Health-care needs of remitted patients with bipolar disorder: A comparison with schizophrenia

Table 1 Profile of the patients and their relatives

	Patients		Relatives
	Bipolar disorder (n = 150)	Schizophrenia (n = 75)	Bipolar disorder (n = 150)	Schizophrenia (n = 75)
Age (yr) mean (SD)	36.1 (10.1)	33.4 (9.9)	42.3 (12.8)	43.7 (11.7)
Gender n (%)					Relatives’ gender χ2 = 6.74; P < 0.01
Male	101 (67)	42 (56)	64	46 (61)a
Female	49	33	86 (57)	29
Marital status n (%)					Marital status of patients χ2 = 7.15; P < 0.01
Not married	43	35	12	5
Married	107 (71)	40 (53)a	138 (92)	70 (93)
Years of schooling mean (SD)	11.4 (4.9)	11.5 (4.4)	11.1 (5.9)	11.6 (6.24)
Occupation n (%)					Occupation of patients χ2 = 21.87; P < 0.001
Paid employment	103 (69)	27	72	44 (59)
Others	47	48 (64)b	78 (52)	31
Family type n (%)
Nuclear	69	35
Non-nuclear	81 (54)	40 (53)
Residence n (%)
Urban	86 (57)	39 (52)
Rural	64	36
Relationship with the patient n (%)					χ2 = 11.69; P < 0.01
Spouse			68 (45%)	17 (23)a
Parents			48 (32%)	30 (40)
Sibs			16 (11%)	14 (19)
Others			18 (12%)	14 (19)
Age of onset (in years) mean (SD)	26.7 (9.5)	26.1 (12.7)
Duration of illness (mo) mean (SD)	110.3 (78.9)	93.7 (65.9)
Duration of treatment (mo) mean (SD)	99.1 (69.5)	100 (94.3)
Number of hospitalizations in the past mean (SD)	0.7 (1.0)	0.5 (0.9)
PANSS positive score mean (SD)	-	10.6 (5.6)
PANSS negative score mean (SD)	-	12.3 (7.2)
PANSS general psychopathology score mean (SD)	-	27.4 (12.6)
YMRS score mean (SD)	2.0 (3.1)	-
HDRS score mean (SD)	1.0 (2.1)	-
GAF score mean (SD)	70.07 (17.79)	66.63 (15.63)
WHOQOL-BREF scores mean (SD)	93.87 (15.17)	88.77 (17.85)

^aP < 0.01;

^bP < 0.001: Comparisons between BD and schizophrenia on marital status and occupation of patients, relatives’ gender and relationship with patient. PANSS: Positive and Negative Syndrome Scale for Schizophrenia; YMRS: Young Mania Rating Scale; HDRS: Hamilton Depression Rating Scale; GAF: Global Assessment of Functioning; WHOQOL-BREF: World Health Organization Quality of Life Bref version; BD: Bipolar disorder.

Table 2 Health-care needs on the Camberwell Assessment of Need-Research version - as reported by patients

