Background: The Health of the Nation Outcome Scales (HoNOS) is a clinician-rated instrument for the differentiated measurement of severity in patients with mental disorder. Item 8 of the instrument, assessing ‘Other mental and behavioral problems’, is particularly relevant for patients with affective disorders, anxiety disorders, and eating and personality disorders. However, some studies have shown that the scale possesses unsatisfactory psychometric properties. The objective of the present study was therefore to validate the psychometric properties of a more specified version of the HoNOS-D item 8. Methods: The instrument’s reliability and validity were tested using a large, representative, clinical sample of patients with mental disorders (study 1: n = 1,918 and n = 1,357). Additional tests of reliability and criterion validity were performed using a further clinical sample of patients with mental disorders (study 2: N = 55). Results: The extended version of the HoNOS provides a differentiated picture of additional problem areas for the patient. Although inter-rater reliability indicates a need for more detailed instructions, the problem areas of item 8 proved on the whole to be suitable for measuring the extent and severity of mental problems that are present in addition to the primary problem. Conclusion: In order to make the extended assessment of the HoNOS useful for clinical routine practice, a supplemental glossary is needed.

Keywords:
Symptom severity, Health of the Nation Outcome Scales
1.
Slade M: Routine outcome assessment in mental health services. Psychol Med 2002;32:1339–1343.
2.
Wing JK, Beevor AS, Curtis RH, Park SBG, Hadden S, Burns A: Health of the Nation Outcome Scales (HoNOS): research and development. Br J Psychiatry 1998;172:11–18.
3.
Lora A, Bai G, Bianchi S, Bolongaro G, Civenti G, Erlicher A, Maresca G, Monzani E, Panetta B, von Morgen B, Rossi F, Torri V, Morosini P: The Italian version of HoNOS (Health of the Nation Outcome Scales), a scale for evaluating the outcome and severity in mental health services. Epidemiol Psichiatr Soc 2001;10:198–212.
4.
Trauer T, Callaly T, Hantz P, Little J, Shields R, Smith J: Health of the Nation Outcome Scales: results of the Victorian field trial. Br J Psychiatry 1999;174:380–388.
5.
Kisely S, Campbell LA, Crossman D, Gleich S, Campbell J: Are the Health of the Nation Outcome Scales a valid and practical instrument to measure outcomes in North America? A three-site evaluation across Nova Scotia. Community Ment Health J 2007;43:91–107.
6.
Bech P, Bille J, Waarst S, Wiese M, Borberg L, Treufeldt P, Kessing L: Validity of HoNOS in identifying frequently hospitalized patients with ICD-10 mental disorders. Acta Psychiatr Scand 2006;113:485–491.
7.
Buckingham B, Burgess P, Solomon S, Pirkis J, Eagar K: Developing a Casemix Classification for Mental Health Services: Summary. Canberra, Commonwealth Department of Health & Family Services, 1998.
8.
Gaines P, Bower A, Buckingham W, Eager K, Burgess P, Green J: New Zealand Mental Health Classification and Outcomes Study: Final Report. Auckland, Health Research Council of New Zealand, 2003.
9.
Andreas S, Harfst T, Dirmaier J, Kawski S, Koch U, Schulz H: A psychometric evaluation of the German version of the ‘Health of the Nation Outcome Scales, HoNOS-D’: On the feasibility and reliability of a clinician-rated measure of severity in patients with mental disorders. Psychopathology 2007;40:116–125.
10.
Orrell M, Yard P, Handysides J, Schapira R: Validity and reliability of the Health of the Nation Outcome Scales in psychiatric patients in the community. Br J Psychiatry 1999;174:409–412.
11.
Brooks R: The reliability and validity of the health of the nation outcome scales: validation in relation to patient derived measures. Aust NZ J Psychiatry 2000;34:504–511.
12.
Eagar K, Trauer T, Mellsop G: Performance of routine outcome measures in adult mental health care. Aust NZ J Psychiatry 2005;39:713–718.
13.
Rock D, Preston N: Honos: Is there any point in training clinicians? J Psychiatr Mental Health Nurs 2001;8:405–409.
14.
