The impact of mental illness on patient satisfaction with the therapeutic relationship - A multilevel analysis

Background The relationship between patients and their clinicians is an essential factor in psychiatric treatment. The purpose of this study was to analyze the influence of psychopathology on patient satisfaction with the therapeutic relationship. Methods Data from 969 patients from 40 different treatment teams collected from eight Norwegian community mental health centres were analyzed. Patient satisfaction with the therapeutic relationship was assessed with a six-item scale: sufficient time for contact/dialogue, clinicians' ability to listen and understand, follow-up of planned interventions, respect for patients' views/opinions, cooperation among clinicians, and patients' influence on treatment. Mental illness was assessed using the Health of the Nation Outcome Scales (HoNOS) and Global Assessment of Functioning (GAF) scale. Diagnoses were established using the International Statistical Classification of Diseases and Related Health Problems-10th revision (ICD-10). Treatment outcomes were clinically assessed retrospectively by rating changes from start of treatment on seven items. Multilevel regression analysis was used for a simultaneous analysis of the contribution of patient and team variables. Results Satisfaction was associated with treatment outcome, better health as assessed using HoNOS, being female, of older age and having less psychiatric team severity indicated by the teams' mean GAF score. Patients with a schizophrenia spectrum disorder were more satisfied when treated as in- and day patients, compared with outpatient treatment. Patients in other diagnostic categories were less satisfied with day treatment. Conclusions Patients' perceptions of the therapeutic relationship may be influenced by psychopathology. Teams comprising many patients with severe mental illness may constrain the therapeutic relationship. Hence, resources and organizational measures should be carefully considered in such care units.