	Bipolar disorder n = 150			Schizophrenia n = 75			t values
Total needs - mean (SD)	6.03 (2.87)			7.45 (2.80)			3.54d
Met needs - mean (SD)	3.92 (2.21)			4.58 (2.32)			2.07a
Unmet needs - mean (SD)	2.1 (1.70)			2.87 (1.88)			3.01b
Domains	Total needs n (%)	Met needs n (%)	Unmet needs n (%)	Total needs n (%)	Met needs n (%)	Unmet needs n (%)	χ2 values
Accommodation	11 (7)	11 (7)	0 (0)	9 (12)	7 (9)	2 (3)	1.34
Food	16 (11)	16 (11)	0 (0)	12 (16)	10 (13)	2 (3)	1.3
Household skills	92 (61)	86 (57)	6 (4)	55 (73)	52 (69)	3 (4)	3.17
Self care	28 (19)	25 (17)	3 (2)	18 (24)	15 (20)	3 (4)	0.87
Daytime activities	65 (43)	44 (29)	21 (14)	41 (55)	21 (28)	20 (27)	2.57
Physical health	68 (45)	47 (31)	21 (14)	32 (43)	27 (36)	5 (7)	0.14
Psychotic symptoms	44 (29)	38 (25)	6 (4)	67 (89)	60 (80)	7 (9)	72.01d
Information about condition and treatment	106 (71)	61 (41)	45 (30)	60 (80)	24 (32)	36 (48)	2.25
Psychological distress	87 (58)	73 (49)	14 (9)	40 (53)	32 (43)	8 (11)	0.44
Safety to self	14 (9)	14 (9)	0 (0)	5 (7)	4 (5)	1 (1)	0.46
Safety to others	21 (14)	16 (11)	5 (3)	8 (11)	5 (7)	3 (4)	0.49
Alcohol	8 (5)	8 (5)	0 (0)	0 (0)	0 (0)	0 (0)	2.73
Drugs	13 (9)	8 (5)	5 (3)	4 (5)	1 (1)	3 (4)	0.39
Company	74 (47)	36 (24)	38 (25)	50 (67)	24 (32)	26 (35)	6.07a
Intimate relationships	17 (11)	7 (5)	10 (7)	10 (13)	3 (4)	7 (9.3)	0.04
Sexual expression	14 (9)	9 (6)	5 (3)	3 (4)	0 (0)	3 (4)	1.34
Child care	21 (14)	18 (12)	3 (2)	10 (13)	6 (8)	4 (5)	0.019
Basic education	9 (6)	7 (5)	2 (1)	7 (9)	6 (8)	1 (1)	0.84
Telephone	33 (22)	28 (19)	5 (3)	27 (36)	23 (31)	4 (5)	5.01a
Transport	19 (13)	14 (9)	5 (3)	18 (24)	12 (16)	6 (8)	4.67a
Money	30 (20)	22 (15)	8 (5)	30 (40)	12 (16)	8 (11)	10.22a
Welfare benefits	114 (76)	1 (1)	113 (75)	63 (84)	0 (0)	63 (84)	1.91

^aP < 0.05;

^bP < 0.01;

^dP < 0.001: Comparisons between BD and schizophrenia on total, met and unmet needs and different types of needs. BD: Bipolar disorder.

Table 3 Health-care needs of patients on the Camberwell Assessment of Need-Research version - as reported by their relatives

	Bipolar disorder n = 150			Schizophrenia n = 75			t values
Total needs	6.72 (3.19)			8.36 (2.91)			3.37f
Met needs	4.15 (2.34)			4.99 (2.18)			2.57a
Unmet needs	2.57 (2.31)			3.37 (2.58)			2.37a
Domains	Total needs	Met needs	Unmet needs	Total needs	Met needs	Unmet needs	χ2 values
Accommodation	12 (8)	11 (7)	1 (1)	15 (20)	13 (17)	3 (4)	6.82b
Food	32 (21)	30 (20)	2 (1)	23 (31)	20 (27)	3 (4)	2.35
Household skills	103 (69)	90 (60)	13 (9)	63 (84)	56 (75)	7 (9)	6.07a
Self-care	36 (24)	31 (21)	5 (3)	25 (33)	19 (25)	6 (8)	2.20
Daytime activities	77 (51)	51 (34)	26 (17)	43 (57)	21 (28)	22 (29)	0.72
Physical health	79 (53)	62 (41)	17 (11)	39 (52)	31 (41)	8 (11)	0.01
Psychotic symptoms	47 (31)	37 (25)	10 (7)	69 (92)	59 (79)	10 (13)	73.68f
Information about condition and treatment	106 (71)	62 (41)	44 (29)	60 (80)	17 (23)	43 (57)	2.251
Psychological distress	87 (58)	70 (47)	17 (11)	49 (65)	39 (52)	10 (13)	1.12
Safety to self	8 (5)	8 (5)	0 (0)	6 (8)	5 (7)	1 (1)	0.61
Safety to others	31 (21)	19 (13)	12 (8)	14 (19)	9 (12)	5 (7)	0.12
Alcohol	11 (7)	8 (5)	3 (2)	2 (3)	2 (3)	0 (0)	1.23
Drugs	18 (12)	5 (3)	13 (9)	4 (5)	2 (3)	2 (3)	1.82
Company	83 (55)	37 (25)	46 (31)	45 (60)	18 (24)	27 (36)	0.44
Intimate relationships	25 (17)	10 (7)	15 (10)	12 (16)	3 (4)	9 (6)	0.02
Sexual expression	13 (9)	5 (3)	8 (5)	2 (3)	0 (0)	2 (3)	2.01
Child care	25 (17)	20 (13)	5 (3)	12 (16)	8 (11)	4 (5)	0.02
Basic education	8 (5)	5 (3)	3 (2)	7 (9)	6 (8)	1 (1)	1.28
Telephone	34 (23)	28 (19)	6 (4)	25 (33)	21 (28)	4 (5)	2.94
Transport	26 (17)	13 (9)	13 (9)	24 (32)	14 (19)	10 (13)	6.22a
Money	31 (21)	20 (13)	11 (7)	24 (32)	10 (13)	14 (19)	3.47
Welfare benefits	117 (78)	1 (1)	116 (77)	66 (88)	1 (1)	65 (87)	3.29

^aP < 0.05;

^bP < 0.01;

^fP < 0.001: Comparisons between BD and schizophrenia on total, met and unmet needs and different types of needs.

