Pub Date : 2010-07-01DOI: 10.1017/s1121189x00001184
Johanna Meier, Thomas Becker, Anita Patel, Debbie Robson, Aart Schene, Martijn Kikkert, Corrado Barbui, Lorenzo Burti, Bernd Puschner
Aim: To investigate the relation between medication-related factors and adherence in people with schizophrenia in outpatient treatment.
Methods: The sample comprised 409 outpatients (ICD-10 diagnosis of schizophrenia) with clinician-rated instability in four European cities (Amsterdam, The Netherlands; Verona, Italy; Leipzig, Germany; London, Great Britain). Adherence was assessed using the Medication Adherence Questionnaire (patient perspective), and the Clinician Rating Scale (clinician perspective). Examined medication-related factors were type (atypical vs. typical), application (oral vs. depot), daily dose frequency of antipsychotic medication (Medication History Scale), number of side effects (Liverpool University Neuroleptic Side Effect Rating Scale), and patient attitudes toward medication (Drug Attitude Inventory). Multiple regression analysis was used to identify predictors of adherence by medication-related factors.
Results: Adherence, as rated by patient and clinician, was predicted by patient attitude towards medication, but was unrelated to type of drug, formulation or side effects of antipsychotic medication. A high daily dose frequency was associated with better adherence, but only when rated by the patient.
Conclusions: In order to improve adherence there is a need to seriously consider and attempt to improve patient attitude toward medication. However, type of antipsychotic and other medication-related factors may not be as closely related to adherence as it has often been suggested.
{"title":"Effect of medication-related factors on adherence in people with schizophrenia: a European multi-centre study.","authors":"Johanna Meier, Thomas Becker, Anita Patel, Debbie Robson, Aart Schene, Martijn Kikkert, Corrado Barbui, Lorenzo Burti, Bernd Puschner","doi":"10.1017/s1121189x00001184","DOIUrl":"https://doi.org/10.1017/s1121189x00001184","url":null,"abstract":"<p><strong>Aim: </strong>To investigate the relation between medication-related factors and adherence in people with schizophrenia in outpatient treatment.</p><p><strong>Methods: </strong>The sample comprised 409 outpatients (ICD-10 diagnosis of schizophrenia) with clinician-rated instability in four European cities (Amsterdam, The Netherlands; Verona, Italy; Leipzig, Germany; London, Great Britain). Adherence was assessed using the Medication Adherence Questionnaire (patient perspective), and the Clinician Rating Scale (clinician perspective). Examined medication-related factors were type (atypical vs. typical), application (oral vs. depot), daily dose frequency of antipsychotic medication (Medication History Scale), number of side effects (Liverpool University Neuroleptic Side Effect Rating Scale), and patient attitudes toward medication (Drug Attitude Inventory). Multiple regression analysis was used to identify predictors of adherence by medication-related factors.</p><p><strong>Results: </strong>Adherence, as rated by patient and clinician, was predicted by patient attitude towards medication, but was unrelated to type of drug, formulation or side effects of antipsychotic medication. A high daily dose frequency was associated with better adherence, but only when rated by the patient.</p><p><strong>Conclusions: </strong>In order to improve adherence there is a need to seriously consider and attempt to improve patient attitude toward medication. However, type of antipsychotic and other medication-related factors may not be as closely related to adherence as it has often been suggested.</p>","PeriodicalId":72946,"journal":{"name":"Epidemiologia e psichiatria sociale","volume":"19 3","pages":"251-9"},"PeriodicalIF":0.0,"publicationDate":"2010-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1017/s1121189x00001184","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"29619483","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Screening of binge eating in a community mental health service.","authors":"Andrea Pierò, Enrica Locati, Francesco Zirilli","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":72946,"journal":{"name":"Epidemiologia e psichiatria sociale","volume":"19 3","pages":"260-5"},"PeriodicalIF":0.0,"publicationDate":"2010-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"29619485","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The British Journal of Psychiatry is an independent mainstream general psychiatric journal that competes reasonably well with others in the field. It does so by keeping a healthy balance between the demands of its readers, its contributors and the need for good science. It publishes an eclectic mix of original articles, reviews, editorials, reappraisals, comment, opinion and extras, the latter including poetry, short summaries, literature and psychiatry, and a touch of humour. These contributions are not always in keeping with the harsh requirements of the impact factor, but we judge that this makes for a better all-round journal that advances psychiatry in all its manifold aspects and is anything but dull.
