1) |
Method described in the literature | 110 (23.5) |
No or non-described method | 157 (33.5) |
Case-load size | |
Mean total number (sd) [median (range)] | 52.2 (31.7) [50 (1–250)] |
Mean number of non-psychotic chronic patients (sd) [median (range)] | 12.4 (13.6) [8 (1–95)] |
n = 467 (%)a | |
---|---|
Sex | |
Female | 269 (57.4) |
Age | |
18–24 | 43 (9.2) |
25–34 | 78 (16.6) |
35–44 | 143 (30.5) |
45–54 | 138 (29.4) |
55–60 | 65 (13.9) |
In psychiatric care ≥ 3 years | 349 (74.5) |
No legal confinement | 387 (82.5) |
Diagnosis (DSM IV) | |
Axis I | |
Mood disorder | 228 (48.6) |
Anxiety disorder | 107 (22.8) |
Substance abuse disorder | 102 (21.7) |
Somatoform disorder | 8 (1.7) |
Factitious Disorder | 1 (0.2) |
Dissociative disorder | 30 (6.4) |
Sexual disorder | 7 (1.5) |
Eating disorder | 14 (3.0) |
Impulse control disorder | 43 (9.2) |
ADHD/autism | 48 (10.2) |
Adjustment disorder | 61 (13.0) |
No or deferred diagnosis | 33 (7.0) |
Other | 23 (4.9) |
Primary diagnosis on Axis I | 208 (44.3) |
Mean number of Axis I diagnoses (sd) [range] | 1.5 (0.81) [1–5] |
Axis II | |
Cluster A | 33 (7.0) |
Cluster B | 210 (44.8) |
Cluster C | 83 (17.7) |
NOS | 52 (11.1) |
No or deferred diagnosis | 89 (19.0) |
Axis III any diagnosis | 152 (32.4) |
Axis IV mean number of problems(sd) [range] | 3.3 (1.8) [0–9] |
Axis V GAF-score | |
41–50 | 337 (71.9) |
31–40 | 98 (20.9) |
21–30 | 18 (3.8) |
10–20 | 15 (3.2) |
Social contacts ≤3 | 387 (82.6) |
Professional variables |
p
|
---|---|
Sex | 0.682 |
Age category | 0.055 |
Educational level | 0.194 |
Number of working hours | 0.741 |
Work setting | 0.068 |
Years of CPN-experience | 0.030 |
Type of care | 0.073 |
Evidence-based practice | 0.869 |
Hours of supervision | 0.273 |
Case-load size | 0.064 |
Perception-related items | |
‘I expect that this patient will not improve much as a result of my care’ | 0.00 |
‘I feel powerless towards this patient’ | 0.00 |
‘I do not experience success in the care of this patient’ | 0.00 |
‘I feel pressured by this patient’ | 0.00 |
‘This patient is dependent on me’ | 0.00 |
‘This patient has too high expectations of his/her contact with me’ | 0.00 |
‘This patient is not hopeful about the care offered’ | 0.00 |
‘There is no clear view on the problems and the treatment of this patient’ | 0.00 |
‘I feel that this patient is able but unwilling to change’ | 0.00 |
‘This patient is not offered intensive treatment while he/she should be’ | 0.00 |
‘This patient’s treatment is not consistent’ | 0.00 |
‘I do not have faith in the treatment of this patient’ | 0.00 |
‘I am pessimistic about the patient’s change capacities’ | 0.00 |
‘People around this patient think that he/she is able but unwilling to change’ | 0.00 |
‘This patient causes trouble within his/her family or social system’ | 0.00 |
‘This patient plays hardly any role in his/her family or social system’ | 0.22 |
Patient variables | |
Sex | 0.738 |
Age category | 0.045 |
Years of psychiatric care | 0.487 |
Legal confinement (once, repeatedly or constantly during last year) | 0.019 |
Axis I diagnosis | 5× p ≤ 0.20 |
Axis II diagnosis | 0.054 |
Number of Axis I diagnoses | 0.006 |
Primary diagnosis on Axis I or Axis II | 0.837 |
Axis III-diagnosis (no/yes) | 0.002 |
Social variables | |
Number of psychosocial problems (Axis IV) | 0.000 |
GAF-score (Axis V) | 0.000 |