¹Between A significantly greater proportion of relatives than patients with schizophrenia reported that needs in the area of information about the condition and its treatment were unmet (χ² = 13.79; P < 0.01). BD: Bipolar disorder.

Table 4 Additional areas of needs: Patients’ and relatives’ reports¹

	Bipolar disorder-mean (SD) (n = 150)	Schizophrenia-mean (SD) (n = 75)		t values
Needs of patients reported by patients
Total needs	2.39 (1.87)	3.08 (2.08)		2.52a
Met needs	0.23 (0.61)	0.27 (0.64)		0.38
Unmet needs	2.15 (1.73)	2.81 (1.9)		2.6a
Needs of patients reported by relatives
Total needs	2.67 (2.26)	3.33 (2.13)		2.13a
Met needs	0.19 (0.49)	0.48 (1.37)		2.29a
Unmet needs	2.47 (2.09)	2.85 (1.82)		1.34
	Patients			Relatives
Seven common areas of additional needs-bipolar disorder (n = 150)	Total needs	Met needs	Unmet needs	Total needs	Met needs	Unmet needs
Free treatment	69	4	65	4	65	70
Medical reimbursement	56	3	53	3	53	67
Job reservations/occupational help	42	1	41	1	41	44
Financial help	35	4	31	4	31	44
Psychoeducation	30	10	20	10	20	29
Travel concessions	20	2	18	2	18	24
Patient groups, clubs, societies	17	0	17	0	17	22
Seven common areas of additional needs - schizophrenia (n = 75)
Medical reimbursement	53	0	53	50	1	49
Free treatment	44	0	44	48	1	47
Job reservations/occupational help	35	1	34	32	4	28
Financial help	28	1	27	30	1	29
Psychoeducation	19	6	13	15	7	8
Travel concessions	12	0	12	15	2	13
Certification needs	11	1	10	11	4	7

^aP < 0.05: Comparisons between BD and schizophrenia on total, met and unmet needs and different types of needs. ¹This additional evaluation was carried out using an instrument designed to cover those areas of needs not specifically covered by the CAN-R; it had 21 areas with a format similar to the CAN-R; only results pertaining to the seven most common needs are depicted. CAN-R: Camberwell Assessment of Need-Research version; BD: Bipolar disorder.

Table 5 Correlates of health-care needs^1,2

Univariate associations	CAN-R scores as per patients’ reports (n = 225)				CAN-R scores as per caregivers’ reports (n = 225)
	Met needs	Unmet needs		Total needs	Met needs	Unmet needs		Total needs
Duration of illness	-0.237
GAF scores		-0.422				-0.553		-0.443
WHOQOL total scores		-0.294				-0.367		-0.306
WHOQOL general		-0.288				-0.276		-0.306
WHOQOL physical health						-0.300
WHOQOL psychological		-0.267				-0.287		-0.295
WHOQOL social relationship		-0.287				-0.304		-0.249
WHOQOL environment						-0.337		-0.242
Multiple regression analyses
	Unmet needs - patients’ reports				Unmet needs - relatives’ reports
	R square		Adjusted R square		R square		Adjusted R square
GAF	0.203		0.199		0.291		0.288
GAF, PANSS positive	0.270		0.264		0.340		0.334
GAF, PANSS positive, Psychological Health domain of WHOQOL- BREF	0.293		0.283		0.361		0.353
					Total needs - relatives’ reports
GAF					0.182		0.178
GAF, PANSS positive					0.236		0.229
GAF, PANSS positive, Psychological Health domain of WHOQOL- BREF					0.258		0.248

¹Pearson’s Product Moment Correlation coefficients or Spearman’s Rank Correlation coefficients; ²Only those significant associations that persisted after adjusting for multiple correlations using Bonferroni correction are depicted. Bonferroni value = 0.05/60 = 0.00083. CAN-R: Camberwell Assessment of Need-Research version; GAF: Global Assessment of Functioning; WHOQOL-BREF: World Health Organization Quality of Life Bref version; PANSS: Positive and Negative Syndrome Scale for Schizophrenia; BD: Bipolar disorder.