{"title":"The place of the British Journal of Psychiatry in the mental health league.","authors":"Peter Tyrer","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The British Journal of Psychiatry is an independent mainstream general psychiatric journal that competes reasonably well with others in the field. It does so by keeping a healthy balance between the demands of its readers, its contributors and the need for good science. It publishes an eclectic mix of original articles, reviews, editorials, reappraisals, comment, opinion and extras, the latter including poetry, short summaries, literature and psychiatry, and a touch of humour. These contributions are not always in keeping with the harsh requirements of the impact factor, but we judge that this makes for a better all-round journal that advances psychiatry in all its manifold aspects and is anything but dull.</p>","PeriodicalId":72946,"journal":{"name":"Epidemiologia e psichiatria sociale","volume":"19 3","pages":"196-9"},"PeriodicalIF":0.0,"publicationDate":"2010-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"29621591","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2010-07-01DOI: 10.1017/S1121189X00001172
D. Holub, B. Wenigová, D. Umbricht, A. Simon
SUMMARY Aim – To explore knowledge, treatment setting, attitudes and needs associated with patients in early phases of psychosis among general practitioners (GPs) in Prague, andto compare results with GPs from 6 countries participating in the International GP Study (IGPS) on Early Psychosis (Canada, Australia, New Zealand, England, Norway,Austria). Methods – Survey questionnaires were mailed to 648 GPs in the city of Prague. Results – The response rate was 19.9%. Prague GPs showed significantly lower diagnostic knowledge of early phases of psychosis compared to their international colleagues. They frequently indicated depression/anxiety and somatic complaints as early warnings of psychosis. They more often considered their behaviour to be problematic and more commonly handed them over to specialists. The majority of Prague GPs wished specialized outpatient services for low-threshold referrals of such patients. Conclusions – Along the mental health reforms in the Czech Republic which emphasis the role of primary care, GPs' knowledge of the early warning signs of psychosis needs to be improved. Declaration of Interest: The study was supported by an unrestricted grant from Sanofi-Synthélabo SA, Switzerland, to the principal investigators of the IGPS (AES, DU). The authors have stated that there are none; all authors are independent from the funding body and the views expressed in this paper have not been influenced by the funding source.
{"title":"Primary care and the early phases of schizophrenia in the Czech Republic","authors":"D. Holub, B. Wenigová, D. Umbricht, A. Simon","doi":"10.1017/S1121189X00001172","DOIUrl":"https://doi.org/10.1017/S1121189X00001172","url":null,"abstract":"SUMMARY Aim – To explore knowledge, treatment setting, attitudes and needs associated with patients in early phases of psychosis among general practitioners (GPs) in Prague, andto compare results with GPs from 6 countries participating in the International GP Study (IGPS) on Early Psychosis (Canada, Australia, New Zealand, England, Norway,Austria). Methods – Survey questionnaires were mailed to 648 GPs in the city of Prague. Results – The response rate was 19.9%. Prague GPs showed significantly lower diagnostic knowledge of early phases of psychosis compared to their international colleagues. They frequently indicated depression/anxiety and somatic complaints as early warnings of psychosis. They more often considered their behaviour to be problematic and more commonly handed them over to specialists. The majority of Prague GPs wished specialized outpatient services for low-threshold referrals of such patients. Conclusions – Along the mental health reforms in the Czech Republic which emphasis the role of primary care, GPs' knowledge of the early warning signs of psychosis needs to be improved. Declaration of Interest: The study was supported by an unrestricted grant from Sanofi-Synthélabo SA, Switzerland, to the principal investigators of the IGPS (AES, DU). The authors have stated that there are none; all authors are independent from the funding body and the views expressed in this paper have not been influenced by the funding source.","PeriodicalId":72946,"journal":{"name":"Epidemiologia e psichiatria sociale","volume":"19 1","pages":"243 - 250"},"PeriodicalIF":0.0,"publicationDate":"2010-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1017/S1121189X00001172","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"57441994","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2010-06-01DOI: 10.1017/S1121189X00000853
M. Drukker, C. Kaplan, Frans J. M. Feron, J. van os, A. Korebrits
Summary Aim – Delinquency among adolescents and antecedent conduct disorder among children has been recognized as a growing public mental health problem in contemporary societies. The contribution of the neighbourhood environment to delinquent behaviour was examined in a cohort of Dutch adolescents (aged approximately 11 years at baseline; n=394). Methods – Multilevel regression analyses estimated associations between baseline neighbourhood socioeconomic status and social capital, and delinquent behaviour two years later controlling for individual-level variables. Results – A significant interaction effect was found between neighbourhood environment variables and gender in models of delinquency, indicating that associations between neighbourhood environment variables and delinquency were apparent, for the most part, in girls only. However, higher level of neighbourhood informal social control was associated with increased delinquency rates in boys. Conclusion – In girls there is a longitudinal association between neighbourhood characteristics and delinquency, suggesting complex gender differences in the way the wider social environment impacts on behavioural outcomes.
