Psychometric properties of an instrument to measure activities and participation according to the ICF concept in patients with mental disorders

PURPOSE

The International Classification of Functioning, Disability and Health (ICF) conceptualizes the bio-psycho-social model of health and illness, but cannot be used as an assessment instrument in routine care. The objective of this study was to psychometrically test a self-report instrument for measuring activities and social participation (ICF-Mental-A&P) of psychotherapy patients.

METHODS

For the psychometric evaluation of the ICF-Mental-A&P, participants completed a questionnaire on symptoms, interpersonal problems and quality of life at admission and at discharge of in-patient treatment. A consecutive sample of 2256 patients diagnosed with at least one mental disorder was recruited from eight in-patient units in Germany.

RESULTS

After item selection, the ICF-Mental-A&P contained 31 items comprising six subscales examined by confirmatory factor analysis. Subscales had acceptable internal consistency (α = 0.78-0.90) and test-retest correlations (r = 0.71-0.86). There were several expected correlations (r ≥ 0.6) between ICF-Mental-A&P scores and measures of symptoms and interpersonal problems.

CONCLUSIONS

Findings suggest that the ICF-Mental-A&P is a comprehensive, reliable measure of activities and participation according to the ICF concept for patients with mental disorders. It may therefore be an important instrument in clinical practice and could help to determine and evaluate functioning-related and patient-focused treatment outcomes.

Comparative psychometric analyses of the SCL-90-R and its short versions in patients with affective disorders

BACKGROUND

Despite the widespread application of Symptom Checklist 90-R (SCL-90-R), its psychometric weaknesses have repeatedly been noted. This study aimed to comparatively assess the psychometric properties of the SCL-90-R scales and the scales of its short versions Brief Symptom Inventory (BSI), Symptom Checklist-27 (SCL-27), Brief Symptom Inventory-18 (BSI-18), Symptom Checklist-14 (SCL-14), and Symptom Checklist short version-9 (SCL-K-9) in patients with affective disorders.

METHODS

The data of 2,727 patients within the main treatment group of affective disorders were assessed according to the DSM-IV. Patients completed the SCL-90-R and Beck Depression Inventory (BDI).

RESULTS

There were no significant differences regarding the internal consistency of the SCL-90-R scales and the scales of the short versions. The dimensional structure was only supported for the short versions BSI-18, SCL-14 and SCL-K-9. The assessment of convergent validity revealed high correlations. With regard to the discriminant validity, there were medium correlations. With regard to the sensitivity of change, no significant differences between the scales were found.

CONCLUSIONS

In summary, the scales of the short versions show mostly satisfactory psychometric properties in comparison to the scales of the SCL-90-R. The results support the application of the short versions as screening instruments, especially the BSI-18, and more economic variants of the SCL-90-R covering a wide range of psychopathological symptoms.

Development of an ICF-based core set of activities and participation for patients with mental disorders: an approach based upon data

Objective:

To use data and patient involvement to identify categories within the International Classification of Functioning, Disability and Health (ICF) component activities and participation relevant for patients with affective, somatoform, anxiety and adjustment disorders.

Design:

The first step was to identify systematically, outcome instruments used in randomized controlled trials, to relate item content to the ICF. Then four patient focus group discussions ( n = 21 participants) were conducted, and finally an expert panel ( n = 11 participants) was used to identify the most relevant categories in therapy settings.

Participants:

Focus groups: inpatient psychotherapy patients. Expert panel: clinicians, stakeholders, patient representative.

Results:

In the literature search, 313 measures were identified, which included 1562 meaningful concepts (separate content units). These were allocated to ICF categories that were validated and complemented in focus groups and by an expert panel. The resulting core set includes 27 categories related to the nine chapters of the ICF component activities and participation.

Conclusions:

A core set of items, set within the World Health Organization ICF and relevant to the treatment of people with affective, somatoform, anxiety and adjustment disorders, has been developed based on existing evidence.

The MentDis_ICF65+ study protocol: prevalence, 1-year incidence and symptom severity of mental disorders in the elderly and their relationship to impairment, functioning (ICF) and service utilisation

BACKGROUND

The EU currently lacks reliable data on the prevalence and incidence of mental disorders in older people. Despite the availability of several national and international epidemiological studies, the size and burden of mental disorders in the elderly remain unclear due to various reasons. Therefore, the aims of the MentDis_ICF65+ study are (1) to adapt existing assessment instruments, and (2) to collect data on the prevalence, the incidence, and the natural course and prognosis of mental disorders in the elderly.

