# Psycho-social predictors of motivation for treatment in patients with mental disorders: the role of adverse childhood experiences and internalized stigma

## TL;DR

The study finds that adverse childhood experiences and higher education are linked to stronger treatment motivation in patients with mental disorders.

## Contribution

This paper identifies a threshold of four adverse childhood experiences as a predictor of increased treatment motivation.

## Key findings

- Higher education and a total ACE score of 4 or more are associated with increased treatment motivation.
- Internalized stigma did not significantly affect treatment motivation.
- A cut-off ACE score of 4 was identified as a meaningful predictor of motivation.

## Abstract

Motivation for treatment is an important socio-psychological characteristic of patients, which is subject to the joint influence of various factors, each of which may require specific rehabilitation interventions.

To analyze and evaluate the cumulative influence of adverse childhood experiences (ACE), internal stigma, social characteristics on the intensity of treatment motivation in patients with mental disorders.

102 patients with mental disorders were examined using Adverse Childhood Experience Questionnaire (ACEQ), Russian-language validated Internalized Stigma of Mental Illness (ISMI) scale and Treatment Motivation Assessment Questionnaire (TMAQ).

As a result of regression analysis (table 1), a model was obtained that predicted an increase in the chances of high patient’s motivation for treatment with an increase in the total score of ACEs (ACEQ total score) and with higher education. The overall severity of internal stigma (ISMI total score) did not show a significant effect on the chances of developing intense motivation in patients.
Table 1.Model of logistic regression analysis of educational, ACE total score and ISMI total score with the severity of motivation for treatment.PredictorBSEpExp (B)95% confidence interval for EXP(B)Secondary education1,1200,6990,1093,0650,778-12,074Higher education1,9720,775,0117,1891,574-32,834ISMI total score-0,4350,7730,5740,6470,142-2,946ACEQ total score0,3460,1470,0191,4141,060-1,886

Model of logistic regression analysis of educational, ACE total score and ISMI total score with the severity of motivation for treatment.

After post data analysis (table 2), a cut-off point was established for the ACEQ total score of 4 points, corresponding to an increased chances of high patient’s treatment motivation.
Table 2.Results of the test ROC analysis for ACEQ total score and the severity of motivation for treatment.CutpointSensitivity (%)Specificity (%)Youden’s indexAUC364.71%53.57%0.1830.689450%75%0.2500.689538.24%85.71%0.2390.689

Results of the test ROC analysis for ACEQ total score and the severity of motivation for treatment.

ACEs may likely be a source of posttraumatic growth in adulthood in patients with mental illness specially if their count amounts to 4 or more variants. The role of social and psychological characteristics of patients with mental disorders in the psychology of the treatment process should be considered systemically, rather than discretely.

None Declared