Abstract
Recent research suggests that despite the development of effective psychiatric treatment, optimal results are not achieved. This hypothesis-generating study had the objective of dissecting the process of care in an attempt to understand outcomes for patients and, this paper's focus, their families.
Twenty-four patients who carried a DSM-III diagnosis of Major Affective Disorder were identified 12-18 months after hospital admission in three countries (Italy, Japan, and the United States). The patients, their families, and their doctors were interviewed separately, and then together, using instruments measuring delivery of treatment (using an ideal treatment criteria set) and achievement of treatment goals, which were then (using nonparametric statistical techniques) correlated with resolution of the index episode for the family.
The data demonstrated that only four families of the 24 had achieved a relatively successful resolution. Physicians delivered only 37% and subsequently, achieved only 44% of what would be considered ideal care to families. The alliance achieved was almost twice as good with patients (4.1 out of 5) as with families (2.3). There was very poor achievement of helping families to understand the relation of the symptoms to the family context, setting goals with or recognizing major family problem areas (causing or resulting from the illness), or achieving psychoeducation.
For the most part, at followup almost all of the families were either no better off, or worse, than at the time of the index episode.