METHOD/DESIGN

Using a cross-sectional and prospective longitudinal design, this multi-centre study from six European countries and associated states (Germany, Great Britain, Israel, Italy, Spain, and Switzerland) is based on age-stratified, random samples of elderly people living in the community. The study program consists of three phases: (1) a methodological phase devoted primarily to the adaptation of age- and gender-specific assessment tools for older people (e.g., the Composite International Diagnostic Interview, CIDI) as well as psychometric evaluations including translation, back translation; (2) a baseline community study in all participating countries to assess the lifetime, 12 month and 1 month prevalence and comorbidity of mental disorders, including prior course, quality of life, health care utilization and helpseeking, impairments and participation and, (3) a 12 month follow-up of all baseline participants to monitor course and outcome as well as examine predictors.

DISCUSSION

The study is an essential step forward towards the further development and improvement of harmonised instruments for the assessment of mental disorders as well as the evaluation of activity impairment and participation in older adults. This study will also facilitate the comparison of cross-cultural results. These results will have bearing on mental health care in the EU and will offer a starting point for necessary structural changes to be initiated for mental health care policy at the level of mental health care politics.

The prevalence of mental disorders in older people in Western countries - a meta-analysis

OBJECTIVE

To conduct a meta-analysis assessing the prevalence of mental disorders in older people in Europe and North America.

METHOD

Studies that reported prevalence rates of mental disorders in older people from the general population were identified through MEDLINE, PsycINFO, Web of Science, and reference lists for the period between January 2000 and December 2011. Studies were included if they reported prevalence rates of mental disorders in older people (50+ years) from the community. The final sample comprised 25 studies. Prevalence rates were extracted, and effect sizes were transformed into logits. Random-effects models were calculated due to significant heterogeneity. In meta-regression analyses possible sources of bias, including age of onset, gender distribution, and risk of bias were examined. To analyze the robustness of the results, sensitivity analyses were performed. Publication bias was assessed with funnel plots and the Egger method.

RESULTS

Disorders with the highest prevalence estimates were dimensional depression (19.47%), lifetime major depression (16.52%), and lifetime alcohol use disorders (11.71%). Disorders with the lowest estimates were current and lifetime drug use disorders (0.34% and 0.19%, respectively), and current bipolar disorder and current agoraphobia (both 0.53%).

CONCLUSION

The majority of studies investigated major depression, panic disorder and social phobia. Future research requires a larger database on the epidemiology of mental disorders in the elderly. Furthermore, an improvement to the methodology that addresses the challenges of older age and produces comparable data, including the use of instruments tailored to the needs of older people, is required.

[Epidemiology, diagnosis and treatment of adult patients with nosocomial pneumonia. S-3 Guideline of the German Society for Anaesthesiology and Intensive Care Medicine, the German Society for Infectious Diseases, the German Society for Hygiene and Microbiology, the German Respiratory Society and the Paul-Ehrlich-Society for Chemotherapy]

Nosocomial pneumonia (HAP) is a frequent complication of hospital care. Most data are available on ventilator-associated pneumonia. However infections on general wards are also increasing. A central issue are infections with multi drug resistant (MDR) pathogens which are difficult to treat particularly in the empirical setting potentially leading to inappropriate use of antimicrobial therapy. This guideline was compiled by an interdisciplinary group on the basis of a systematic literature review. Recommendations are made according to GRADE giving guidance for the diagnosis and therapy of HAP on the basis of quality of evidence and benefit/risk ratio. The guideline has two parts. First an update on epidemiology, spectrum of pathogens and antiinfectives is provided. In the second part recommendations for the management of diagnosis and treatment are given. Proper microbiologic work up is emphasized for knowledge of the local patterns of microbiology and drug susceptibility. Moreover this is the optimal basis for deescalation in the individual patient. The intensity of antimicrobial therapy is guided by the risk of infections with MDR. Structured deescalation concepts and strict limitation of treatment duration should lead to reduced selection pressure.

