Rasch Validation and Cross-Validation of the Health of Nation Outcome Scales for Monitoring of Psychiatric Disability in Traumatized Refugees in Western Psychiatric Care.

There are no validated measures of psychiatric disability for traumatized refugees in Western psychiatric care. This is a serious shortcoming as it precludes monitoring of global treatment outcomes in this group, as well as appropriate matching of treatment needs to the disability levels. Using Rasch analysis, we evaluated the psychometrics of the Health of Nation Outcome Scales (HoNOS) in pretreatment data of consecutive refugee patients (N = 448) from a Danish psychiatric clinic. Then, we carried out a cross-validation of the pretreatment HoNOS model on posttreatment data from the same group. A revised 10-item HoNOS fit the Rasch model at pretreatment and also showed excellent fit within the cross-validation data. Culture, gender, and need for translation did not exert serious bias on the measure's performance. The results establish good monitoring properties of the 10-item HoNOS as the first validated measure of psychiatric disability for traumatized refugees in Western psychiatric care.

Comparison of psychiatric disability on the health of nation outcome scales (HoNOS) in resettled traumatized refugee outpatients and Danish inpatients.

BACKGROUND: Currently, the mental health issues of traumatized refugees are mainly documented in terms of posttraumatic stress disorder, depression, and anxiety. Importantly, there are no reports of the level of psychiatric disability in treatment seeking traumatized refugees resettled in the West. Insufficient acknowledgment of the collective load of bio-psycho-social problems in this patient group hinders effective psychiatric and social service utilization outside the specialized clinics for traumatized refugees. METHODS: The level of psychiatric disability in traumatized refugees from Danish specialized clinics (N = 448) is documented using routine monitoring data from pre- and post-treatment on the Health of Nation Outcome Scales (HoNOS). Furthermore, the HoNOS ratings are compared with routine monitoring data from Danish inpatients with different diagnoses (N = 10.911). RESULTS: The routinely collected data indicated that despite their outpatient status, traumatized refugees had higher levels of psychiatric disability at pre-treatment compared to most inpatients. Moreover, the traumatized refugees had a HoNOS profile characterized by an overall high problem level in various psychiatric and social domains. The rate of pre- to post-treatment improvement on the HoNOS was smaller for the traumatized refugees than it was for the psychiatric inpatients. CONCLUSIONS: The level, and the versatile profile, of psychiatric disability on the HoNOS point to complex bio-psycho-social problems in resettled treatment seeking traumatized refugees. Thus, a broader assessment of symptoms and better cooperation between psychiatric, health care, and social systems is necessary in order to meet the treatment needs of this group.