Anne Unger

Gender aspects of parents' needs of schizophrenia patients.

BackgroundMost studies about the problems and needs of schizophrenia carers included only one care-giving relative, usually the patients’ mothers.Methods101 mothers and fathers of the same patients suffering from schizophrenia were included into this study. Their needs were assessed by means of the “Carers’ Needs Assessment for Schizophrenia”.ResultsMothers reported significantly more often problems than fathers concerning stress due to earlier life events and burn-out. Mothers needed interventions such as individual psychoeducation or family counselling more than twice as often as fathers. Overall, mothers reported higher numbers of problems and needs for intervention than fathers. The number of mothers’ problems was predicted by not living with a partner and by a shorter duration of the patients’ illness. The number of mothers’ needs was predicted by more psychiatric symptoms, not living with a partner and a shorter duration of the patients’ illness. Among fathers we could not identify any predictors, neither for the number of problems nor for the number of needs.ConclusionsFathers and mothers often report problems and frequently need professional support. Overall, mothers exhibited more problems and needs for interventions than fathers. The differences between mothers and fathers indicate the importance of considering the carer’s gender in clinical work.

The importance of statistical modelling in clinical research : Comparing multidimensional Rasch-, structural equation and linear regression models for analyzing the depression of relatives of psychiatric patients.

SummaryBackgroundVarious studies have shown that caregiving relatives of schizophrenic patients are at risk of suffering from depression. These studies differ with respect to the applied statistical methods, which could influence the findings. Therefore, the present study analyzes to which extent different methods may cause differing results.MethodsThe present study contrasts by means of one data set the results of three different modelling approaches, Rasch Modelling (RM), Structural Equation Modelling (SEM), and Linear Regression Modelling (LRM).ResultsThe results of the three models varied considerably, reflecting the different assumptions of the respective models.ConclusionsLatent trait models (i. e., RM and SEM) generally provide more convincing results by correcting for measurement error and the RM specifically proves superior for it treats ordered categorical data most adequately.ZusammenfassungHintergrundIn zahlreichen Studien konnte gezeigt werden, dass die Betreuung schizophrener Patienten durch Angehörige eine große Belastung für die Angehörigen darstellen und zu Depressionen der Angehörigen führen kann. Allerdings unterscheiden sich diese Studien in ihrer statistischen Herangehensweise, was einen Einfluss auf die Ergebnisse haben kann.MethodikDie vorliegende Studie vergleicht daher drei verschiedene statistische Modelle, das Rasch-Modell (RM), das Strukturgleichungsmodell (SEM) und das lineare Regressionsmodell an einem Datensatz.ErgebnisseEs zeigten sich zum Teil deutliche Unterschiede zwischen den drei untersuchten Modellen, die sich durch deren spezifischen Annahmen erklären lassen.SchlussfolgerungenLatent-trait-Modelle (d. h. das RM und das SEM) führen im Allgemeinen zu überzeugenderen Ergebnissen, da sie den Messfehler korrigieren. Das RM erweist sich darüber hinaus als überlegen gegenüber den anderen Modellen, da es ordinalskalierte Daten am angemessensten verarbeiten kann.

The importance of statistical modelling in clinical research@@@Zur Bedeutung statistischen Modellierens in der klinischen Forschung: Comparing multidimensional Rasch-, structural equation and linear regression models for analyzing the depression of relatives of psychiatric patients@@@Ein Vergleich von mehrdimensionalem Rasch-Modell, Strukturgleichungsmodell und linearer Regressionsanalyse am Beispiel der Vorhersage von Depression Angehöriger von psychiatrischer Patienten

