Treatment results for severe psychiatric illness: which method is best suited to denote the outcome of mental health care?

Beurs, Edwin de; Blankers, Matthijs; Delespaul, Philippe; Duijn, Erik van; Mulder, Niels L.; Nugter, Annet; Swildens, Wilma; Tiemens, Bea; Theunissen, Jan; Voorst, Arno F. A. van; Weeghel, Jaap van

doi:10.1186/s12888-018-1798-4

Cited by 9 publications

(6 citation statements)

References 37 publications

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“…Our findings, especially the cut-off scores and benchmark values, reciprocally corroborate and validate previous results, obtained in different clinical samples, with other statistical methods (Boon et al, 2019;De Beurs et al, 2018;Parabiaghi et al, 2005Parabiaghi et al, , 2011Parabiaghi et al, , 2014. The percentage of change for improvement (treatment response) and deterioration determined in our analysis are in accordance with generally accepted thresholds (Duff, 2012;Evans et al, 1998;Schennach-Wolff et al, 2010).…”

Section: Discussionsupporting

confidence: 91%

Assessing the severity of psychiatric disorders using the Health of the Nation Outcome Scales: An equipercentile linking analysis

Egger

Bobes

Theodoridou

et al. 2020

Aust N Z J Psychiatry

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Objective: The Health of the Nation Outcome Scales was developed as an overall measure of mental health, applicable to the complete range of psychiatric disorders. Meanwhile, it is a benchmark tool for service providers and is also used for the allocation of costs and funding. The ability of the Health of the Nation Outcome Scales to assess and differentiate the severity of psychiatric disorders is largely unknown, as it is the interpretation of a change in score. We aim to establish Health of the Nation Outcome Scales cut-off and benchmark values for severity and improvement – respectively change, using equipercentile linking to the Clinical Global Impression scales. Methods: In a clinical sample of 30,616 individuals with a psychiatric disorder, we used a multivariate regression analysis to determine the correlation between the scales and possible confounders. We used an equipercentile linking analysis of the Clinical Global Impressions severity scale with the Health of the Nation Outcome Scales sum score to establish cut-off values for severity. The linking of the Health of the Nation Outcome Scales sum score difference and the percentage of change to the Clinical Global Impression improvement scale determined benchmark values for change (i.e. improvement or deterioration). Results: The Health of the Nation Outcome Scales and Clinical Global Impression scales showed a Spearman correlation of 0.38 ( p < 0.000). Clinical Global Impression–Severity: ‘borderline-ill’ corresponded to Health of the Nation Outcome Scales score 3–5; ‘mildly ill’ to 6–10; ‘moderately ill’ to 11–16; ‘markedly ill’ to 17–25; ‘severely ill’ to 26–35; and ‘extremely ill’ to a score ⩾36. The Spearman correlation between the percentage change of the Health of the Nation Outcome Scales was 0.39 ( p > 0.000); Clinical Global Impression–Improvement: ‘minimally improved’ corresponded to Health of the Nation Outcome Scales reduction of 4 points or 9%; ‘much-improved’ to 12 points or 48%; ‘very-much-improved’ to ⩾20 points or ⩾90%. Clinical Global Impression–Improvement: ‘minimally worse’ corresponded to an increase of 6 points or 25%; ‘much-worse’ to 12 points or 54%; and finally, ‘very-much-worse’ to >18 points or ⩾82%. Conclusion: Our results allow for the comparison of severity and response to treatment of patients with a psychiatric disorder, independent of diagnosis.

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Section: Discussionsupporting

confidence: 91%

Assessing the severity of psychiatric disorders using the Health of the Nation Outcome Scales: An equipercentile linking analysis

Egger

Bobes

Theodoridou

et al. 2020

Aust N Z J Psychiatry

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“…The study was conducted in a long-term residential setting and consisted of a longitudinal cohort study without control group in a consecutive patient sample. As data sources, we used regular chart information and routine outcome questionnaires [22].…”

