[Review Model for the Assessment of Psychometric Instruments--Recommendations of the German College of Psychosomatic Medicine (DKPM)]. / Kriterienkatalog zur Beurteilung psychodiagnostischer Selbstbeurteilungsinstrumente--Empfehlung des Deutschen Kollegiums für Psychosomatische Medizin (DKPM).

OBJECTIVES: Psychometric instruments are commonly applied in psychotherapeutic research and care for the baseline assessment of symptoms, the planning of therapeutic interventions, the assessment of the longitudinal course of symptoms and outcomes of therapeutic interventions as well as quality management of care. Psychometric properties as well as economic aspects should be considered in the selection of specific instruments. It is assumed that users of psychometric instruments face a great variety of instruments and related information. For that reason, it seems challenging to absorb the current knowledge and to integrate it into clinical practice and research. Thus, it is likely that well-known, established and easily accessible instruments are commonly used, while new developed instruments might not be disseminated in research and healthcare. METHODS: Based on available international review models, the working group "Psychometrics and Psychodiagnostics" of the German College of Psychosomatic Medicine (DKPM) has developed and tested a review model specifically tailored for psychotherapeutic research and care. RESULTS: The different steps of development, as well as the final review model based on the consensus of the working group are presented. The review model contains 6 generic terms (reliability, validity, objectivity, reference groups and aspects of application) with 21 different criteria to be assessed with 0-3 asterisks (*). The criteria are clearly operationalized and the practical use of the review model is explained and discussed. CONCLUSIONS: With the review model for the assessment of psychometric instruments a well-defined evaluation system is made available for research and clinical practice which has been developed by an expert group. The review model facilitates systematic, transparent and comparative evaluation of psychometric instruments along clearly defined criteria. It also supports the selection of psychometric instruments in research and care. Next, the working group aims at disseminating and implementing the review model as well as the application and publication of reviews for different psychometric instruments based on the review model.

Psychometric properties of an instrument to measure activities and participation according to the ICF concept in patients with mental disorders.

PURPOSE: The International Classification of Functioning, Disability and Health (ICF) conceptualizes the bio-psycho-social model of health and illness, but cannot be used as an assessment instrument in routine care. The objective of this study was to psychometrically test a self-report instrument for measuring activities and social participation (ICF-Mental-A&P) of psychotherapy patients. METHODS: For the psychometric evaluation of the ICF-Mental-A&P, participants completed a questionnaire on symptoms, interpersonal problems and quality of life at admission and at discharge of in-patient treatment. A consecutive sample of 2256 patients diagnosed with at least one mental disorder was recruited from eight in-patient units in Germany. RESULTS: After item selection, the ICF-Mental-A&P contained 31 items comprising six subscales examined by confirmatory factor analysis. Subscales had acceptable internal consistency (α = 0.78-0.90) and test-retest correlations (r = 0.71-0.86). There were several expected correlations (r ≥ 0.6) between ICF-Mental-A&P scores and measures of symptoms and interpersonal problems. CONCLUSIONS: Findings suggest that the ICF-Mental-A&P is a comprehensive, reliable measure of activities and participation according to the ICF concept for patients with mental disorders. It may therefore be an important instrument in clinical practice and could help to determine and evaluate functioning-related and patient-focused treatment outcomes.

Is the Health of the Nation Outcome Scales appropriate for the assessment of symptom severity in patients with substance-related disorders?

The Health of the Nation Outcome Scales (HoNOS) is an internationally established clinician-rated instrument. The aim of the study was to assess the psychometric properties in inpatients with substance-related disorders. The HoNOS was applied in a multicenter, consecutive sample of 417 inpatients. Interrater reliability coefficients, confirmatory factor analysis, and regression tree analyses were calculated to assess the reliability and validity of the HoNOS. The factor validity of the HoNOS and its total score could not be confirmed. After training, all items of the HoNOS revealed sufficient values of interrater reliabilities. As the results of the regression tree analyses showed, the single items of the HoNOS were one of the most important predictor of service utilization. The HoNOS can be recommended for obtaining detailed ratings of the problems of inpatients with substance-related disorders as a clinical application in routine mental health care at present. Further studies should include comparisons of HoNOS and Addiction Severity Index.

The validity of the German version of the Health of the Nation Outcome Scales (HoNOS-D): a clinician-rating for the differential assessment of the severity of mental disorders.

The Health of the Nation Outcome Scales (HoNOS) is an internationally-established clinician-rating instrument for the differential assessment of the severity of patients with mental disorders. The aim of this study was to examine the validity of the German version of the HoNOS (HoNOS-D). Evaluation of validity, including factor validity, convergent and discriminant validity and sensitivity to change, was conducted on a large, virtually representative, clinical sample of patients with mental disorders in inpatient psychotherapy (Study 1, N = 3169). Additional assessment of criterion-based validity was completed using another clinical sample of patients with mental disorders (Study 2, N = 55). Although factor validity of the HoNOS-D and its total score could not be confirmed as expected, the majority of single items of the HoNOS-D proved to be valid in terms of convergent validity, criterion-based validity and sensitivity to change. Hence, single items, rather than the total score of the HoNOS-D, can be recommended for obtaining a picture of the impairment of patients with mental disorders in the clinical setting.

Development and evaluation of a case group concept for inpatients with mental disorders in Germany: using self-report and expert-rated instruments.

The aim of this study was to evaluate a case-mix system to classify inpatients with mental disorders in Germany by means of self-report and expert-rated instruments. The use of case-mix systems enhances the transparency of performance and cost structure and can thus improve the quality of mental health care. We analysed a consecutive sample of 1677 inpatients with mental disorders from 11 hospitals using regression tree analysis. The model assigns patients to 17 groups, accounting for 17% of the variance for duration of stay. Patients with eating disorders had a longer duration of stay than patients with anxiety disorder, duration of mental illness of less than 3-5 years, lower levels of interpersonal problems and higher occupational position. The results showed that besides diagnosis, variables such as duration of illness and interpersonal problems are important for classifying inpatients with mental disorders. The results of the study should be critically reviewed regarding the empirical results of other studies and the appropriateness of case group concepts for inpatients with mental disorders.

[Predictors of resource use in inpatient psychotherapy: development of a German case group concept for patients with mental disorders]. / Lassen sich Zusammenhänge zwischen Patientenmerkmalen und dem fachspezifischen Ressourcenverbrauch in der stationären Behandlung von Patienten mit psychischen/psychosomatischen Störungen bestimmen? Erste empirische Ergebnisse zur Entwicklung eines Klassifikationssystems.

OBJECTIVE: Recent research on predictors of resource use in inpatient psychotherapy indicates that various patient characteristics as well as therapeutic factors may influence resource use. The aim of our study was to examine the relationship between patient attributes and psychotherapeutic costs in German inpatient psychotherapy. The amount of variance explained in resource use was calculated. METHOD: The existing sample used in this study consists of sociodemographic and clinical variables of 2375 patients treated in various inpatient psychosomatic clinics. Resource use was measured on the basis of clinical staff activities (Klassifikation Therapeutischer Leistungen, KTL, BfA 2000). Regression Tree Analysis was performed to classify patient attributes based on resource use. RESULTS: The model assigns patients to 20 classes, accounting for 17.5 % of variance. Those patients with single status and personality or eating disorder consume more resources than those patients with non-single status, low motivation for psychotherapy, comorbidity of physical illness and lower levels on symptom severity. CONCLUSIONS: Implications of the results for the development of a patient classification system in inpatient psychotherapy will be discussed.