Revisiting the concept of severe mental illness: severity indicators and healthcare spending in psychotic, depressive and dissociative disorders.

Background: The concept of severe mental illness (SMI) has been related to bipolar or psychotic diagnosis, or to some cases of depressive disorders. Other mental health problems such as personality disorders or posttraumatic dissociative conditions, which can sometimes lead to relevant functional impairments, remain separate from the SMI construct.Aims: This study aimed to evaluate the clinical severity as well as healthcare spending on dissociative disorders (DDs). This diagnostic group was compared with two other groups usually considered as causing severe impairment and high healthcare spending: bipolar and psychotic disorders, and unipolar depression.Methods: From a random sample of 200 psychiatric outpatients, 108 with unipolar depression (N = 45), psychotic/bipolar (N = 31) or DDs (N = 32) were selected for this study. The three groups were compared by the severity of their disorder and healthcare indicators.Results: Of the three groups, those with a DD were more prone to and showed higher indices of suicide, self-injury, emergency consultations, as well as psychotropic drug use. This group ranked just below psychotic/bipolar patients in the amount of psychiatric hospitalisations.Conclusions: Despite a certain intra-professional stigma regarding DDs, these data supported the severity of these posttraumatic conditions, and their inclusion in the construct of SMI.

Validaty and reliability of the Spanish version of the Somatoform Dissociation Questionnaire (SDQ-20) / Validez y fiabilidad de la versión española del Somatoform Dissociation Questionnaire (SDQ-20)

BACKGROUND: The Somatoform Dissociation Questionnaire (SDQ-20) is a self-reported questionnaire measuring somatoform dissociation. The aim of this study is to analyze the psychometric properties of the Spanish version of the SDQ-20 and its short version (SDQ-5). METHODS: Validity and reliability were examined in a sample of 360 psychiatric outpatients: 38 dissociative (conversion) disorders, 30 dissociative (psychoform) disorders, and 292 patients suffering from other disorders. Dissociative disorders were diagnosed using the SCID-D and a specific interview for conversion disorders. RESULTS: Subjects meeting criteria for any dissociative or conversion disorder scored significantly higher in the SDQ-20 (criterion validity). Somatoform dissociation, psychoform dissociation and early trauma were significantly correlated (construct validity). An alpha coefficient of .866 (reliability) and a test-retest correlation of 0.91 were obtained. The cut-off score maximizing sensitivity and specificity was 27.5 for psychoform dissociative disorders (sensitivity of 81.6% and specificity of 71.0%) and 29.5 for conversion disorders (81.6% and 71.0%). For the SDQ-5, the coefficient alpha was 0.561 and the selected cut-off score was 5.5 (sensitivity of 73.33% and specificity of 70.41%). CONCLUSIONS: The Spanish version of the SDQ-20 presents good psychometric properties while the SDQ-5 shows worse characteristics and its use with Spanish samples is not recommended

ANTECEDENTES: SDQ-20 (Somatoform Dissociation Questionnaire) es un autoinforme que mide la presencia de disociación somatomorfa. Se analizan las propiedades psicométricas de la versión española de la SDQ-20 y su versión abreviada (SDQ-5). MÉTODO: su validez y fiabilidad han sido examinadas en una muestra de 360 pacientes: 38 trastorno disociativo (de conversión), 30 trastorno disociativo (psicomorfo) y 292 diagnosticados de otros trastornos. El diagnóstico de trastorno disociativo se realizó mediante la SCID-D-TR y una entrevista específica para los trastornos conversivos. RESULTADOS: los sujetos que cumplieron criterios de trastorno disociativo o conversivo puntuaron significativamente más alto en la SDQ-20 (criterio de validez). La disociación psicomorfa y somatomorfa y el trauma temprano se correlacionaron significativamente (validez del constructo). Se obtuvieron un coeficiente alpha de 0.866 (fiabilidad) y una correlación test-retest de 0,91. El punto de corte para los trastornos disociativos fue 27,5 (sensibilidad 81,6% y especificidad 71%) y 29,5 para los trastornos conversivos (81,6% y 71%). En la SDQ-5 se obtuvo un coeficiente alpha de 0,561 y un punto de corte de 5,5 (sensibilidad 73,33% y especificidad 70,41%). CONCLUSIONES: la versión española de la SDQ-20 presenta buenas propiedades psicométricas. La SDQ-5 muestra peores características y su uso en muestras españolas no se recomienda

Validity and reliability of the Spanish version of the Somatoform Dissociation Questionnaire (SDQ-20).

BACKGROUND: The Somatoform Dissociation Questionnaire (SDQ-20) is a self-reported questionnaire measuring somatoform dissociation. The aim of this study is to analyze the psychometric properties of the Spanish version of the SDQ-20 and its short version (SDQ-5). METHODS: Validity and reliability were examined in a sample of 360 psychiatric outpatients: 38 dissociative (conversion) disorders, 30 dissociative (psychoform) disorders, and 292 patients suffering from other disorders. Dissociative disorders were diagnosed using the SCID-D and a specific interview for conversion disorders. RESULTS: Subjects meeting criteria for any dissociative or conversion disorder scored significantly higher in the SDQ-20 (criterion validity). Somatoform dissociation, psychoform dissociation and early trauma were significantly correlated (construct validity). An alpha coefficient of .866 (reliability) and a test-retest correlation of 0.91 were obtained. The cut-off score maximizing sensitivity and specificity was 27.5 for psychoform dissociative disorders (sensitivity of 81.6% and specificity of 71.0%) and 29.5 for conversion disorders (81.6% and 71.0%). For the SDQ-5, the coefficient alpha was 0.561 and the selected cut-off score was 5.5 (sensitivity of 73.33% and specificity of 70.41%). CONCLUSIONS: The Spanish version of the SDQ-20 presents good psychometric properties while the SDQ-5 shows worse characteristics and its use with Spanish samples is not recommended.