Patient-appraised beneficial moments during inpatient psychiatric treatment

Abstract

Background: Psychiatric inpatients receive a multidisciplinary treatment approach, covering psychiatry, nursing, occupational therapy, and psychology. Research findings reveal that the effectiveness of any treatment is associated with three types of factors: specific (e.g., treatment techniques), common (e.g., clinician-patient relationship, patients' expectations) and extra-therapeutic. However, there is little published research on the factors and events which inpatients themselves consider to be beneficial ('beneficial moments').

Methods: Inpatients (N = 107) of a psychiatric clinic completed a questionnaire to elicit their appraisal of beneficial moments. A qualitative content analysis was applied. The coding procedure was conducted independently by two authors.

Results: Self-appraised beneficial moments were found in five areas: therapy-specific components (number of quotations, N = 204), positive relationships (N = 140), clinical setting and environment (N = 52), inpatients' new insights (N = 36), and factors unrelated to either therapy or the clinic (N = 30). In total, 44% of the quotations were related to specific factors, 49% to common factors, and 7% to extra-therapeutic factors.

Conclusions: Inpatients judge both specific and common factors as crucial for the therapeutic benefit they gain during their stay at the clinic. Our results differ from meta-analytical findings, where the impact of specific factors on symptom improvement has shown to be much smaller (i.e., 17%) than appraised by patients in our study (i.e., 44%). Our study underlines the importance of a patient-centred care approach as well as shared decision making and patient-clinician communication. For clinical practice, knowledge of inpatients' perspectives on beneficial moments is crucial in order to reinforce precisely these therapeutic components.

Keywords: Beneficial moments; Common factors; Content analysis; Inpatients; Qualitative; Specific factors.

Fig. 1

Number of Quotations for Main Themes. Note. Black bars are specific factors, grey bars are common factors and bright bars are extra-therapeutic factors

Fig. 2

a Ranking of how important different factors are in treatment: Inpatients’ perspectives (N = 107) Note. Based on the main themes of the questionnaire. b Ranking of how important different factors are in treatment: Meta-analytic research findings in out- and inpatients (N = 2′805). Note. Factors outside the therapy = extra-therapeutic factors; non-specific factors = common factors. Reprinted from “The efficacy of non-directive supportive therapy for adult depression: a meta-analysis.” Clinical psychology review, 32 (4), 280–291, Copyright (2012), with permission from Elsevier