What do patients expect of psychiatric services? A systematic and criticalreview of empirical studies

The article reviews literature concerning patients' expectations of psychia tric care. Early research (pre-1980) is outlined, followed by a systematic review of 21 studies fulfilling specific inclusion criteria from 1980 onwar ds. Overall, patients expected to improve as a result of psychiatric treatm ent, and had higher expectations of the helpfulness of psychological and co mbined treatments than other interventions. Few studies considered expectat ions of the process of psychiatric cars or determinants of expectations. Th e majority of studies focused on examining the relation between expectation s and outcomes. There were indications that expectations of improvement wer e linked to clinical outcomes, although the relationship appeared to be com plex. There was also some evidence that when expectations of the process of care were incongruent with the service provided, outcomes were poorer. The findings of studies in the systematic review were generally congruent with earlier work (pre-1980), although expectations of improvement appeared to be higher in the later studies. Interventions to prepare patients for what to expect were found to have beneficial effects on attendance, satisfaction and the accuracy of expectations about the process of psychiatric care. Fu ture research should focus on developing valid and reliable measures for us e in different settings, and on determining the mechanism by which expectat ions may relate to outcomes, including clinical outcomes, attendance and sa tisfaction. (C) 2001 Elsevier Science Ltd. All rights reserved.