Kumar Rajeet, Chakrabarti Subho, Ghosh Abhishek
Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India.
World J Psychiatry. 2022 Jun 19;12(6):814-826. doi: 10.5498/wjp.v12.i6.814.
Treatment alliance has an impact on several key patient outcomes in all psychiatric disorders, including bipolar disorder (BD). It has been suggested that the construct of treatment alliance is different among patients from routine psychiatric settings compared to psychotherapeutic settings. However, research on the composition of treatment alliance in psychiatric disorders, such as BD, is relatively limited.
To determine whether a broader construct of treatment alliance was prevalent among outpatients with BD.
This is a cross-sectional study, conducted in the psychiatric unit of a multi-specialty hospital in north India over 12 mo (September 2018 to September 2019). A consecutive sample of 160 remitted adult outpatients with BD on mood stabilizers for at least a year were selected. The principal instrument to assess treatment alliance was the Working Alliance Inventory-client version (WAI-Client). Other potential constituents of the alliance explored were perceived trust in clinicians assessed by the Trust in Physicians (TRIP) scale, perceived support from clinicians assessed by the Psychosocial Care by Physicians (PCP) scale, and perceived treatment satisfaction assessed by the Patient Satisfaction Questionnaire (PSQ). Associations between scores on all scales were determined by correlational and multiple regression analyses. Exploratory factor analysis of combined items of all scales was conducted using a principal components analysis.
Scores on all the three WAI-Client subscales were significantly correlated with each other ( = 0.66-0.81; < 0.0001). The total TRIP scores were associated with the total WAI-Client scores ( = 0.28; < 0.01). The total TRIP scores and the total PCP scores were also significantly associated with the WAI-Client scores on the Task subscale ( = 0.28-0.29; < 0.01). The total TRIP scores were significantly associated with the total PSQ scores ( = 0.45; < 0.0001). Factor analysis yielded two independent and coherent factors, which explained 69% of the variance in data. Factor-1 ("alliance and support"), which explained about 41% of the variance, was comprised of a combined WAI-Client goal-task-bond component as well as the PCP support items. Factor-2 ("trust and satisfaction"), which explained about 28% of the variance, consisted of all the TRIP trust and the PSQ treatment satisfaction items.
A broader construct of treatment alliance in BD was found. Apart from collaborative components, this construct included patients' perceptions regarding trust in clinicians, support from clinicians, and treatment satisfaction.
治疗联盟对所有精神障碍的几个关键患者结局都有影响，包括双相情感障碍（BD）。有人提出，与心理治疗环境中的患者相比，常规精神科环境中的患者治疗联盟的构成有所不同。然而，关于精神障碍（如BD）中治疗联盟构成的研究相对有限。
确定BD门诊患者中是否普遍存在更广泛的治疗联盟概念。
这是一项横断面研究，于2018年9月至2019年9月在印度北部一家多专科医院的精神科进行，为期12个月。选取了160名连续样本，这些成年BD门诊患者服用情绪稳定剂至少一年且病情已缓解。评估治疗联盟的主要工具是工作联盟量表-患者版（WAI-Client）。探索的联盟其他潜在组成部分包括通过医师信任量表（TRIP）评估的对临床医生的感知信任、通过医师社会心理护理量表（PCP）评估的来自临床医生的感知支持以及通过患者满意度问卷（PSQ）评估的感知治疗满意度。通过相关性和多元回归分析确定所有量表得分之间的关联。使用主成分分析对所有量表的组合项目进行探索性因素分析。
WAI-Client的所有三个子量表得分之间均显著相关（r = 0.66 - 0.81；P < 0.0001）。TRIP总分与WAI-Client总分相关（r = 0.28；P < 0.01）。TRIP总分和PCP总分也与任务子量表上的WAI-Client得分显著相关（r = 0.28 - 0.29；P < 0.01）。TRIP总分与PSQ总分显著相关（r = 0.45；P < 0.0001）。因素分析产生了两个独立且连贯的因素，解释了数据中69%的方差。解释约41%方差的因素1（“联盟与支持”）由WAI-Client目标-任务-纽带成分以及PCP支持项目组成。解释约28%方差的因素2（“信任与满意度”）由所有TRIP信任和PSQ治疗满意度项目组成。
发现BD中存在更广泛的治疗联盟概念。除了协作成分外，该概念还包括患者对临床医生的信任、来自临床医生的支持以及治疗满意度的感知。
