[The ICD-10 Symptom Rating (ISR): validation of the depression scale in a clinical sample]. / Das ICD-10 Symptomrating (ISR): Validierung der Depressionsskala an einer klinischen Stichprobe.

The ICD-10 Symptom Rating (ISR) 1 measures the severity of psychiatric disorders with 29 items on 5 subscales as comprehensively as possible. The following syndromes are measured: Depressive syndrome, anxiety syndrome, obsessive-compulsive syndrome, Somatoform syndrome, eating disorder syndrome as well as additional items that cover various mental syndromes, and an overall score. The study reports findings on the validity and sensitivity to change of the depression subscale (ISR-D). In a clinical sample of N=949 inpatients with depression spectrum disorders the convergent validity was determined by correlation with the Beck Depression Inventory (BDI) 3 and the subscale "depression" of the Symptom-Checklist-90-R (SCL-90-R) 4. The high correlation between the different instruments confirms the validity of the ISR-Depression Scale. The sensitivity to change of the ISR seems higher than that of the BDI and the SCL-90. Because of its economy and the good psychometric properties the ISR is recommended for use in clinical samples.

Benefits and challenges in practice-oriented psychotherapy research in Germany: the TK and the QS-PSY-BAY projects of quality assurance in outpatient psychotherapy.

OBJECTIVE: Two patient-focused long-term research projects performed in the German outpatient psychotherapy system are focused on in this article. The TK (Techniker Krankenkasse) project is the first study to evaluate a quality assurance and feedback system with regard to its practical feasibility in German routine care. The other study ("Quality Assurance in Outpatient Psychotherapy in Bavaria"; QS-PSY-BAY) was designed to test a new approach for quality assurance in outpatient psychotherapy using electronic documentation of patient characteristics and outcome parameters. In addition this project provides the opportunity to analyze data on health-related costs for the patients undergoing outpatient psychotherapy. METHOD: Both projects and their results indicating high effect sizes are briefly described. RESULTS: From the perspectives of the research teams, advisory boards and other stakeholders, the experiences with these projects are discussed focusing on obstacles, challenges, difficulties, and benefits in developing and implementing the studies. The triangle collaboration of therapists, researchers, and health insurance companies/health service institutions turned out to be fruitful in both studies. CONCLUSIONS: Despite some controversies between the partners the experiences indicate the importance of practiced-research collaborations to provide relevant information about the delivery of outpatient psychotherapy in the health system.

[Efficacy of psychosomatic inpatient treatment for somatoform disorders: results of a multicenter study]. / Wie wirksam ist psychosomatische Therapie bei somatoformen Storungen? Ergebnisse einer Multicenterstudie.

OBJECTIVES: The present study describes self- and therapist-reported treatment effects of inpatient psychotherapy for various somatoform disorders. METHODS: A total of 2,062 patients with the primary diagnosis F45.XX (ICD-10, Somatoform Disorders) were treated at 17 psychosomatic clinics in Bavaria, Germany. Subgroup analyses were performed for F45.0X, F45.3X, and F45.4X as well as a combined group of F45.1X, F45.2X, and F45.5X. RESULTS: Symptom severity decreased for all subgroups of somatoform disorders. The pre-post effect size was d = -.58 for the Symptom Check-List 90-R (GSI), and -1.26 for the impairment score rated by the therapist. Symptom levels differed among the various subgroups; patients with somatoform pain had the highest scores. CONCLUSIONS: Patients with various somatoform disorders appear to profit well from psychosomatic inpatient psychotherapy. Patients with somatoform pain disorders reported the lowest effect on GSI, but received the highest effect in the therapist ratings.

[The effectiveness of psychosomatic inpatient treatment - results of a multicenter follow-up study]. / Effektivität stationärer psychosomatischer Krankenhausbehandlung - Ergebnisse einer multizentrischen Katamnesestudie.

