BackgroundCross-cultural comparison of mental health service utilisation and costs is complicated by the heterogeneity of service systems. For data to be locally meaningful yet internationally comparable, a carefully constructed approach to its collection is required.AimsTo develop a research method and instrument for the collection of data on the service utilisation and related characteristics of people with mental disorders, as the basis for calculating the costs of care.MethodVarious approaches to the collection of service use data and key stages of instrument development were identified in order to select the most appropriate methods.ResultsBased on previous work, and following translation and cross-cultural validation, an instrument was developed: the Client Socio-Demographic and Service Receipt Inventory – European Version (CSSRI–EU). This was subsequently administered to 404 people with schizophrenia across five countries.ConclusionThe CSSRI – EU provides a standardised yet adaptable method for collating service receipt and associated data alongside assessment of patient outcomes.

BackgroundIn international research on the consequences of psychiatric illnesses for relatives of patients, the need for an internationally standardised measure has been identified.AimsTo test the internal consistency and the test-retest reliability of the Involvement Evaluation Questionnaire (IEQ) in five European countries.MethodThe IEQ was administered twice to a sample of relatives or friends of patients with an ICD-10 diagnosis of schizophrenia. Reliability was tested using Cronbach's α, intraclass correlation coefficients and standard error of measurement. Reliability estimates were tested between sites.ResultsTest sample sizes ranged from 30 to 90 across sites, and retest sample sizes ranged from 21 to 77. Cronbach's α values of IEQ sub-scales and sumscore were substantial at most sites; but at two, α values were moderate. Intraclass correlation coefficients were substantial to high at all sites. The standard errors of measurement differed across sites, indicating differences in performance.ConclusionThe reliability of the IEQ in five languages varies across sites, but is sufficiently high in at least four out of five.

This article focuses on (1) the dimensionality of the caregiving concept; (2) the relation between the identified caregiving dimensions and characteristics of the patient, the caregiver, and their relationship; and (3) the relation between caregiving dimensions and caregiver distress. Findings are based on data from 480 members of the Dutch family organization for patients with schizophrenia/chronic psychosis who completed (1) the Involvement Evaluation Questionnaire (IEQ), which assesses general information (e.g., household characteristics), caregiving, help seeking, coping and distress, and (2) a questionnaire comprising questions on onset and course of the patient's disorder and symptoms characteristic of schizophrenic disorders. Four caregiving domains were found: tension, supervision, worrying, and urging. These domains were strongly related to the patient's symptomatology, contact between the relative and the patient's mental health professional, and the number of hours of mutual contact between the patient and the relative. The connection between patient, caregiver, and relationship variables and the caregivers' distress could be explained substantially by the overall caregiving score. Our findings suggest that caregiving tasks and problems may be diminished and related distress lowered by reducing the patient's symptomatology, increasing relatives' coping capacities, and decreasing the number of contact hours. If distress is reduced, relatives may use less psychotropic medication and may visit their general practitioner less often.

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BackgroundSatisfaction with mental health services is an important quality and outcome variable. The Verona Service Satisfaction Scale (VSSS) is a well-established method for measuiring service satisfaction.AimTo report the development and reliability study of the European Version of the VSSS (VSSS–EU).MethodA sample of people with schizophrenia on the case-load of local mental health services in the five European participating countries was assessed. The VSSS–EU was administered at one site in each country at two points in time. Internal consistency and test–retest reliability were assessed and compared between the five sites.ResultsThe α coefficient for the VSSS–EU total score in the pooled sample was 0.96 (95% CI 0.94–0.97) and ranged from 0.92 (95% CI 0.60–1.00) to 0.96 (95% CI 0.93–0.98) across the sites. Test–retest reliability for VSSS–EU total score, pooled over sites, was 0.82 (95% CI 0.78–0.85) and ranged from 0.73 (95% CI 0.6–0.86) to 0.93 (95% CI 0.89–0.97) across the sites.ConclusionVSSS–EU is a reliable instrument for measuring service satisfaction in people with schizophrenia, for use in comparative cross-national research projects and in routine clinical practice in mental health services across Europe.

Clinicians should assess symptoms of caregiver distress. When caregiver distress is noticed, efforts should be undertaken to support the caregiver and teach them skills to cope effectively with the consequences they experience in order to stay well.

The European Psychiatric Services: Inputs Linked to Outcomes and Needs (EPSILON) study was a EU BIOMED-2-funded comparative, cross-national, cross-sectional study aimed (1) to produce standardized versions of five key research instruments in five languages, and (2) to compare the characteristics, needs, and life qualities of people with schizophrenia and their caregivers in these five countries. One of the key instruments was the Involvement Evaluation Questionnaire (IEQ), an instrument to assess caregiving consequences. In this article, the intercultural validity of the IEQ is described. It was concluded that the IEQ covers the same caregiving domains in all five countries: interpersonal tension, worrying, urging, and supervision. Differences in score levels between countries were found. When adjusted for variables known to correlate with IEQ scores (patient, caregiver, and relationship), these differences still persisted. It could not be determined how far the remaining variation could be explained by site-level characteristics, because only limited site-level data had been collected. This means that researchers must still resolve the question of whether levels of caregiver consequences that cannot be explained by the data presented here are caused by cultural factors or by differences in mental health care provision. As long as cultural bias cannot be ruled out, researchers are advised to compose their own national norm groups and use these as a local standard.

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