SummaryBackgroundVarious studies have shown that caregiving relatives of schizophrenic patients are at risk of suffering from depression. These studies differ with respect to the applied statistical methods, which could influence the findings. Therefore, the present study analyzes to which extent different methods may cause differing results.MethodsThe present study contrasts by means of one data set the results of three different modelling approaches, Rasch Modelling (RM), Structural Equation Modelling (SEM), and Linear Regression Modelling (LRM).ResultsThe results of the three models varied considerably, reflecting the different assumptions of the respective models.ConclusionsLatent trait models (i. e., RM and SEM) generally provide more convincing results by correcting for measurement error and the RM specifically proves superior for it treats ordered categorical data most adequately.ZusammenfassungHintergrundIn zahlreichen Studien konnte gezeigt werden, dass die Betreuung schizophrener Patienten durch Angehörige eine große Belastung für die Angehörigen darstellen und zu Depressionen der Angehörigen führen kann. Allerdings unterscheiden sich diese Studien in ihrer statistischen Herangehensweise, was einen Einfluss auf die Ergebnisse haben kann.MethodikDie vorliegende Studie vergleicht daher drei verschiedene statistische Modelle, das Rasch-Modell (RM), das Strukturgleichungsmodell (SEM) und das lineare Regressionsmodell an einem Datensatz.ErgebnisseEs zeigten sich zum Teil deutliche Unterschiede zwischen den drei untersuchten Modellen, die sich durch deren spezifischen Annahmen erklären lassen.SchlussfolgerungenLatent-trait-Modelle (d. h. das RM und das SEM) führen im Allgemeinen zu überzeugenderen Ergebnissen, da sie den Messfehler korrigieren. Das RM erweist sich darüber hinaus als überlegen gegenüber den anderen Modellen, da es ordinalskalierte Daten am angemessensten verarbeiten kann.

The importance of statistical modelling in clinical research

SummaryBackgroundVarious studies have shown that caregiving relatives of schizophrenic patients are at risk of suffering from depression. These studies differ with respect to the applied statistical methods, which could influence the findings. Therefore, the present study analyzes to which extent different methods may cause differing results.MethodsThe present study contrasts by means of one data set the results of three different modelling approaches, Rasch Modelling (RM), Structural Equation Modelling (SEM), and Linear Regression Modelling (LRM).ResultsThe results of the three models varied considerably, reflecting the different assumptions of the respective models.ConclusionsLatent trait models (i. e., RM and SEM) generally provide more convincing results by correcting for measurement error and the RM specifically proves superior for it treats ordered categorical data most adequately.ZusammenfassungHintergrundIn zahlreichen Studien konnte gezeigt werden, dass die Betreuung schizophrener Patienten durch Angehörige eine große Belastung für die Angehörigen darstellen und zu Depressionen der Angehörigen führen kann. Allerdings unterscheiden sich diese Studien in ihrer statistischen Herangehensweise, was einen Einfluss auf die Ergebnisse haben kann.MethodikDie vorliegende Studie vergleicht daher drei verschiedene statistische Modelle, das Rasch-Modell (RM), das Strukturgleichungsmodell (SEM) und das lineare Regressionsmodell an einem Datensatz.ErgebnisseEs zeigten sich zum Teil deutliche Unterschiede zwischen den drei untersuchten Modellen, die sich durch deren spezifischen Annahmen erklären lassen.SchlussfolgerungenLatent-trait-Modelle (d. h. das RM und das SEM) führen im Allgemeinen zu überzeugenderen Ergebnissen, da sie den Messfehler korrigieren. Das RM erweist sich darüber hinaus als überlegen gegenüber den anderen Modellen, da es ordinalskalierte Daten am angemessensten verarbeiten kann.

Limitations to Participation in Opioid Maintenance Treatment in Europe

Objective Our aim was to identify areas of improvement for current Opioid Maintenance Treatment (OMT) approaches, by analysing European Quality Audit of Opioid Treatment (EQUATOR) data from 8 European countries (Austria, Denmark, France, Germany, Norway, Portugal, Sweden, UK). Method A standardised face-to-face survey was administered to OMT patients (OMT-P) and active opioid user (AOU). Reasons for entering and staying out of OMT, rules pertaining to OMT, and factors facilitating OMT retention were compared between countries, and between OMT-P and AOU groups. Both groups were divided into those who never had OMT before [un-experienced OMT-P (n=573) and AOU (n=360)] and those who had been maintained at least once [experienced OMT-P (n=746) and AOU (n=377)]. Results Motives for starting OMT vary distinctly between countries (p≤0.001). Transnationally, experienced AOU reported concerns about their ability to follow treatment rules and negative treatment experiences as decisive reasons for staying out of OMT . Greater flexibility, less pressure to reduce their treatment dose and greater treatment structure were ranked significantly higher by experienced compared to un-experienced OMT-P as factors that might facilitate treatment retention (p≤0.05). Conclusion The major strength of this investigation was the homogenous methodology applied in all countries, which enabled new insights in variations between treatment systems and their impact on patient outcome. Treatment systems need to aim an optimal balance between flexibility and structure. Standardised approaches that still permit tailoring treatment to individual patient needs are crucial to yield maximum benefit for patients, and reduce the considerable societal economic burden of addiction.

