A Psychometric evaluation of the German version of the 'Health of the Nation Outcome Scales, HoNOS-D': on the feasibility and reliability of clinician-performed measurements of severity in patients with mental disorders.
BACKGROUND
The assessment of the severity of a mental illness is a central component in the treatment of patients with mental disorders in both the in- and outpatient settings. In Great Britain, the 'Health of the Nation Outcome Scales, HoNOS' were developed to assess the health and social functioning of patients with mental disorders.


OBJECTIVE
To examine the psychometric properties, especially the feasibility and reliability, of a German version of the HoNOS (HoNOS-D) and to thus provide international data for the comparison of different mental health services.


METHODS
The HoNOS was translated into German (HoNOS-D) in an extensive and multilayered consensus procedure. The HoNOS-D was then reviewed within the framework of a pilot study on quality assurance measures implemented by the German statutory health insurance institutes in 11 hospitals. Assessments were made of the psychometric qualities of feasibility and reliability using a representative sample of patients with mental and behavioral disorders.


RESULTS
An analysis of the feasibility of the HoNOS-D showed a range of missing values between 1.3 and 4.5% for 11 of the 12 items. An item analysis showed that three items of the HoNOS-D are particularly positively skewed. In most instances, the individual items of the rating scale exhibited only slight correlations to each other. With regard to retest reliability, satisfactory intraclass correlations between 0.80 and 0.91 were seen for 9 of the 12 items.


CONCLUSIONS
The authors of the original version of the HoNOS [Wing et al.:Br J Psychiatry 1998;172:11-18] primarily emphasized the feasibility of the instrument and the independence of the individual items and dimensions. The analysis of the missing values showed satisfactory results for feasibility. The intercorrelation matrix of the individual items also exhibited only few correlations >0.30. The retest reliability also proves to be satisfactory for the majority of the items. The narrow distribution of some of the items must be critically discussed in comparison to analyses of results in other countries (e.g. Great Britain) and other settings (e.g. inpatient psychiatric hospitals or outpatient psychotherapy).
Andreas
Sylke
S
Institute for Medical Psychology, Center for Psychosocial Medicine, University Medical Center at Hamburg-Eppendorf, Germany. sandreas@uke.uni-hamburg.de
Harfst
Timo
T
Dirmaier
Jörg
J
Kawski
Stephan
S
Koch
Uwe
U
Schulz
Holger
H
D000328:Adult; D000368:Aged; D003431:Cross-Cultural Comparison; D005240:Feasibility Studies; D005260:Female; D005858:Germany; D006760:Hospitalization; D006801:Humans; D007802:Language; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis* / Q000523:psychology; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data*; D010552:Personality Assessment / Q000706:statistics & numerical data*; D011594:Psychometrics / Q000706:statistics & numerical data; D015203:Reproducibility of Results