Aims, outcome measures, study sites and patient sample. EPSILON Study 1. European Psychiatric Services: Inputs Linked to Outcome Domains and Needs

Efficacy of a real-time patient feedback system: patient satisfaction study in psychiatry

Aim: The aim of the study was two-fold: first, to assess the efficacy of an electronic real-time feedback system; second, to examine patient satisfaction.Methods: This was a mixed-method study. Data were collected from two psychiatric outpatient clinics using electronic patient feedback devices. The efficacy of the real-time feedback system was assessed by calculating the overall response rate, and the response rate to each individual five-point Likert scale statement and open-ended question by using descriptive statistics. Patient satisfaction was examined by analyzing the response rate to each statement. Open-ended feedback was analyzed by using inductive qualitative content analysis.Results: The overall response rate was 21.0% (n = 1658) and response rates varied by statements. Most of the patients saw that they received the appointment to the outpatient clinic quickly enough (n = 1404, 85%), the personnel treated them well (n = 1126, 95%), the information about the care was understandable (n = 1066, 94%), and decisions regarding their care were made together with them (n = 1051, 94%). Of the patients, 94% (n = 1052) would recommend the service. Positive open-ended feedback highlighted good service, skilled staff, perceived benefits and help from care. Critique and development areas dealt with the large number of forms that required filling out beforehand, subjective experience of long waiting times, and having too many collaborative professionals present during treatment.Conclusions: The real-time feedback system proved to be an efficient method of gathering patient feedback. Patient satisfaction seemed to be high with received care in all fields.

High Functioning Autism Spectrum Disorders in Adults: Consequences for Primary Caregivers Compared to Schizophrenia and Depression

Primary caregivers experience consequences from being in close contact to a person with autism spectrum disorder (ASD). This study used the Involvement Evaluation Questionnaire to explore the level of consequences of 104 caregivers involved with adults with High Functioning ASD (HF-ASD) and compared these with the consequences reported by caregivers of patients suffering from depression and schizophrenia. Caregivers involved with adults with an HF-ASD experience overall consequences comparable to those involved with patients with depression or schizophrenia. Worrying was the most reported consequence. More tension was experienced by the caregivers of ASD patients, especially by spouses. More care and attention for spouses of adults with an HF-ASD appears to be needed.

Indonesian adaptation of the Quality in Psychiatric Care-Inpatient (QPC-IP) instrument: Psychometric properties and factor structure

AIM

The aim of the present study was to adapt and evaluate the psychometric properties and factor structure of the Indonesian version of the Quality in Psychiatric Care - Inpatient (QPC-IP) instrument.

METHODS

The QPC-IP is based on a definition of quality of care from the patient's perspective; it consists of 30 items covering six factors. A sample of 150 inpatients at general psychiatric wards in Indonesia completed the QPC-IP questionnaire.

RESULTS

Confirmatory factor analysis revealed that the factor structure of the Indonesian version was equivalent to that of the original Swedish QPC-IP, with the exception of the secluded environment factor. The results thus demonstrate that the concept of quality of care expressed in the QPC-IP is to a large extent equivalent among inpatients in fundamentally different health care systems and cultural contexts. Internal consistency for the full QPC-IP was adequate, but poor for the separate factors.

CONCLUSION

The Indonesian QPC-IP is a useful instrument for evaluating psychiatric inpatient care, and thus contributes to health care improvement in the field of psychiatry.

Caregivers consequences of care among patients with eating disorders, depression or schizophrenia

BACKGROUND

The consequences of caring for a person with a mental illness can impose a substantial burden. Few studies have compared this burden among caregivers of patients with eating disorders and other mental illnesses. The objective of this study was to compare caregiver consequences in eating disorders (ED) with caregiver consequences in depression and schizophrenia, assessed with the same instrument, the Involvement Evaluation Questionnaire (IEQ). Another aim was to identify factors that may predict these consequences.

METHODS

We conducted a cross-sectional study involving 251 caregivers of ED patients; 252 caregivers of patients with depression; and 151 caregivers of patients with schizophrenia. Caregivers completed the Involvement Evaluation Questionnaire EU Version (IEQ-EU). Descriptive statistics, ANOVA, and Chi-square were applied to examine the inter-variable relationships. Consequences- indexes were also computed.

RESULTS

In all samples, worrying was the most commonly reported consequence of caregiving. Predictive variables for a high level of caregiver burden included being a mother or partner of the person being cared for (p = <.01), and being a caregiver of a patient with ED.

CONCLUSIONS

The burden of caregiving is higher among caregivers of patients with eating disorders patients than among caregivers of patients with depression or schizophrenia. Our findings suggest that caregivers of patients with an ED could benefit from providing adequate assessment and support.