S09-04 - Needs of fathers and mothers of schizophrenia patients

Introduction Most studies investigating the problems and needs of schizophrenia patients’ carers include only one care-giving relative - mostly the patients’ mothers. Purpose The compare needs of mothers and fathers of patients with schizophrenia. Methods 101 sets of parents of patients suffering from schizophrenia were included in this study. They were assessed by means of the “Carers’ Needs Assessment for Schizophrenia”. Results Compared to fathers, mothers reported significantly more often problems concerning stress due to earlier life events and burn-out. Mothers required some interventions such as individual psychoeducation or family counselling more than twice as often than fathers. Overall, mothers reported more problems and needs than fathers. The number of mothers’ problems was predicted by not living with a partner and a shorter duration of the patients’ illness (DUPI). The number of mothers’ needs was predicted by patients’ psychiatric symptoms, not living with a partner and a shorter DUPI. Among fathers we could not identify any predictors, neither for problems nor for needs. Conclusions Parents of schizophrenic patients have various problems handling their childs illness and therefore need professional support. Overall, mothers reported more problems and needs for interventions than fathers. The differences between mothers’ and fathers’ problems and needs indicate the importance of considering the carers gender in clinical work.

CS11-01 Disability in schizophrenic disorders

Aims The purpose of this study was to investigate disability among patients suffering from schizophrenia and to identify predictors of disability. Methods 101 patients from different types of psychiatric services in Vienna and diagnosed with schizophrenia according to ICD-10 were included. They were investigates by means of 36-Item self-administered version of the WHO Disability Assessment Schedule II (WHO-DAS-II) and the PANSS-scale. Patients’ mothers and fathers were asked to fill in the Family Problem Questionnaire. Results The mean total score of the WHO-DAS-II was 74.1 (SD 21.9). When using weighted sub-scores the highest disability scores were found for social contacts, participation in society and household (means 2.58, 2.57 and 2.51 respectively). Using logistic regression, overall disability was positively associated with patients age, overall severity of symptoms (PANSS) and number of previous hospital admissions. Overall disability was not associated with duration of illness and or patients gender. The subjective burden experienced by patients’ fathers and mothers were increased by reduced social contacts and impaired participation in society, while we could not find an association with other domains of patients disability (understanding, mobility, self-care, household). Conclusions This study shows that schizophrenia results in disability in several domains. Family caregivers’ burden was predominantly increased by social consequences of schizophrenia.

P4-172: Concurrent validity of the “Carers’ Needs Assessment Schedule for Dementia”

Background: Caregivers of dementia patients often suffer from numerous burdens. Several studies have shown that various interventions to caregivers are effective to reduce their burden and improve the patients’ outcome. A recently developed research instrument for assessing the needs of caregivers (“Carers’ Needs Assessment Schedule for Dementia” CNA-D) has been shown to have satisfactory inter-rater and retest reliability as well as content validity. Objective(s): The aim of the present study was to investigate concurrent validity of the CNA-D. Methods: Forty five relatives of dementia patients were enrolled for this study. To evaluate if plausible associations (i.e. indicators for concurrent validity) exist, two summary scores of the CNA-D were used: the number of moderate or serious problems among the carers and the number of interventions needed. Further the “Camberwell Assessment of Needs for the Elderly” (CANE) and the “General Health Questionnaire” (GHQ-12) were used. Results: The numbers of carers’ problems (CNA-D) were positively associated with the number of symptoms indicating anxiety disorders or depression (GHQ; r 0.625, p 0.000), the living situation of the patient (private household vs. nursing home; r 0.642, p 0.000) and the amount of time spent with the patient (r 0.330, p 0.040). Negative correlations were found with the extent of support the patient received from the private social network (r 0.430, p 0.005) or from professional services (r -0.384, p 0.012). Similar results were yielded for the number of interventions needed (CNAD). Conclusions: Overall, these results indicate that the concurrent validity of the CNA-D is satisfactory.