Zihan Liu
The prevalence of emotional disorders is high among people who seek help from general medical services. In most international studies, the prevalence of depression and anxiety ranges from 3.6% to 13.1%. Co-morbid emotional problems such as depression and anxiety are associated with a decreased quality of life, impaired self-management behaviors, and a diminished perception of disease control in medical patients.
Unfortunately, most of the patients with emotional problems are not properly treated. For example, an investigation of the Epidemiology of Mental Disorders (ESEMeD) of 21,400 adults from six European countries indicated that the lifetime prevalence of major depression was 13.4%, but only 4.6% of the depressive patients accepted antidepressants treatment.
Moreover, we believe that a high concordance in the assessment of psychological needs rated by patients and medical staff is another important precondition for an adequate treatment of patients with depression or anxiety. However, it has been shown that doctor and patient attitudes relating to mental health services are not always consistent (19,20). Richards et al. reported that 37% and 12% of patients with psoriasis were identified as probable clinical cases for anxiety disorder and depression respectively. Dermatologists identified only 39% of the patients with significant psychological difficulties during the consultation. The level of concordance between patients’ ratings and dermatologists’ ratings regarding the presence of anxiety or depression was low (kappa values of 0.24 and 0.26 respectively)
Methods
Research design and sampling
This cross-sectional survey was approved by the Ethics Committee of West China Hospital of Sichuan University and was conducted from October to November, 2013. Participants in this study were inpatients recruited from 10 voluntary departments (Oncology, Internal Cardiology, Respiratory Medicine, Rehabilitation, Geriatrics and Gerontology, General Practice, Pain Management, Rheumatology, Hepatic Surgery, and Thyroid and Breast Surgery) of West China Hospital, a major tertiary general hospital in Chengdu, China. All hospitalized patients of the listed departments were selected as potential participants
Instruments and measures
Results
Participants
From the 1,662 hospitalized patients which could be approached at the 10 departments that day, 151 patients were excluded based on the exclusion criteria. Among the included 1,511 hospitalized patients, 149 patients refused to participate in the study with “lack of time” and “not interested” as the most common reasons; 89 participants were excluded because their doctors did not respond. The overall response rate was 84.25% and the final sample consisted of 1,273 participants. The sociodemographic characteristics of the study group. The mean (SD) age was 53.1±16.3 years; 58.37% of the sample were men (n=743).
Discussion
The ability to recognize emotional problems is believed to be one of the most important influencing factors for the proper treatment of patients with depression or anxiety. Unfortunately, patients’ and doctors’ ability to recognize distress is poor.
In this study, only 59.56% of patients with significant depression or anxiety indicated their need for psychological help. The result was similar to the results of a study from Seekles [2012] who found that just over half of patients had needs for mental health services (55.3%) (15). Prins et al. conducted a systematic review including 71 studies and found that only 49% to 84% of the patients with depression or anxiety perceived the need for treatment
Discussion of the patients’ emotional problems requires time, good communication skills and sufficient knowledge about emotional problems in patients. Most of the doctors did not have the skills or expertise to deal with these problems.
Moreover, medical staff may refer patients for psychiatric evaluation only when the problems become acute. McDonald et al. reported that when patients had obvious symptoms, such as crying and a depressed mood, the detection of psychological needs by staff was higher.
The concordance between doctors’ and patients’ perception of psychological needs was low (kappa =0.055). The concordance between patients and doctors on perceived needs for psychological services has not been broadly studied before. Therefore, it is difficult to compare our results with previous research. Richards conducted a study on patients with psoriasis and found that the level of concordance between patients’ and dermatologists’ rating for the presence of anxiety or depression was also low (kappa values of 0.24 and 0.26).
Logistic regression was used to find potential influencing factors of the concordance rate. However, only the wards in which the patients were treated at the time of the investigation could be identified as a reason for the discordance and this result might be not persuasive because of the low ratio (6.21%) of surgical patients. In the next study, the ward of the patient should be reasonably included and the number of surgical patients might be increased.
Conclusion
In this paper, we explored the concordance between Chinese patients’ perception of their own mental needs and the corresponding evaluation by doctors in charge of these inpatients. This concordance is believed to be an important factor to guarantee timely and adequate treatment. However, the concordance in this study was very low (kappa =0.055), even in patients with depression and anxiety, which is a severe problem on inpatients’ mental health. Therefore, in the future, we hope to shed some light on this topic by studying potential effective strategies to prompt this process, such as the raising of doctors’ awareness, the use of screening-instruments, and the training of health professionals.
Note: This work is partly presented at 3rd International Conference on Mental Health and Human Resilience on June 21-23, 2017 held in London, UK
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