Section: Designmentioning

confidence: 99%

Diagnose, indicate, and treat severe mental illness (DITSMI) as appropriate care: A three-year follow-up study in long-term residential psychiatric patients on the effects of re-diagnosis on medication prescription, patient functioning, and hospital bed utilization

et al. 2020

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Background. While polypharmacy is common in long-term residential psychiatric patients, prescription combinations may, from an evidence-based perspective, be irrational. Potentially, many psychiatric patients are treated on the basis of a poor diagnosis. We therefore evaluated the DITSMI model (i.e., Diagnose, Indicate, and Treat Severe Mental Illness), an intervention that involves diagnosis (or re-diagnosis) and appropriate treatment for severely mentally ill long-term residential psychiatric patients. Our main objective was to determine whether DITSMI affected changes over time regarding diagnoses, pharmacological treatment, psychosocial functioning, and bed utilization. Methods. DITSMI was implemented in a consecutive patient sample of 94 long-term residential psychiatric patients during a longitudinal cohort study without a control group. The cohort was followed for three calendar years. Data were extracted from electronic medical charts. As well as diagnoses, medication use and current mental status, we assessed psychosocial functioning using the Health of the Nations Outcome Scale (HoNOS). Bed utilization was assessed according to length of stay (LOS). Change was analyzed by comparing proportions of these data and testing them with chi-square calculations. We compared the numbers of diagnoses and medication changes, the proportions of HoNOS scores below cut-off, and the proportions of LOS before and after provision of the protocol. Results. Implementation of the DITSMI model was followed by different diagnoses in 49% of patients, different medication in 67%, some improvement in psychosocial functioning, and a 40% decrease in bed utilization. Conclusions. Our results suggest that DITSMI can be recommended as an appropriate care for all long-term residential psychiatric patients.

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“…54 Third, the used routine outcome measurements are possibly not responsive and distinctive enough with regard to SMI symptoms, care needs and quality of life. 64 Finally, implementing this intervention in daily clinical practice also meant that the NET protocol and the agreed biweekly FACT support were not always strictly followed. This concerns mostly interruptions during NET and replacement of FACT care providers.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

Treating patients with severe mental illness with narrative exposure therapy for comorbid post-traumatic stress disorder

et al. 2020

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Background Interpersonal trauma and post-traumatic stress disorder (PTSD) in patients with severe mental illness (SMI) negatively affect illness course. Narrative exposure therapy (NET) is effective in vulnerable patient groups, but its efficacy and applicability has not been studied in out-patients with SMI. Aims We aimed to evaluate the efficacy and applicability of NET in SMI on changes in PTSD, dissociation, SMI symptoms, care needs, quality of life, global functioning and care consumption. Method The study had a single-group, pre-test–post-test, repeated-measures design and was registered in The Netherlands National Trial Register (identifier TR571). Primary outcomes were assessed at pre-treatment (T0), 1 month post-treatment (T1) and 7 months’ follow-up (T2), with a structured interview for PTSD and dissociation screening. Secondary outcomes followed routinely SMI measurements and medical data. Mixed models were used for data analysis. Results The majority of the 23 participants was female (82%). Mean age was 49.9 years (s.d. 9.8) and mean PTSD duration was 24.1 years (s.d. 14.5). Mean PTSD severity decreased from 37.9 at T0 to 31.9 at T1 (−6.0 difference, 95%CI −10.0 to −2.0), and decreased further to 24.5 at T2 (−13.4 difference, 95%CI −17.4 to −9.4). Dissociation, SMI symptoms, duration of contacts, and medication decreased; global functioning increased; and quality of life and perceived needs did not change. Eleven participants were in remission for PTSD at T2, of which five were also in remission for major depression. Conclusions NET appeared efficacious and applicable to out-patients with SMI and PTSD, and was well tolerated.

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Treatment results for severe psychiatric illness: which method is best suited to denote the outcome of mental health care?

Cited by 9 publications

References 37 publications

Assessing the severity of psychiatric disorders using the Health of the Nation Outcome Scales: An equipercentile linking analysis

Assessing the severity of psychiatric disorders using the Health of the Nation Outcome Scales: An equipercentile linking analysis

Diagnose, indicate, and treat severe mental illness (DITSMI) as appropriate care: A three-year follow-up study in long-term residential psychiatric patients on the effects of re-diagnosis on medication prescription, patient functioning, and hospital bed utilization

Treating patients with severe mental illness with narrative exposure therapy for comorbid post-traumatic stress disorder

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