{"title":"Delinquency in context; neighbourhood and gender interactions among adolescents","authors":"M. Drukker, C. Kaplan, Frans J. M. Feron, J. van os, A. Korebrits","doi":"10.1017/S1121189X00000853","DOIUrl":"https://doi.org/10.1017/S1121189X00000853","url":null,"abstract":"Summary Aim – Delinquency among adolescents and antecedent conduct disorder among children has been recognized as a growing public mental health problem in contemporary societies. The contribution of the neighbourhood environment to delinquent behaviour was examined in a cohort of Dutch adolescents (aged approximately 11 years at baseline; n=394). Methods – Multilevel regression analyses estimated associations between baseline neighbourhood socioeconomic status and social capital, and delinquent behaviour two years later controlling for individual-level variables. Results – A significant interaction effect was found between neighbourhood environment variables and gender in models of delinquency, indicating that associations between neighbourhood environment variables and delinquency were apparent, for the most part, in girls only. However, higher level of neighbourhood informal social control was associated with increased delinquency rates in boys. Conclusion – In girls there is a longitudinal association between neighbourhood characteristics and delinquency, suggesting complex gender differences in the way the wider social environment impacts on behavioural outcomes.","PeriodicalId":72946,"journal":{"name":"Epidemiologia e psichiatria sociale","volume":"8 1","pages":"148 - 158"},"PeriodicalIF":0.0,"publicationDate":"2010-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1017/S1121189X00000853","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"57440668","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2010-06-01DOI: 10.1017/S1121189X00000774
N. Hepgul, V. Mondelli, C. Pariante
Abstract Depression is frequently seen in patients with medical illnesses yet the link between medical illnesses and depression remains unclear. There is increasing data to suggest that the array of depressive symptoms experienced by the medically-ill may involve inflammation. The activation of the immune system and the subsequent release of innate immune products such as cytokines can have important effects on behaviour. The treatment of choice for chronic viral hepatitis C, interferon-alpha IFN-α, acutely induces the production and release of other innate immune cytokines, and has been indicated to cause clinically significant depression in 30% of patients receiving treatment. This in turn can impair quality of life and affect treatment compliance. We and others use IFN-α induced depression as a model to identify alterations in psychological and biological pathways that predispose to depression in the medically-ill, and thus provide an explanatory link between inflammation and the subsequent behavioural changes. In this editorial, we aim to describe the main biological pathways involved in IFN-induced depression and to discuss psychological, clinical and biological factors that have been found to predict those who will develop more severe psychiatric symptoms during treatment with IFN-α. Among these, particular attention would be given to psychological traits, genetic polymorphisms regulating inflammation and serotonergic function, and changes in plasma levels of pro-inflammatory cytokines.
{"title":"Psychological and biological mechanisms of cytokine induced depression","authors":"N. Hepgul, V. Mondelli, C. Pariante","doi":"10.1017/S1121189X00000774","DOIUrl":"https://doi.org/10.1017/S1121189X00000774","url":null,"abstract":"Abstract Depression is frequently seen in patients with medical illnesses yet the link between medical illnesses and depression remains unclear. There is increasing data to suggest that the array of depressive symptoms experienced by the medically-ill may involve inflammation. The activation of the immune system and the subsequent release of innate immune products such as cytokines can have important effects on behaviour. The treatment of choice for chronic viral hepatitis C, interferon-alpha IFN-α, acutely induces the production and release of other innate immune cytokines, and has been indicated to cause clinically significant depression in 30% of patients receiving treatment. This in turn can impair quality of life and affect treatment compliance. We and others use IFN-α induced depression as a model to identify alterations in