Number of social contacts (≤3/>3) | 0.045 |
Treatment variables | |
Number of mental health contacts per month (≤1/>1) | 0.000 |
Regularity of contacts (regular, irregular) | 0.471 |
Treatment goal (recovery, prevent relapse, structure life, monitor risk behavior, unclear) | 2× p ≤ 0.20 |
Number of mental health professionals involved | 0.435 |
Cooperation of mental health professionals involved (none, irregular, regular) | 0.414 |
Additional psychiatric services (emergency services, admission, partial hospital) | 3× p ≤ 0.20 |
Number of additional psychiatric services | 0.006 |
Number of non-psychiatric institutions involved | 0.302 |
ORa
| 95% CI | AORb
| 95% CI |
p
| |
---|---|---|---|---|---|
Model 1: patient, professional, treatment and social variables (p ≤ 0.10) | |||||
Dichotomous/categorical | |||||
Substance abuse disorder (no/yes) | 1.42 | 0.89–2.28 | 0.50 | 0.27–0.94 | 0.031 |
Diagnosis Axis III (no/yes) | 1.97 | 1.30–3.00 | 2.02 | 1.25–3.27 | 0.004 |
CPN contacts per week (≤ 1/> 1) | 2.65 | 1.75–4.02 | 2.07 | 1.27–3.37 | 0.003 |
Use of crisis intervention services during last year (no/yes) | 2.10 | 1.38–3.19 | 1.97 | 1.05–3.68 | 0.033 |
Use of open closed ward during last year (no/yes) | 1.84 | 1.17–2.88 | 1.90 | 0.97–3.76 | 0.063 |
Use of locked admission ward during last year (no/yes) | 2.06 | 1.23–3.44 | 2.34 | 1.13–4.82 | 0.021 |
GAF-score (reference category = 41–50) | 1 | – | 1 | – | 0.00 |
31–40 | 2.90 | 1.80–4.65 | 3.07 | 0.94–10.09 | 0.064 |
21–30 | 2.84 | 1.08–7.46 | 3.23 | 1.08–9.69 | 0.036 |
10–20 | 3.11 | 1.09–8.86 | 2.52 | 1.44–4.41 | 0.001 |
Number of diagnoses Axis I (reference category = 1) | 1 | – | 1 | – | 0.088 |
2 diagnoses | 1.78 | 1.11–2.88 | 1.80 | 1.01–3.20 | 0.047 |
>2 diagnoses | 2.22 | 1.24–3.98 | 1.80 | 0.87–3.75 | 0.113 |
Continuousc
| |||||
Number of psychosocial problems Axis IV (0–9) | 1.34 | 1.20–1.51 | 1.25 | 1.08–1.43 | 0.002 |
Number of used psychiatric services during last year (0–7) | 1.22 | 1.06–1.40 | 0.79 | 0.61–1.04 | 0.095 |
Model 2: perception-related variables (p ≤ 0.10) | |||||
Continuousc
| |||||
‘I feel powerless towards this patient’ (1–7) | 1.75 | 1.51–2.20 | 1.51 | 1.27–1.81 | 0.000 |
‘I feel that this patient is able but unwilling to change’ (1–7) | 1.35 | 1.17–1.56 | 1.18 | 0.99–1.40 | 0.072 |
‘I am pessimistic about the patient’s change capacities’ (1–7) | 1.37 | 1.21–1.56 | 1.30 | 1.07–1.59 | 0.009 |
‘This patient causes trouble within his/her family or social system’ (1–7) | 1.29 | 1.16–1.44 | 1.20 | 1.02–1.41 | 0.027 |
‘This patient does not receive intensive treatment while he/she should’ (1–7) | 1.57 | 1.31–1.80 | 1.30 | 1.13–1.49 | 0.000 |
Model 3: all remaining variables combined (p ≤ 0.05) | |||||
Dichotomous | |||||
CPN contacts per week (≤1/>1) | 2.65 | 1.75–4.02 | 1.25 | 1.09–1.44 | 0.001 |
Use of locked admission ward during last year (no/yes) | 2.06 | 1.23–3.44 | 2.81 | 1.70–4.66 | 0.000 |
Continuousc
| |||||
Number of psychosocial problems Axis IV (1–9) | 1.34 | 1.20–1.51 | 2.18 | 1.20–3.97 | 0.011 |
‘I feel powerless towards this patient’ (1–7) | 1.75 | 1.51–2.20 | 1.67 | 1.42–1.98 | 0.000 |
‘I feel that this patient is able but unwilling to change’ (1–7) | 1.35 | 1.17–1.56 | 1.27 | 1.06–1.51 | 0.008 |
‘I am pessimistic about the patient’s change capacities’ (1–7) | 1.37 | 1.21–1.56 | 1.19 | 1.01–1.39 | 0.035 |