Chapter 2 56 professional carers (Goossens et al. 2007). Knowing these unmet needs allows for a well informed decision to either invest in countering the identified unmet needs or not. We compared our data with two studies on the needs of older patients with schizophrenia (mean age 69) (Meesters et al. 2013) or unipolar depressive disorder (mean age 72) (Houtjes et al. 2011). The schizophrenia patients reported a higher number of both total needs (7.57 versus 4.31 in our study) and unmet needs (1.46 versus 0.81 in our study). This may be explained by the fact that older patients with bipolar disorder had higher mean GAF scores (48.2 versus 65 in our study), fewer depressive symptoms (CES-D score 15 versus 8 in our study), a larger social network and higher social participation score (9.2 versus 11.5), and a better quality of life (MANSA 4.8 versus 5.2 in our study). Fewer psychiatric symptoms and better social functioning corresponded with a lower number of unmet needs in both studies. The older patients with unipolar depressive disorder had even more unmet needs (2.3) (Houtjes et al. 2011), possibly because of higher rates of depressive symptoms. These studies on older patients with depression and schizophrenia underscore our hypothesis that patients with more psychiatric symptoms report more needs. This is not surprising, however it is important to point out that symptoms and needs maybe interrelated; symptoms may require help and therefore induce needs, but unmet needs may induce symptoms. Patients in our bipolar sample had fewer current psychiatric symptoms and less social impairment. This may be explained by the fact that bipolar patients, especially when using lithium as a long-term maintenance treatment, are recommended to remain in psychiatric care even when stable, thus enabling us to include both euthymic and symptomatic patients. Another aspect could be that bipolar patients only episodically have severe symptoms. Differences in accessibility and structure of healthcare could not explain our findings in older patients, as all studies were situated in the Netherlands. A study using the Camberwell Assessment of Need Short Appraisal Schedule (CANSAS) in younger adults with severe mental illness reported similar findings as our study. The subgroup of patients with bipolar disorder had significantly higher recovery and higher empowerment scores than the subgroup of patients with schizophrenia or depressive disorder and fewer needs unmet (Lloyd et al. 2010). Studies on the needs of patients with dementia using the CANE reported a higher number of needs, respectively 10.3 and 10.2 (van der Roest et al. 2008; Kaiser et al. 2010). Lower cognitive functioning (mean MMSE 20 and <18 respectively) could explain the higher number of total needs in these studies, in line with our findings. Presumably, people with lower cognitive functioning usually have higher physical and functional dependency and need for support
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