Validation of an outcome scale for use in adult psychiatric practice

Abstract

Objective-To clarify the usefulness, acceptability, sensitivity, and validity of version 4 of the Health of the Nation Outcome Scale (HoNOS), a scale developed to meet the requirement for a clinically acceptable outcome scale for routine use in mental illness services. Design-Patients with a range of mental illnesses were rated on the HoNOS at the beginning and end of an episode by interviews with mental health professionals. Subjects-934 patients from eight diagnostic categories were rated by 129 mental health professionals at 17 sites; 250 were also rated on a range of comparison scales. Outcome measures-Comparison of patients' scores at the beginning and end of an episode using individual item scores, dimensional subscores, and the total score. Results-HoNOS scores decreased by almost 50% between the beginning and end of episodes. They varied with the severity of the setting and discriminant analysis showed that the HoNOS had a moderate level of discriminatory power. Correlation analysis showed acceptable levels of agreement with independent scales, although the accuracy of ratings of some items at the beginning of an episode was aVected by information deficits. Conclusion-The findings indicate thatHoNOS is sensitive to change across time and to diVerences in illness type and severity, and has a suYcient degree of both construct and criterion related validity to fulfil the requirements of a mental health outcome scale for routine use in clinical settings.

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

“…As such we suggest that the HoNOS has moderate concurrent validity in covering psychopathology and clinical status. Other authors tested concurrent validity with the Brief Psychiatric Rating Scale, the Positive and Negative Syndrome Scale and other instruments [2,28,29]. Basically, the HoNOS seemed to perform well; however, there are exceptions with a low correlation being found [30] between the HoNOS and the Brief Psychiatric Rating Scale.…”

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.…”

Does the HoNOS 65+ meet the criteria for a clinical outcome indicator for mental health services for older people?

“…Previous research (Burns et al, 1998;Orrell, 1999;Shergill et al, 1999), suggests that the HoNOS 65 has good concurrent and criterion validity, reasonable interrater reliability and is acceptable to clinicians. The HoNOS is sensitive to change (McClelland et al, 2000), but, to the authors' knowledge, to date there are no published studies demonstrating sensitivity to change for the HoNOS 65.…”