OBJECTIVES: This multicenter follow-up study examines the effectiveness of psychosomatic inpatient treatment under the conditions of routine practice. METHODS: We chose a naturalistic design with one pre- and two postmeasurements: admission, discharge, and 1-year follow-up with a follow-up sample of 935 patients from five psychosomatic hospitals.We assessed the effectiveness of inpatient psychosomatic treatments with the Global Severity Index (GSI) of the SCL-90-R at admission (M = 1.20, SD = 0.68), discharge (M = 0.67, SD = 0.58), and 1-year follow-up (M = 0.83, SD = 0.68) as well as with the Veränderungsfragebogen des Erlebens und Verhaltens (VEV-K) at discharge (M = 125.42, SD = 27.27) and follow-up (M = 115.50, SD = 31.16). RESULTS: Significant improvements were shown in the GSI from admission to discharge (F = 802.70, df = 1, p

[Development of the "ICD-10-Symptom-Rating"(ISR) questionnaire]. / Entwicklung des Fragebogens "ICD-10-Symptom-Rating" (ISR).

OBJECTIVES: Construction of the newly developed "ICD-10 Symptom Rating" (ISR) is presented together with some statistical data. This questionnaire is founded on the well-known ICD-10, according to which symptoms are relevant for assessing psychological disorders. The ISR aims at a comprehensive evaluation of the severity of psychological disorders. The ISR 2.0 has 29 items and six syndrome scales: Depression, Anxiety, Obsessive/Compulsive, Somatoform, Eating Disorders, and the Supplementary Scale, which covers a variety of syndromes, as well as a total score. METHODS AND RESULTS: In a first cross-validation with 108 patients, some rather high correlations were found between the SCL-90-R and the ISR. They ranged from r = 0.78 to 0.37 for the individual syndrome scales, and amounted to r = 0.78 for the GSI versus the total score.

How does the ICD-10 symptom rating (ISR) with four items assess depression compared to the BDI-II? A validation study.

OBJECTIVE: The "ICD-10 Symptom-Rating" (ISR) is a novel 29-item self-rating questionnaire with scales for the assessment of depression, anxiety, OCD, somatisation and eating disorders and additional items. This study aims at the validation of the depression subscale. METHODS: Based on a sample of 1844 depressed inpatients, the ISR was correlated with the Beck-Depression-Inventory-II (BDI-II). To estimate the sensitivity to change, the effect sizes were also calculated. RESULTS: The correlation between ISR and BDI-II was r=0.79. The sensitivity to change for the BDI-II was d=1.44, for the ISR-depression scale d=1.64. LIMITATIONS: The studied sample shows a higher psychiatric and somatic comorbidity, a lower mean age and a higher level of education than comparable samples from other psychiatric or psychosomatic studies. Although we cannot find any effects of these differences on our results, they cannot be fully dismissed without further study. CONCLUSION: The ISR-depression scale correlates highly with the BDI-II. Being more sensitive to change than the BDI-II, the ISR is a useful tool to diagnose and measure the severity and course of depression.

[Non-completion of insurance-funded outpatient psychotherapy: frequency, risk factors, outcome]. / Abbrüche antragspflichtiger ambulanter Psychotherapien: Häufigkeit, Risikofaktoren, Outcome.

OBJECTIVE: Because premature discontinuation of psychotherapy limits the effectiveness of the interventions, in a naturalistic design we examined the prevalence, predictors, and outcome of premature discontinuation. METHODS: The sample included N = 584 patients with various mental disorders. Risk factors were identified using regression analysis. As outcome Patient Health Questionnaire scales were considered. We compared pre and post averages as well as post averages of premature discontinuation versus regular termination. RESULTS: Risk factors were: female and/or unemployed patient, low patient and/or therapist ratings regarding therapy success, and extraordinarily high therapist ratings of the therapeutic alliance. Despite premature discontinuation we found significant reductions of depression, anxiety, somatic symptoms, and stress (ES = 0.30, …, 0.44). Compared to regular termination though, patients with premature discontinuation were more impaired at last measurement (ES = 0.17, …, 0.37). CONCLUSION: Not each premature discontinuation is a psychotherapeutic failure. Warning signals for looming premature discontinuation are low ratings of therapy success while psychotherapeutic treatment.