Is Clinical Assessment of Addiction Severity of Individuals with Substance Use Disorder, Using the Addiction Severity Index, A Predictor of Future Inpatient Mental Health Hospitalization? A Nine-Year Registry Study.

OBJECTIVE: In Sweden, the Addiction Severity Index (ASI) is the Swedish National Board of Health and Welfare's recommended substance use disorder assessment tool and used routinely for patient intakes. Our study of 213 individuals assessed for substance use disorder with the ASI used nine years of the National Patient Register and examined whether clinical social workers' assessments of addiction severity at baseline were associated with later hospitalizations for mental health disorder (MHD). METHODS: ASI composite scores and interviewer severity rating were used to measure clients' problems in seven areas (mental health, family and social relationships, employment, alcohol, drug use, health, and legal) at baseline. A stepwise regression method was used to assess the relative importance of ASI composite scores, MHD hospitalization two years prior to baseline, age, and gender for MHD hospitalization seven years post-baseline. RESULTS: Almost two-thirds of the individuals (63%) were hospitalized at least once for MHD in the seven years post-baseline. At the multivariable level, MHD hospitalization prior to baseline was the strongest predictor of future MHD hospitalization, followed by ASI composite scores for drug use, employment, mental health and, last, male gender. CONCLUSIONS: A key finding is that higher ASI composite scores for drug use and mental health are predictors of future need for MHD treatment. Future studies will replicate this effort with a national population of individuals with substance use disorder.

Association between immigrant status and history of compulsory treatment in a national sample of individuals assessed for drug use disorders through the Swedish public welfare system.

In-person interview data from 13,903 individuals assessed for a drug use disorder in the Swedish welfare system from 2002-2008, were analyzed using logistic regression methods. Second generation immigrants with non-Scandinavian parents were 41% more likely to report a history of compulsory treatment compared to those born in Sweden to Swedish parents after controlling for age, gender, education, mental health treatment homeless status history, and criminal justice history. Implications include the need to study acculturation, stigma, and discrimination-related factors as well as to promote culturally competent outreach to immigrant populations.

Baseline training in cognitive and psychodynamic psychotherapy during a psychologist training program. Exploring client outcomes in therapies of one or two semesters.

This effectiveness study explored the outcomes of 187 clients seen by 187 students undergoing baseline training in psychotherapy. Clients reduced their symptoms (SCL-90) and increased their positive self-image (SASB introject) during the therapy. Multiple regression analyses showed no differences between the cognitive and the psychodynamic training approaches and no differences between one and two semesters duration of the therapies. However, 2-3% of variance in end states was accounted for by the interaction between the variables, indicating a moderating effect of duration in the two approaches. Outcomes for clients in the cognitive training approach were significantly better with two semesters than with one semester, while there was no such difference in the psychodynamic approach. Consequences for baseline training are discussed.

The adolescent drug abuse diagnosis composite scores in Swedish normal and antisocial adolescents.

The present study evaluates the utility and issues around the composite scores in Adolescent Drug Abuse Diagnosis (ADAD). Participants were Swedish normal adolescents (121) and adolescents manifesting antisocial problems (1,168), ages 10 to 21. The results show that the interviewer severity ratings seem to be the most appropriate outcome when the objective is to differentiate between normal and antisocial adolescents. The composite scores appear to function as an indicator of current problems in all areas except for Medical and Alcohol sections. The critical items within the Medical and Alcohol composite scores are explored and discussed.

Sources of psychiatric staff members' feelings towards patients and treatment outcome.

This study had two purposes. The first was to assess to what extent psychiatric staff members' feelings towards patients in small psychiatric units could be attributed to (a) the individual staff member's habitual feeling style, (b) stable and consistent feelings towards individual patients (the patient's evocative style) and (c) the interaction between these two factors. The second purpose was to analyse the associations between the proportions of these factors and the average outcome for the patients in the units. The study was based on a previously presented model for analysing sources of staff counter-transference. The model specifies contributions from the different sources by using two-way ANOVAs. In the present study, data from 21 psychiatric treatment units for patients with psychosis and personality disorder were used. The results indicated that the staff members' individual habitual feeling style and the interaction between this habitual feeling style and the patient's evocative style contributed most to the variance in staff feelings. Patients' individual evocative patterns contributed less. Positive treatment outcome was mainly negatively associated with contributions to the staff counter-transference from these sources, implying that fixed patterns in personal feeling style or fixed reaction styles to individual patients had a negative influence on outcome.

Reliability of global assessment of functioning ratings made by clinical psychiatric staff.

OBJECTIVE: In the Swedish psychiatric care system, systematic follow-up of clinical work with patients is becoming a part of regular service, and a number of care providers are using the Global Assessment of Functioning (GAF) to measure outcomes. This study investigated the reliability of the GAF and analyzed certain factors that affect measurement errors when the scale is used by regular psychiatric staff. METHODS: Eighty-one raters from various psychiatric outpatient clinics rated eight case vignettes. Interrater reliability was assessed by using intraclass correlation coefficients (ICCs), and factors associated with reliability were analyzed by using raters' unique residual values. RESULTS: The results showed that staff who are responsible for assessing first-time patients at outpatient psychiatric clinics and making diagnoses are using the GAF with satisfactory reliability (ICC(1,1)=.81). The factors associated with reliability were raters' subjective attitude toward the GAF and motivation to use the scale and other measurement instruments in psychiatry. CONCLUSIONS: GAF ratings made by an individual rater can be used to measure changes and outcomes at the group level. However, the measurement error is too large for assessment of change for an individual patient, in which case it might be necessary to use several raters. If raters are positively inclined to use rating instruments, measurement errors are minimized and reliability is maximized.

Relationship between the Global Assessment of Functioning and other DSM axes in routine clinical work.

OBJECTIVES: The aim of this study was to investigate the validity of the Global Assessment of Functioning (GAF) when routinely used in clinical work by focusing on the relations between the GAF, other axes in the DSM system, and some demographic variables conceptually derived on theoretical and clinical grounds. METHODS: A clinical database containing data for 5,538 patients assessed by 181 raters as a part of routine practice in psychiatric outpatient settings in Sweden was used. A hierarchical linear regression model and a variance component model were used to analyze the data. Regression models were also used to determine how the relation between the GAF and axis I depends on the selection of diagnostic groups in the sample. RESULTS: Seventeen percent of the systematic variance in GAF scores was explained by diagnostic differences as defined on DSM-IV axis I, and 5.1 percent was explained by psychosocial and environmental problems as measured on DSM-IV axis IV. Unexpectedly, the site of the investigation explained another 3.6 percent of the variance. CONCLUSIONS: The GAF can be used as a comprehensive measure of global mental health in routine clinical work for assessment and for outcome management.

The psychometric properties of the Swedish version of the Adolescent Drug Abuse Diagnosis (ADAD).

The psychometric properties of the Swedish version of the Adolescent Drug Abuse Diagnosis (ADAD) instrument were evaluated in two adolescent groups. The participants in the Normal group comprised 121 adolescents aged 15-17 years and the participants in the group of adolescents with antisocial problems comprised 1168 youths aged 10-21 years detained under the Swedish Care of Young Persons Act in special youth homes. The ADAD instrument produced good interrater reliability; the subscales showed moderate internal consistency and concept validity was satisfactory and comparable with American and Swiss versions. Finally, the ADAD subscales produced meaningful correlations. The interviewer rating, the adolescent's rating and the composite scores are compared and discussed. The Swedish version of ADAD appears to be a psychometrically good instrument for assessing the severity of adolescent problems and their need for treatment. However, the composite scores need to be reconstructed to be useful in future research.