EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
J Affect Disord. 2011 Nov;134(1-3):242-8. doi: 10.1016/j.jad.2011.05.052.
There is evidence that late life depression is associated with high levels of unmet needs. Only a minority of the depressed patients appears to be adequately treated.
Ninety-nine older patients (58-92 years), 96 informal carers and 85 health-care professionals were recruited from six outpatient facilities for old age psychiatry in the Netherlands and interviewed to identify met and unmet needs, using the Camberwell Assessment of Needs for the Elderly (CANE). The severity of depression was measured with the Montgomery Åsberg Depression Rating Scale (MADRS).
On average patients scored more unmet needs than staff and carers. On item level, patients and staff showed the highest agreement in the psychological needs category. Patient and carers showed the highest agreement on physical health needs. Logistic regression showed that severe depression is a significant predictor of low concordance between stakeholders on a substantial number of CANE items.
Kappa coefficients were computed to determine agreement between parties involved. However, Kappa coefficients should be interpreted with caution, especially when obvious disparity in unmet needs scores between groups of interest can be observed.
Home dwelling older patients with major depressive disorder, their practitioners and their informal carers have different perceptions of the older patients unmet needs.Practitioners should be aware of the negative impact of depression severity on reaching agreement regarding unmet needs and its possible consequences for mutual goal setting and compliance.
有证据表明，老年抑郁症与未满足的需求高度相关。只有少数抑郁患者得到了充分的治疗。
从荷兰的六个老年精神病门诊机构招募了 99 名老年患者（58-92 岁）、96 名非正式照顾者和 85 名卫生保健专业人员，并使用老年坎贝尔评估需求量表（CANE）对他们进行访谈，以确定满足和未满足的需求。使用蒙哥马利抑郁评定量表（MADRS）来测量抑郁的严重程度。
平均而言，患者的未满足需求得分高于工作人员和照顾者。在项目层面上，患者和工作人员在心理需求类别上表现出最高的一致性。患者和照顾者在身体健康需求上表现出最高的一致性。逻辑回归显示，严重抑郁是利益相关者在大量 CANE 项目上低一致性的一个重要预测因素。
计算了 Kappa 系数来确定各利益相关方之间的一致性。然而，Kappa 系数的解释应该谨慎，特别是当可以观察到有兴趣的群体之间的未满足需求评分存在明显差异时。
患有重度抑郁症的居家老年患者、他们的治疗师和他们的非正式照顾者对老年患者的未满足需求有不同的看法。治疗师应该意识到抑郁严重程度对达成关于未满足需求的共识的负面影响，以及其对共同目标设定和依从性的可能后果。
