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Outcome of services for patients with Common Mental Disorders (CMDs): A prospective cohort study
Varun S Mehta1, D Ram1, Triptish Bhatia2,3
1Department of Psychiatry, Central Institute of Psychiatry, Kanke, Ranchi, Jharkhand, India.
Background:
Depressive and anxiety disorders, together contribute to over 50% of the Disability-Adjusted Life Years (DALYs). While outcomes for severe mental illnesses have been extensively studied, outcome-based research on CMDs remains limited.
Aim:
To evaluate the needs, barriers, caregiver involvement, recovery and service satisfaction of patients with CMDs as a measure of service outcome.
Methods:
This prospective cohort study included 274 patients with CMDs diagnosed per ICD-10 criteria. Participants were assessed at baseline and six months using researcher-rated and service user-rated outcome measures. Instruments included the Camberwell Assessment of Needs-Research (CAN-R), Client Satisfaction Questionnaire (CSQ), Barriers to Access to Care Evaluation (BACE v3), Involvement Evaluation Questionnaire (IEQ), and Importance of Services in Recovery (INSPIRE). Generalized Linear Mixed Models (GLMM) and negative binomial regression were employed to analyze outcomes over time.
Results:
At baseline, 90.9% of participants had needs, with unmet needs comprising 80.7%. Major unmet needs were psychological distress (73.4%), looking after the home (57.7%), and daytime activities (50.7%). Depression had the highest impact on unmet needs, contributing to a 32% increase per unit rise in depression severity (IRR = 1.318, P < 0.001). Stigma accounted for only about one-fifth of the total perceived barriers to accessing care, with worrying and urging behaviors among the caregivers. At the end of six months, the unmet needs significantly improved, but caregivers were still concerned about the well-being of the participants, associated with improvements in service satisfaction.
Conclusions:
CMD patients had significant unmet needs, especially for psychological distress, household, and daily activities. Depression was the largest contributor to unmet needs, while panic and somatic disorders were lower. Caregiver burden evolved, and non-stigma-related barriers to care were significant.
