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.
Patient satisfaction with services is an important outcome variable that is increasingly used in mental health service evaluation. This study includes 404 people with schizophrenia in five European sites and addresses five questions focused on site, service, and patient characteristics as variables that might explain service satisfaction, using the Verona Service Satisfaction Scale. Patient satisfaction differed significantly across sites (highest in Copenhagen, lowest in London). In all sites, patients were least satisfied with involvement of relatives in care and information about illness. A multiple regression model showed that lower levels of total service satisfaction were associated with living in London or Santander, being retired/unemployed, having more hospital admissions, having more severe psychopathology, having more unmet needs, or having lower satisfaction with life. This model explained 31 percent of variance in service satisfaction. Our data show that service satisfaction can be seen as a result of (1) the ability of the service to provide a standard of care above a certain quality threshold, and (2) the perception of each patient that the care received has been tailored to the patient's own problems.
Rehabilitation following spinal cord injury is likely to depend on recovery of corticospinal systems. Here we investigate whether transmission in the corticospinal tract may explain foot drop (inability to dorsiflex ankle) in persons with spinal cord lesion. The study was performed in 24 persons with incomplete spinal cord lesion (C1 to L1) and 15 healthy controls. Coherence in the 10- to 20-Hz frequency band between paired tibialis anterior muscle (TA) electromyographic recordings obtained in the swing phase of walking, which was taken as a measure of motor unit synchronization. It was significantly correlated with the degree of foot drop, as measured by toe elevation and ankle angle excursion in the first part of swing. Transcranial magnetic stimulation was used to elicit motor-evoked potentials (MEPs) in the TA. The amplitude of the MEPs at rest and their latency during contraction were correlated to the degree of foot drop. Spinal cord injured participants who exhibited a large foot drop had little or no MEP at rest in the TA muscle and had little or no coherence in the same muscle during walking. Gait speed was correlated to foot drop, and was the lowest in participants with no MEP at rest. The data confirm that transmission in the corticospinal tract is of importance for lifting the foot during the swing phase of human gait.
Comparative analyses of the use and cost of mental health services can highlight existing variations helpfully in service provision and uptake. Methodological consistency is required if meaningful conclusions are to be drawn from such comparative data.
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