Trust and expectation on psychiatrist and its correlation with
					satisfaction and adherence in patients with mental illness

RAM, DUSHAD; GOWDAPPA, BASAVANA

doi:10.1590/0101-60830000000040

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Original articles • Arch. Clin. Psychiatry (São Saulo) 42 (1) • Feb 2015 • https://doi.org/10.1590/0101-60830000000040 linkcopy

Trust and expectation on psychiatrist and its correlation with satisfaction and adherence in patients with mental illness

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Background Trust and expectation are important aspect of doctor patient relationship and its role in patient’s satisfaction and medication adherence is unclear.

Objective To study the levels of trust and expectation on psychiatrist and its relationship with patient’s satisfaction and treatment adherence.

Methods One hundred and twenty three consecutive outpatients were recruited on follow-up if they satisfied the selection criteria. They were assessed with socio-demographic and clinical proforma designed for this study, Patient Trust Scale, Patient Satisfaction Survey, Patient Expectations Questionnaire and Medication Adherence Rating Scale.

Results There was a high mean score on trust scale (Mean 38.9, SD 8.5) and expectation questionnaire (Mean 13.5, SD 3.3). On Kruskal-Wallis H test significant group differences were observed in nuclear vs joint family type (c²= 18.496, h² = .151, df = 1, Sig. = .000) and knowledge of treatment option (medication only vs medication + psychotherapy) treatment option (c²= 18.100, h² = .148, df = 2, Sig. = .000) and occupational status (employed vs unemployed) (c²= 3.165, h² =.029, df = 1, Sig. = .056) on the score of PTS. Similar differences were also observed in method of treatment sought before (no treatment vs allopathic) (c²= .065, h² = .065, df = 3, Sig. = .005), knowledge about treatment option (medication only vs medication + psychotherapy) (c²= .026, h² = .161, df = 2, Sig. = .000) and occupation (employed vs unemployed) (c²= .061, h² = .061, df = 1, Sig. = .006) on the score of PEQ. On regression analysis (R²= .723, F = 156.46, p = .000) value of the score on patient satisfaction was statistically significant as predicted by score on measure of expectation (beta = -0.095, t = -1.966, p = 0.052) and trust (beta = .842, t = 17.504, p = .000).

Discussion Levels of patients trust and expectation on physician varies with knowledge about treatment option & occupational status, and significantly associated with levels of satisfaction.

Patient trust; patient expectation; patient satisfaction; medication adherence; mental illness

Variables	n	%
Gender
Male	61	49.6
Female	62	50.4
Occupation
Unemployed	57	46.3
Self-employed	39	31.7
Employed	27	22.0
Socioeconomic status
Low	54	43.9
Middle	68	55.3
High	1	0.8

Variables	Mean	Std. deviation

Religion
Hindu	110	89.4
Muslim	13	10.6
Marital status
Single	29	23.6
Married	93	75.6
Other	1	0.8
Domicile
Rural	67	54.5
Urban	56	45.5
Family type
Nuclear	75	61.0
Joint	47	38.2
Other	1	0.8
Consulting single psychiatrist
Yes	110	89.4
No	13	10.6
First referral by
Self	47	38.2
Family	58	47.2
Society	5	4.1
Health professionals	13	10.6
Regularity of follow-up
Always	80	65.0
Mostly	31	25.2
Half the time	10	8.1
Some time	2	1.6

Variables	Mean	Std. deviation

Diagnosis
F 10	11	8.9
F20	9	7.3
F 30	85	69.1
F 40	16	13.0
Other	2	1.6
Treatment sought before
No treatment	100	81.3
Magico-religious	3	2.4
Allopathic	17	13.8
Ayurvedic	3	2.4
Option about treatment decision
Doctor should decide	75	61.0
I should decide	5	4.1
Both should decide	39	31.7
Any of these	4	3.3
Referring others to his physician
Yes	118	95.9
No	5	4.1
Knowledge about treatment option
Medication only	68	55.3
Psychotherapy only	4	3.3
Medication + psychotherapy	51	41.5

Variables	Mean	Std. deviation
Age	37.12	12.74
Education	5.69	5.23
Age at onset	32.20	12.58
Total duration of illness	4.59	5.14
Duration of consultation	2.19	2.34
Score on Patient Trust Scale	38.98	8.53
Score on Patient Satisfaction Survey	32.52	8.05
Score on Medication Adherence Rating Scale	16.04	2.26
Score on Patient Expectations Questionnaire	13.57	3.30

		Group	N	Mean Rank	χ²	η²	df	Asymp. Sig
PTS Total* Occupation		Unemployed	57	68.61	3.658	.029	1	.056
		Employed	66	56.30
PTS Total* Family type		Nuclear	76	51.14	18.496	.151	1	.000
		Joint	47	79.55
PTS Total* Knowledge of treatment	1	Medication only	68	36.26	.155	.002	1	.694
PTS Total* Knowledge of treatment		Psychotherapy only	4	40.50
	2	Psychotherapy only	4	13.88	3.380	.062	1	.066
		Medication + psychotherapy	51	29.11
	3	Medication only	68	48.37	18.100	.153	1	.000
		Medication + psychotherapy	51	75.51
PEQ Total* Occupation		Unemployed	57	52.80	7.474	.061	1	.006
		Employed	66	69.95
PEQ Total* Treatment sought before	1	No treatment	100	52.52	1.118	.010	1	.290
PEQ Total* Treatment sought before		Magicoreligious	3	34.50
	2	Magicoreligious	3	4.83	3.516	.185	1	.061
		Allopathic	17	11.50
	3	Allopathic	17	11.03	.977	.051	1	.323
		Ayurvedic	3	7.50
	4	No treatment	100	55.44	8.029	.069	1	.005
		Allopathic	17	79.94
	5	No treatment	100	51.89	.049	.000	1	.825
		Ayurvedic	3	55.67
	6	Magicoreligious	3	2.83	.784	.156	1	.376
		Ayurvedic	3	4.17
PEQ Total* Knowledge of treatment	1	Medication only	68	35.60	2.454	.034	1	.117
PEQ Total* Knowledge of treatment		Psychotherapy only	4	51.75
	2	Psychotherapy only	4	49.88	8.442	0.153	1	.004
		Medication + psychotherapy	51	26.28
	3	Medication only	68	75.01	31.779	.267	1	.000
		Medication + psychotherapy	51	39.98

Model	Predictor	Unstandardized Coefficient		Standardized Coefficients	t	Sig.

		B	Std. Error	Beta
1	(Constant)	4.698	2.449		1.919	.057
	PEQ Total	-.230	.117	-.095	-1.966	.052
	PTS Total	.794	.045	.842	17.504	.000

Model	Predictor	Unstandardized Coefficients		Standardized Coefficients	t	Sig.

		B	Std. Error	Beta
1	(Constant)	17.186	1.291		13.316	.000
	PTS Total	.009	.024	.032	.360	.719
	PEQ Total	-.108	.062	-.158	-1.756	.082

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[TFN1] Dependent variable: PSS total.

[TFN2] R² = .723, F = 156.46, p = .000.