Psychometric Assessment of an Item Bank for Adaptive Testing on Patient-Reported Experience of Care Environment for Severe Mental Illness: Validation Study.

BACKGROUND: The care environment significantly influences the experiences of patients with severe mental illness and the quality of their care. While a welcoming and stimulating environment enhances patient satisfaction and health outcomes, psychiatric facilities often prioritize staff workflow over patient needs. Addressing these challenges is crucial to improving patient experiences and outcomes in mental health care. OBJECTIVE: This study is part of the Patient-Reported Experience Measure for Improving Quality of Care in Mental Health (PREMIUM) project and aims to establish an item bank (PREMIUM-CE) and to develop computerized adaptive tests (CATs) to measure the experience of the care environment of adult patients with schizophrenia, bipolar disorder, or major depressive disorder. METHODS: We performed psychometric analyses including assessments of item response theory (IRT) model assumptions, IRT model fit, differential item functioning (DIF), item bank validity, and CAT simulations. RESULTS: In this multicenter cross-sectional study, 498 patients were recruited from outpatient and inpatient settings. The final PREMIUM-CE 13-item bank was sufficiently unidimensional (root mean square error of approximation=0.082, 95% CI 0.067-0.097; comparative fit index=0.974; Tucker-Lewis index=0.968) and showed an adequate fit to the IRT model (infit mean square statistic ranging between 0.7 and 1.0). DIF analysis revealed no item biases according to gender, health care settings, diagnosis, or mode of study participation. PREMIUM-CE scores correlated strongly with satisfaction measures (r=0.69-0.78; P<.001) and weakly with quality-of-life measures (r=0.11-0.21; P<.001). CAT simulations showed a strong correlation (r=0.98) between CAT scores and those of the full item bank, and around 79.5% (396/498) of the participants obtained a reliable score with the administration of an average of 7 items. CONCLUSIONS: The PREMIUM-CE item bank and its CAT version have shown excellent psychometric properties, making them reliable measures for evaluating the patient experience of the care environment among adults with severe mental illness in both outpatient and inpatient settings. These measures are a valuable addition to the existing landscape of patient experience assessment, capturing what truly matters to patients and enhancing the understanding of their care experiences. TRIAL REGISTRATION: ClinicalTrials.gov NCT02491866; https://clinicaltrials.gov/study/NCT02491866.

Long term studies of depression: what is relevant for the physician?

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Following a meticulous review of long term studies of depression, we conclude that prolonging antidepressant medication after full recovery is clearly beneficial. In this article, we examine recent long term studies that reveal substantial evidence in this sense. However, we advise physicians to keep in mind that this prophylactic effect has been proven for a restricted population, i.e., patients showing recurrent depressive disorders with low comorbidity on axis 1, and having revealed a satisfying response to antidepressant agents during the acute phase of the index episode. This does not mean that antidepressant agents are not useful for patients showing other characteristics, but more studies are needed to assert this possible advantage. We also examine the limited data on chronic forms of depressive disorders. The effect of long term prescription is believed to be advantageous as long as the medication is taken; it has been demonstrated for up to 5 years. Full dosage is indicated even if the effect of active drug over placebo persists at lower doses. The differences between antidepressant agents appear minor and physicians should be more concerned about the long term tolerance of these drugs than their efficacy when choosing the appropriate medication for maintenance treatment. Physicians should also be aware of the greater risk of recurrence during the 6 months following the discontinuation of medication. This risk occurs regardless of the total length of prescription. The possibility that recurrence may be mistaken for withdrawal symptoms cannot be ruled out. Finally, the side-effects of antidepressant drugs are a major concern, particularly when extending the length of prescription. Even though the newer generation medications display a more favorable short-term side-effect profile, the effects of chronic use of these agents are still unclear. Therefore, the decision to extend treatment over several years requires comprehensive discussion with patients and cautious clinical monitoring to identify potential late-onset side effects (AU)