psychological and biological pathways that predispose to depression in the medically-ill, and thus provide an explanatory link between inflammation and the subsequent behavioural changes. In this editorial, we aim to describe the main biological pathways involved in IFN-induced depression and to discuss psychological, clinical and biological factors that have been found to predict those who will develop more severe psychiatric symptoms during treatment with IFN-α. Among these, particular attention would be given to psychological traits, genetic polymorphisms regulating inflammation and serotonergic function, and changes in plasma levels of pro-inflammatory cytokines.","PeriodicalId":72946,"journal":{"name":"Epidemiologia e psichiatria sociale","volume":"19 1","pages":"98 - 102"},"PeriodicalIF":0.0,"publicationDate":"2010-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1017/S1121189X00000774","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"57440337","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2010-06-01DOI: 10.1017/S1121189X00000877
L. Grigoletti, F. Amaddeo, A. Grassi, M. Boldrini, M. Chiappelli, M. Percudani, F. Catapano, A. Fiorillo, F. Perris, M. Bacigalupi, P. Albanese, Simona Simonetti, P. De Agostini, M. Tansella
Summary Aim – To develop predictive models to allocate patients into frequent and low service users groups within the Italian Community-based Mental Health Services (CMHSs). To allocate frequent users to different packages of care, identifing the costs of these packages. Methods – Socio-demographic and clinical data and GAF scores at baseline were collected for 1250 users attending five CMHSs. All psychiatric contacts made by these patients during six months were recorded. A logistic regression identified frequent service users predictive variables. Multinomial logistic regression identified variables able to predict the most appropriate package of care. A cost function was utilised to estimate costs. Results – Frequent service users were 49%, using nearly 90% of all contacts. The model classified correctly 80% of users in the frequent and low users groups. Three packages of care were identified: Basic Community Treatment (4,133 Euro per six months); Intensive Community Treatment (6,180 Euro) and Rehabilitative Community Treatment (11,984 Euro) for 83%, 6% and 11% of frequent service users respectively. The model was found to be accurate for 85% of users. Conclusion – It is possible to develop predictive models to identify frequent service users and to assign them to pre-defined packages of care, and to use these models to inform the funding of psychiatric care.
{"title":"A predictive model to allocate frequent service users of community-based Mental Health Services to different packages of care","authors":"L. Grigoletti, F. Amaddeo, A. Grassi, M. Boldrini, M. Chiappelli, M. Percudani, F. Catapano, A. Fiorillo, F. Perris, M. Bacigalupi, P. Albanese, Simona Simonetti, P. De Agostini, M. Tansella","doi":"10.1017/S1121189X00000877","DOIUrl":"https://doi.org/10.1017/S1121189X00000877","url":null,"abstract":"Summary Aim – To develop predictive models to allocate patients into frequent and low service users groups within the Italian Community-based Mental Health Services (CMHSs). To allocate frequent users to different packages of care, identifing the costs of these packages. Methods – Socio-demographic and clinical data and GAF scores at baseline were collected for 1250 users attending five CMHSs. All psychiatric contacts made by these patients during six months were recorded. A logistic regression identified frequent service users predictive variables. Multinomial logistic regression identified variables able to predict the most appropriate package of care. A cost function was utilised to estimate costs. Results – Frequent service users were 49%, using nearly 90% of all contacts. The model classified correctly 80% of users in the frequent and low users groups. Three packages of care were identified: Basic Community Treatment (4,133 Euro per six months); Intensive Community Treatment (6,180 Euro) and Rehabilitative Community Treatment (11,984 Euro) for 83%, 6% and 11% of frequent service users respectively. The model was found to be accurate for 85% of users. Conclusion – It is possible to develop predictive models to identify frequent service users and to assign them to pre-defined packages of care, and to use these models to inform the funding of psychiatric care.","PeriodicalId":72946,"journal":{"name":"Epidemiologia e psichiatria sociale","volume":"19 1","pages":"168 - 177"},"PeriodicalIF":0.0,"publicationDate":"2010-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1017/S1121189X00000877","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"57440902","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2010-06-01DOI: 10.1017/S1121189X00000890