Dilling H, Mombour W, Schmidt MH: Internationale Klassifikation psychischer Störungen: ICD-10 Kapitel V (F) – klinisch-diagnostische Leitlinien. Bern, Verlag Hans Huber, 1993.
15.
Harfst T, Koch U, Kurtz von Aschoff C, Nutzinger DO, Rüddel H, Schulz H: Entwicklung und Validierung einer Kurzform der Symptom Checklist-90-r. DRV-Schriften 2002;33:71–73.
16.
Harfst T, Dirmaier J, Koch U, Schulz H: Entwicklung und psychometrische Überprüfung einer multidimensionalen Kurzform des Inventars zur Erfassung interpersonaler Probleme. DRV-Schriften 2004;52:53–55.
17.
Ware JE, Kosinski M, Dewey JE, Gandek B: How to Score and Interpret Single-Item Health Status Measures: a Manual for Users of the SF-8 Health Survey. Lincoln, Quality Metric, 2000.
18.
Cohen J: Statistical Power and Analysis for the Behavioral Sciences, ed 2. Hillsdale, Lawrence, 1988.
19.
Kazis LE, Anderson JJ, Meenan RF: Effect sizes for interpreting changes in health status. Med Care 1989;27:S178–189.
20.
Margraf J: Mini-dips: Diagnostisches Kurz-Interview bei psychischen Störungen. Berlin, Springer, 1994.
21.
World Health Organization: Composite International Diagnostic Interview – version 1.1. Geneva, WHO, 1993.
22.
Fydrich T, Schmitz B, Bodem M: Skid-II. Strukturiertes klinisches Interview für DSM-IV, Achse II. Göttingen, Beltz-Test, 1995.
23.
Derogatis L: Scl-90-r, Administration, Scoring and Procedures Manual for the R(evised) Version. Towson, Clinic Psychometric Research, 1983.
24.
Beck AT, Ward CH, Mendelson M, Mock JE, Erbaugh JT: An inventory for measuring depression. Arch Gen Psychiatry 1961;4:561–571.
25.
Endicott J, Spitzer RL, Fleiss JL, Cohen J: The global assessment scale: a procedure for measuring overall severity of psychiatry disturbance. Arch Gen Psychiatry 1976;33:766–771.
26.
Schepank H: Der Beeinträchtigungs-Schwere-Score (BSS). Göttingen, Beltz-Test, 1995.
27.
Landis JR, Koch GG: The measurement of observer agreement for categorical data. Biometrics 1977;33:159–174.
28.
Fleiss JL, Cohen J: The equivalence of weighted kappa and the intraclass correlation coefficient as measures of reliability. Educ Psychol Measurement 1973;33:613–619.
29.
Wing JK, Curtis RH, Beevor AS: Honos: Health of the Nation Outcome Scales: Report on Research and Development July 1993-December 1995. London, Royal College of Psychiatrists, 1996.
30.
Adams M, Palmer A, O’Brien JT, Crook W: Health of the nation outcome scales for psychiatry: are they valid? J Mental Health, 2000;9:193–198.
31.
Garner DM: Eating Disorder Inventory. 2. Professional Manual. Odessa, Psychological Assessment Resources, 1991.
32.
Sharma VK, Wilkinson G, Fear S: Health of the nation outcome scales: a case study in general psychiatry. Br J Psychiatry 1999;174:395–398.
33.
Andreas S, Harris-Hedder K, Schwenk W, Koch U, Schulz H: Is the HoNOS appropriate for the assessment of symptom severity in patients with substance-related disorders? J Substance Abuse Treatment 2010;39:32–40.
34.
Page AC, Hooke GR, Rutherford EM: Measuring mental health outcomes in a private psychiatric clinic: Health of the Nation Outcome Scales and medical outcomes short form SF-36. Aust NZ J Psychiatry 2001;35:377–381.
35.
Audin K, Marginson FR, Clark JM, Barkham M: Value of HoNOS in assessing patient change in nhs psychotherapy and psychological treatment services. Br J Psychiatry 2001;178:561–566.
36.
Overall JE, Gorham DR: Bprs. Brief psychiatric rating scale; in Guy W (ed): ECDEU Assessment Manual for Psychopharmacology. Rockville, National Institute of Mental Health, 1976, pp 157–169.
© 2011 S. Karger AG, Basel
2011
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.