Expectations, outcome, and patient satisfaction with mental health treatment.

Abstract

This study examines the process by which patients become satisfied with mental health treatment. The key research variables are patient expectations about the outcome of their treatment for depression, the actual outcome of this treatment, and patient satisfaction with their treatment. To gain more empirical information about the process of satisfaction, these variables and their interrelationships were examined over time. To examine them theoretically, the data were fitted to two models based on expectancy theory and borrowed from consumer satisfaction research: the assimilation model and the contrast model. To that end, 46 adult inpatients with a diagnosis of depression completed rating scales designed to measure levels of expectations, depression, and satisfaction at four approximately equal time intervals during their hospitalization in a psychiatric hospital. Upon admission, the research subjects were severely depressed, but their depression ratings improved gradually, and by discharge the ratings had improved significantly. Subjects were excellent predictors of treatment outcome: patients expressed very high expectations about the outcome of their treatment, and these expectations proved to be highly accurate. Satisfaction with treatment developed over time, with subjects having neutral or slightly positive levels of satisfaction at admission but high levels of satisfaction by discharge. All three key variables showed little correlation with each other at admission, but by discharge they were all highly correlated. The data gave strong support to the contrast model and only weak support to the assimilation model, suggesting that outcome plays a more important role than expectations in predicting satisfaction with treatment. Some secondary variables, including sex, personality factors, and knowledge about mental health treatment, demonstrated important relationships with the major research variables. The data support the thesis that consumers of mental health treatment are not fundamentally different from other consumers and that their levels of satisfaction are important components of program evaluation in mental health agencies. The implications for mental health practice and policy are discussed.