The Concurrent Validity and Sensitivity of Change of the German Version of the Health of the Nation Outcome Scales in a Psychiatric Inpatient Setting

Abstract

Background: The Health of the Nation Outcome Scales (HoNOS) were developed to assess the severity of a mental illness. They are used as outcome measures in different countries, and are meanwhile translated from the original English version into many languages, among others into German (HoNOS-D). We conducted a study in order to estimate the concurrent validity and sensitivity to change using clinical parameters as ICD-10 diagnoses, as well as the Clinical Global Impression Scale (CGI), and the Association for Methodology and Documentation in Psychiatry (AMDP) psychopathology scale, a frequently used psychopathological rating system, in a representative clinical sample. Sampling and Methods: Data on the three instruments (CGI, AMDP, HoNOS-D) were collected at admission and discharge of 100 psychiatric inpatients using a representative clinical sample. Experienced clinicians completed the CGI, AMDP and HoNOS-D. Descriptive and comparative data analyses were performed. We estimated the concurrent validity by calculating correlations between the HoNOS and other scales. Secondly, we examined the differences between HoNOS scores related to diagnoses and demographic parameters. Thirdly we calculated change criteria and outcome effect size for the HoNOS. Results: Even in a small clinical sample (n = 100), the HoNOS-D items are highly correlated with the corresponding AMDP syndromes (p < 0.003). The HoNOS-D score is associated with the CGI score (p < 0.01). Correlations of HoNOS symptoms, behavior and impairment items with AMDP syndromes as well as differences in diagnoses were appropriate and comprehensible as regards clinical content, and change on the HoNOS total score is statistically significant (t = 6.57, d.f. = 89, p < 0.0001). Conclusion: This study is the first to investigate the concurrent validity of HoNOS-D concerning psychopathology using the AMDP rating system in a clinical sample of patients with mental disorders in an inpatient setting. HoNOS-D can be recommended for routinely screening outcomes in inpatient psychiatric settings. Our analysis showed that HoNOS-D covers psychopathology corresponding to the AMDP rating system. A limitation of the study is that the study sample comprised only an inpatient population; there may well be differences compared to an outpatient sample.

Treatment needs, diagnoses and use of services for acutely admitted psychiatric patients in northwest Russia and northern Norway

“…The HoNOS-scores from both countries did not differ substantially from what has been found in other inpatient studies [40-46], but due to the structural and demographic differences between the two countries, the difference may seem unexpectedly small. A partly explanation may be different attitudes towards admitting mental problems: In a comparative study, Angermeyer et al [10] found that Russian respondents had a stronger tendency to consider mental disorders as self-inflicted.…”

Admission to acute mental health services after contact with crisis resolution and home treatment teams: an investigation in two large mental health-care providers

“…shown to be related to illness severity 25,26 . Every item is rated on a Likert-style scale, ranging from 0 (no problem) to 4 (severe problem), yielding a total score from 0 to 48.…”

Comprehensive Psychopathological Assessment Based on the Association for Methodology and Documentation in Psychiatry (AMDP) System: Development, Methodological Foundation, Application in Clinical Routine, and Research

“…were discussed in comparison with the AMDP-System, which is representative for a comprehensive, multifaceted global scale. In this context, in their exemplary study, Theodoridou et al (30) investigated the concurrent validity and sensitivity to change of the 12-item Health of Nation Outcome Scales and the 3-item CGI in relation to the 100-item AMDP-System, which the authors used as a psychopathological reference scale. The correlations between the instruments were significant and plausible.…”