Alessia Bajoni, A. Barbato, B. D'avanzo, E. Muggia
Conoscere la percezione dei familiari rispetto ai Servizi di salute mentale è importante in funzione del loro ruolo nella cura dei pazienti gravi, della conoscenza che essi hanno della situazione di un congiunto malato, dei loro specifici bisogni di cura e assistenza (Noble et al., 2004). Gli studi svolti fino agli anni ‘80 hanno evidenziato valutazioni critiche tra i familiari e notevoli discrepanze tra familiari e operatori nella percezione dell’adeguatezza dei Servizi. Venivano criticate soprattutto l’accessibilità e la qualità delle cure, nonché la scarsa disponibilità dei clinici alla collaborazione e allo scambio di informazioni (Holden & Lewine, 1982). In seguito è emersa un’evoluzione positiva della relazione tra operatori e familiari (Hatfield et al., 1996). Nel complesso, le ricerche mostrano che i familiari attribuiscono grande importanza al coinvolgimento nel programma di cura, alle informazioni sulla salute del paziente e sulle prestazioni dei Servizi, al sostegno a domicilio, alla collaborazione tra operatori e familiari (Noble et al., 2004; Drapalski et al., 2008; Schene & Wijngarden, 1995). Questi elementi sono stati confermati, pur con una notevole variabilità di risultati, dalle ricerche italiane, che sono state effettuate su singoli Servizi, con campioni relativamente piccoli (Ruggeri & Dall’Agnola, 1994; Cozza et al., 1997; Gigantesco et al., 2002, Pizzichi et al., 2004). Benché aspettative e preferenze dei familiari siano simili a quelle dei pazienti, vi sono alcune divergenze significative: i familiari attribuiscono maggiore importanza agli interventi di emergenza e ai contesti di cura caratterizzati da supervisione e controllo, mentre i pazienti valorizzano di più la libertà di scelta nell’ambito dei trattamenti (Noble et al., 2004). In molti casi le rilevazioni sono state curate da associazioni di familiari che hanno raccolto le opinioni dei propri aderenti, in altri le indagini sono state gestite dai Servizi o da Istituti di ricerca e hanno interessato campioni di familiari in contatto coi Servizi (Noble et al., 2004). Nel primo caso si pone il problema della rappresentatività dei familiari organizzati rispetto ai familiari in generale; nel secondo è possibile che la partecipazione a una ricerca gestita, controllata ed eseguita da professionisti induca più facilmente la tendenza al compiacimento attenuando possibili attitudini critiche. È stato proposto il coinvolgimento delle associazioni dei familiari nella valutazione affinché acquisiscano strumenti per interagire coi Servizi, superando la tendenza a documentarne le carenze in modo aneddotico o in riferimento a casi singoli (Lomonaco et al., 2003). Peraltro è importante per le associazioni rilevare il punto di vista dei familiari che non riescono a raggiungere. Sulla base di queste considerazioni, l’Unione Nazionale Associazioni per la Salute Mentale (UNASAM), principale associazione italiana dei familiari, ha chiesto all’Istituto di Ricerche Farmacologiche Mario Negri
了解家庭成员对精神卫生服务的看法是很重要的，因为他们在照顾严重病人方面的作用，他们对病人的情况的了解，以及他们对治疗和护理的具体需要(Noble et al.， 2004)。直到20世纪80年代进行的研究显示，家庭成员之间存在关键的评估，家庭成员和从业人员对服务的充分性的看法存在显著差异。主要的批评是治疗的可及性和质量，以及临床医生缺乏合作和信息交流的意愿(Holden & Lewine, 1982)。从那以后，工人和家庭之间的关系出现了积极的发展(Hatfield et al.， 1996)。总的来说，研究表明，家庭成员非常重视参与护理计划、病人健康和服务信息、家庭支持、家庭工作者之间的合作(Noble et al.， 2004;Drapalski等人，2008;Schene & Wijngarden, 1995)。这些因素得到了意大利对个别部门进行的研究的证实，这些研究的结果差别很大，这些研究的样本相对较小(Ruggeri & agnola, 1994;贻贝等，1997;(参见《巨人et al.， 2002, Pizzichi et al.， 2004》)。虽然家庭的期望和喜好的病人,有一些类似的重大分歧:家庭成员更重视紧急干预和治疗的情况下的监督和控制,而病人的治疗范围内更多的选择自由的重视(Noble et al ., 2004)。在许多情况下，调查是由收集成员意见的家庭协会进行的，而在另一些情况下，调查是由部门或研究机构进行的，涉及与服务有关的家庭成员的样本(Noble et al.， 2004)。在第一种情况下，问题是有组织家庭成员相对于一般家庭成员的代表性;在第二种情况下，参与由专业人员管理、控制和执行的研究可能会更容易导致自满情绪，从而降低批评态度的可能性。有人建议，家庭成员协会应参与评价，以便获得与服务相互作用的工具，并克服以轶事或个案为基础记录其不足之处的倾向(Lomonaco et al.， 2003)。然而，重要的是，协会要注意那些无法接触到的家庭成员的观点。在这种背景下,欧洲联盟国家精神健康协会(UNASAM)、意大利家庭协会,要求该研究所主要药理研究Mario进行一项旨在研究黑人家庭提供一种直接参与模式,组建家庭小组拟订和评价收集高质量的指标,来从未经挑选的家庭成员中获得关于精神病学服务质量的意见。为实现这些目标而设计的研究由卫生部资助，并在2006年至2008年期间进行。
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