Treatment utilization and satisfaction: Examining the contributions of Axis II psychopathology and t

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Treatment utilization and satisfaction Examining
the contributions of Axis II psychopathology and
the Five-Factor Model of personality Joshua D.
Miller University of Georgia Paul A. Pilkonis
and Edward P. Mulvey University of Pittsburgh
Medical Center

• DISCUSSION
• Both personality disorder constructs and general
  personality traits provide useful information
  regarding treatment utilization and satisfaction.
• The personality constructs that were predictive
  of utilization or satisfaction tended to be
  consistent across the level of personality
  conceptualization (traits vs. disorders). For
  instance, antagonistic, antisocial individuals
  attended fewer therapy sessions and were less
  likely to be compliant with medications.
• Introverted, avoidant individuals were more
  likely to take advantage of clinical services,
  which may be a result of their more limited
  informal social support.
• Openness to Experience was the only consistent
  predictor of satisfaction. Individuals high on
  this trait prefer more open-ended discussions,
  more diversity of opinion, more equality of
  participation, and more complexity of thought
  (McCrae, 1996, p. 328) these preferences would
  be played out in a therapeutic setting which is
  often characterized by exchanges regarding
  values, belief systems, and discussions of
  changing longstanding behavioral patterns.
• The results suggest that it would be shortsighted
  to focus solely on Borderline PD when predicting
  these constructs as other PDs were more
  consistently related to the utilization of
  services.
• Personality constructs provide important
  information regarding the processes by which some
  individuals come to accept and utilize various
  forms of psychiatric interventions. Clinicians
  would be well-served to consider the role of
  individual differences when conducting treatment
  planning.

METHOD (cont.) Sample 2 Participants (n 544
47 female) were solicited as part of the
MacArthur Violence Risk Assessment Study. Data
collected at three inpatient facilities. After
discharge, participants were assessed five times
during a one-year period. Sample 2
measures Clinician ratings of DSM PD categories
(absent/present), depression and anxiety via the
Brief Psychiatric Rating Scale, and the Global
Assessment of Functioning scale. NEO-FFI 60
item self-report inventory that assesses the
Five-Factor Model. Information was gathered
regarding medication utilization and use of other
clinical services at each assessment.
ABSTRACT A critical issue facing mental health
practitioners is the need to increase our
understanding of what variables impact patients
treatment utilization and satisfaction with care.
The current study examined whether personality
disorders (PDs) and general personality traits,
as measured by the Five-Factor Model (FFM), could
predict these outcomes in two clinical samples.
The results suggest that both PD symptom counts
and the FFM have substantial predictive power
with regard to treatment utilization and
satisfaction. These findings suggest that both
types of personality information should be
included in treatment planning and implementation.
ANALYTIC STRATEGY RESULTS Multiple regression
analyses conducted Step 1 Depression/Anxiety
and GAF Step 2 Personality Disorder symptom
counts or diagnoses Step 3 Five-Factor Model
dimensions

• INTRODUCTION
• Psychiatric treatment can reduce distress and
  increase global functioning in individuals with
  Axis I (Lambert Bergin, 1994) and/or Axis II
  disorders (Sanislow McGlashan, 1998) and these
  interventions are often cost effective.
• A recent meta-analysis (Chiles, Lambert, Hatch,
  1999) found that psychological interventions
  resulted in a 20 savings in overall medical
  costs.
• The costs and the advent of managed care make it
  critical to know how people seek care and how
  they react to it understanding the factors that
  affect treatment utilization and satisfaction is
  an important aspect of designing an effective
  mental health service system.
• Commonly explored factors in the prediction of
  treatment utilization include accessibility,
  affordability, and perceived barriers.
• Commonly explored factors in the prediction of
  treatment satisfaction include age, gender, and
  education.
• Relatively ignored in this literature is the role
  of individual differences however, the extant
  literature suggests that individuals with PDs use
  more clinical services but are less satisfied.

• Treatment Utilization
• Medication
• PDs accounted for 14 (sample 1) and 13 (median
  sample 2) of the variance in the outcome.
• FFM accounted for an additional 9 (sample 1 and
  median of sample 2) of the variance.
• Clinical services (e.g., therapy)
• PDs accounted for 19 (sample 1) and 7 (median
  sample 2) of the variance in the outcome.
• FFM accounted for an additional 11 (sample 1)
  and 7 (median sample 2) of the variance.
• Personality Disorders
• Antisocial was negatively related to using
  medication (in 3 of 6 assessment periods) and
  clinical services (6 of 6).
• Schizotypal was negatively related to using
  clinical services (2 of 5), while Avoidant was
  positively related to this outcome (2 of 6).
• FFM dimensions
• Agreeableness was consistently positively related
  to use of medication (4 of 6) and clinical
  services (5 of 6).
• Extraversion was consistently negatively related
  to use of medication (3 of 6) and clinical
  services (4 of 6).
• Treatment Satisfaction
• Medication
• PDs accounted for 15 (sample 1) of the variance.

REFERENCES Chiles, J. A., Lambert, M. J.,
Hatch, A. L. (1999). The impact of psychological
interventions on medical cost offset A
meta- analytic review. Clinical Psychology
Science and Practice, 6, 204-220. Lambert, M.
J., Bergin, A. E. (1994). The effectiveness of
psychotherapy. In A. E. Bergin S. L. Garfield
(Eds.), The handbook of psychotherapy and
behavior change (4th ed., pp. 143-189). New
York Wiley. McCrae, R. R. (1996). Social
consequences of experiential openness.
Psychological Bulletin, 120, 323-337. Sanislow,
C. A., McGlashan, T. H. (1998). Treatment
outcome of personality disorders. Canadian
Journal of Psychiatry, 43, 237- 250.
METHOD Sample 1 Participants (n 99 58
female) were solicited from inpatient and
outpatient programs at Western Psychiatric
Institute and Clinic, Pittsburgh, PA. Sample 1
measures Intake Consensus ratings of DSM PD
symptoms, along with Hamilton Depression and
Anxiety scores and Global Assessment of
Functioning. NEO-PI 180 item self-report
inventory that assesses the five broad
personality domains as articulated by the
Five-Factor Model. Six-month follow-up Self-report
s of medication usage (no/yes), therapy
sessions, and satisfaction (rated from 1 to 5)
for medication and therapy.