Need assessment 2 49 The YMRS consists of 11 items and is based on clinical observations and the patient’s subjective report of the last 48 hours, measuring manic symptoms on a scale from 0 to 60. A score ≥ 7 is considered indicative of clinically relevant (hypo)mania. The CES-D measures the presence of depressive symptoms during the previous week, with a scoring range of 0 to 60. A score ≥ 16 is considered indicative of clinically relevant depression in the general population. Patients with scores below the threshold on both the YMRS and the CES-D were considered to be in symptomatic remission. The MMSE (Folstein et al. 1975) was used to screen for cognitive impairment. Self-reported limitations in activities of daily living were evaluated through the Groningen Activity Restriction Scale (GARS) (Kempen et al. 1996), which includes 11 activities of daily living (ADL) items and 7 instrumental activities of daily living (IADL) items. Scores were dichotomized into independent performance versus performance only with someone’s help, resulting in a total score ranging from 18 (independent for all items) to 36 (dependent for all items). Social integration was defined by network size and social participation. To assess the size of their social network, patients were asked to estimate the number of persons, outside of their household, with whom they had regular and meaningful contact. In addition, they were asked if they had an unpaid informal carer for at least one hour per week. Information was gathered on the presence of persons in their proximity, besides their partner, who they experienced as being emotionally or materially supportive. Self-report of involvement in 11 social activities (e.g., visiting others, going to church) was measured through the Social Participation Scale (Depla et al. 2003), with scores ranging from 0 (no activities) to 22 (regular participation in all activities). Quality of life was evaluated with the Manchester Short Assessment of Quality of Life (MANSA) (Priebe et al. 1999), which rates patient satisfaction with various aspects of life (e.g., daily activities and physical health). The MANSA score is the mean of the 12 individual item scores, ranging from 1 (very dissatisfied) to 7 (very satisfied). Needs for carewere assessedwith theDutch version (Dröes et al. 2004) of the CANE (Reynolds et al. 2000) by interviewing both the patient and a staffmember who knew the patient well. A total of 15 staff members were interviewed as a number of the participating patients shared the same staff member. The CANE is a semi-structured interview, based on the Camberwell Assessment of Need (CAN) and adapted for the elderly, that covers 24 areas (Table 2) of the four domains of environmental, physical, psychological and social needs, and has good validity and reliability (Reynolds et al. 2000; van der Roest et al. 2008). Each of the 24 items can
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