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Social Psychiatry and Psychiatric Epidemiology

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01-04-2014 | Original Paper

The motivation paradox: higher psychosocial problem levels in severely mentally ill patients are associated with less motivation for treatment

Authors: Cornelis L. Mulder, E. Jochems, H. E. Kortrijk

Published in: Social Psychiatry and Psychiatric Epidemiology | Issue 4/2014

Abstract

Purpose

Lack of motivation for treatment makes a subgroup of patients with severe mental illness (SMI) difficult to engage in psychiatric treatment. Such difficult-to-engage patients may also be the most in need of treatment. We hypothesized that the level of psychosocial problems would be inversely related to motivation for treatment.

Methods

Cross-sectional study in two independent samples. The first sample (n = 294) included SMI patients who participated in a randomized controlled trial and were assessed using the Health of the Nation Outcome Scales (HoNOS) and self-rated and clinician-rated motivation-for-treatment scales. The second sample (n = 1,170) included SMI patients who were treated in Assertive Outreach Teams and were routinely assessed with the HoNOS and a motivation-for-treatment scale. In both samples, patients also self-rated their quality of life.

Results

In both samples, patients with HoNOS scores of 16 and higher had lower motivation scores on all motivation scales than patients with lower HoNOS scores, and also a lower quality of life.

Conclusions

A motivation paradox seems inherent to this association between higher psychosocial problems levels, less motivation for treatment, and lower quality of life. Such a paradox has clinical relevance, as it may provide an ethical basis for outreach services which aim to engage marginally motivated SMI patients with severe psychosocial problems into mental health care.

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Title: The motivation paradox: higher psychosocial problem levels in severely mentally ill patients are associated with less motivation for treatment
Authors: Cornelis L. Mulder
E. Jochems
H. E. Kortrijk
Publication date: 01-04-2014
Publisher: Springer Berlin Heidelberg
Published in: Social Psychiatry and Psychiatric Epidemiology / Issue 4/2014
Print ISSN: 0933-7954
Electronic ISSN: 1433-9285
DOI: https://doi.org/10.1007/s00127-013-0779-7

At a glance: The STEP trials

Springer Medicine

The motivation paradox: higher psychosocial problem levels in severely mentally ill patients are associated with less motivation for treatment

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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