[Mechanisms of cardiovascular co-morbidity in patients with obstructive sleep apnoea syndrome]

The repetitive intermittent hypoxic episodes, central nervous arousal and intrathoracic pressure fluctuations that occur together with obstructive sleep apnoea are the primary pathophysiological mechanisms responsible for the cardiovascular co-morbidity. These phenomena lead to increased oxidative stress, systemic inflammation, disrupted vasomotor function, increased sympathetic activity and the development of arteriosclerosis in blood vessels. CPAP therapy lowers arterial blood pressure and has a positive effect on relevant specific aspects of cardiovascular co-morbidity. Until the results of current randomised studies have been published, it has to be decided on an individual basis whether the cardiovascular situation alone justifies CPAP therapy. This will usually be the case in severe OSA with daytime sleepiness, in young patients and patients with good compliance. Interventions that reduce cardiovascular risk and also have a positive effect on OSA, i. e., weight reduction, physical exercise and smoking cessation are always appropriate.

The relationship between individual resource realization and sociodemographic and clinical characteristics in mentally ill patients

OBJECTIVE

There has been a recent effort to investigate the role of individual resources in the field of mental health, but systematic research on this topic is lacking. The overall aim of the present study was the exploration of resource realization and other related variables in patients with mental disorders to provide basic knowledge on the upcoming field of psychotherapy research, which focuses on patients' strengths.

METHOD

Current resource realization was assessed with a shortened form of the Resource Realization Questionnaire in a sample of 332 inpatients with mental disorders. To explore the association between resource realization and related variables, group differences (t tests, analyses of variance) in gender, age, marital status, educational level, and type and number of diagnoses were calculated. The relationships between resource realization, symptom severity, interpersonal behavior, and therapeutic alliance were examined, and a regression tree analysis was calculated to establish relevant predictors of resource realization.

RESULTS

There are several significant differences in current resource realization regarding marital status and number and type of diagnoses. A significant relationship between resource realization and symptom severity was found. The results regarding interpersonal behavior and therapeutic alliance were more heterogeneous. Symptom severity, gender, and chronic depression were found to be relevant predictors of resource realization.

CONCLUSION

The close association between resource realization and symptom severity supports further investigation of the construct of resource realization within psychotherapy research.

Enhancing medical students' communication skills: development and evaluation of an undergraduate training program

BACKGROUND

There is a relative lack of current research on the effects of specific communication training offered at the beginning of the medical degree program. The newly developed communication training "Basics and Practice in Communication Skills" was pilot tested in 2008 and expanded in the following year at the University Medical Centre Hamburg-Eppendorf in Germany. The goal was to promote and improve the communicative skills of participants and show the usefulness of an early offered intervention on patient-physician communication within the medical curriculum.

METHODS

The students participating in the project and a comparison group of students from the standard degree program were surveyed at the beginning and end of the courses. The survey consisted of a self-assessment of their skills as well as a standardised expert rating and an evaluation of the modules by means of a questionnaire.

RESULTS

Students who attended the communication skills course exhibited a considerable increase of communication skills in this newly developed training. It was also observed that students in the intervention group had a greater degree of self-assessed competence following training than the medical students in the comparison group. This finding is also reflected in the results from a standardised objective measure.

CONCLUSIONS

The empirical results of the study showed that the training enabled students to acquire specialised competence in communication through the course of a newly developed training program. These findings will be used to establish new communication training at the University Medical Centre Hamburg-Eppendorf.

Do measures used in studies of anxiety disorders reflect activities and participation as defined in the WHO International Classification of Functioning, Disability and Health?

Background: Besides the measurement of symptoms, information on functioning and disability in daily routines expands the description of impairments in patients with anxiety disorders. Therefore, the measurement of activities and participation, as theoretically included in the International Classification of Functioning, Disability and Health (ICF) is of increasing importance. The objective of this study is to give an overview over the implementation of the concept ‘activities and participation’ in outcome measurements of patients with anxiety disorders.

Methods: Based on a literature review in PubMed and PsycInfo databases and including 200 papers, this study analyses 65 outcome instruments used in randomized controlled trials in anxiety disorders according to their content related to the ICF domain of ‘Activities and participation’.

Results: Instruments used in trials evaluating outcome in patients with anxiety disorder only partially address activities and participation. Over all 65 instruments, the chapters on ‘Interpersonal interactions and relationships’ and ‘Mobility’ were most frequently included in measurements.

Conclusions: The identification of relevant ICF categories (core sets) according to activities and participation and especially interpersonal interactions and relationships as well as mobility, can be a basis for describing functioning and evaluating treatment in anxiety disorders, helping to improve outcome assessment in clinical practice.