Determinants of patient satisfaction with hospital health care in psychiatry: results based on the SATISPSY-22 questionnaire

BACKGROUND

The aim of our study was to identify patient- and care-related factors that are associated with patients' satisfaction with psychiatric hospital care, using a specific, self-administered questionnaire based exclusively on the patient's point of view: the Satisfaction with Psychiatry Care Questionnaire-22 (SATISPSY-22).

METHODS

This cross-sectional study was conducted in the psychiatric departments of two French public university teaching hospitals. The data collected included sociodemographic information, clinical characteristics, care characteristics, and the SATISPSY-22. A multivariate analysis using multiple linear regressions was performed to determine the variables potentially associated with satisfaction levels.

RESULTS

Two hundred seventy patients were enrolled in our study. Only one moderate association was found between satisfaction and sociodemographic characteristics: the personal experience dimension with age (β=0.15). Clinical improvement was moderately associated with higher global satisfaction (β=-0.15), higher satisfaction with quality of care (β=-0.19), and higher satisfaction with food (β=-0.18). Stronger associations with satisfaction were found for care characteristics, particularly the therapeutic alliance with all of the satisfaction dimensions (β, 0.20-0.43) except food, and for seclusion with global satisfaction (β=-0.33) and personal experience (β=-0.32). Patients with previous hospitalization also had a higher level of satisfaction with quality of care compared with patients who were admitted for the first time (β=-0.15).

CONCLUSION

This study has identified a number of potential determinants of satisfaction. The therapeutic relationship and seclusion were the most important features associated with a patient's satisfaction. These factors might be amenable through intervention, which, in turn, might be expected to improve satisfaction, patients' management, and health outcomes in psychiatric hospitals.

Caregiving in severe mental illness: the psychometric properties of the Involvement Evaluation Questionnaire in Portugal

BACKGROUND

Despite the achievements of previous research, caregiving assessments in severe mental illness should be crossculturally validated in order to define risk groups or to evaluate family work. This study reports on the psychometric properties of the European version of the Involvement Evaluation Questionnaire (IEQ-EU) in Portugal.

METHODS

A Portuguese translation of the IEQ-EU was developed according to the 'European Psychiatric Services: Inputs Linked to Outcome Domains and Needs' (EPSILON) group guidelines. We then studied 194 caregivers who were related to patients with schizophrenia spectrum disorders in psychiatric outpatient services. All relatives were assessed using the IEQ-EU. In order to describe the corresponding patients' sample, the majority (n = 162) was evaluated with the World Health Organization Disability Assessment Schedule (WHO-DAS II); 108 patients were also assessed with the Brief Psychiatric Rating Scale (BPRS) and the Global Assessment of Functioning (GAF).

RESULTS

The factor structure of the Portuguese version of the questionnaire was similar to the original; internal consistency was good, with Cronbach's α ranging from 0.71 to 0.87 in the IEQ-EU scales (total score and domains: tension, supervision, worrying, urging); test-retest reliability yielded intraclass correlation coefficients (ICCs) from 0.80 to 0.94, concerning the same scores. Ecological validity was confirmed. Most caregiving consequences were reported on the worrying domain of the IEQ-EU.

CONCLUSIONS

Validity and reliability of the Portuguese IEQ-EU translation were established. Specifically the four IEQ-EU subscale domains seem to be valid in Portugal.

Factors associated with hospital service satisfaction in a sample of Arab subjects with schizophrenia

Background

Assessment of patients' satisfaction with health care services could help to identify the strengths and weaknesses of the system and provide guidance for further development. The study's objectives were to: (i) assess the pattern of satisfaction with hospital care for a sample of people with schizophrenia in Kuwait, using the Verona Service Satisfaction Scale (VSSS-EU); ii) compare the pattern of satisfaction with those of similar studies; and iii) assess the association of VSSS seven domains with a number of variables representing met and unmet needs for care, family caregiver burden, severity of psychopathology, level of psychosocial functioning, socio-demographic characteristics, psychological well-being and objective quality of life.

Methods

Consecutive outpatients in stable condition and their family caregivers were interviewed with the VSSS-EU and measures of needs for care, caregiver burden, quality of life and psychopathology.

Results

There were 130 patients (66.1%m, mean age 36.8). While over two-thirds expressed satisfaction with the domains of "overall satisfaction", "professionals' skills", "access", "efficacy", and "relatives' involvement", only about one-third were satisfied with the domains of "information" and "types of intervention". The later two domains were the areas in which European patients had better satisfaction than our patients, while our patients expressed better satisfaction than the Europeans in the domain of "relatives' involvement". In multiple regression analyses, self-esteem, positive and negative affect were the most important correlates of the domains of service satisfaction, while clinical severity, caregiver burden and health unmet needs for care played relatively minor roles.

Conclusion

The noted differences and similarities with the international data, as well as the predictive power of self-esteem and affective state, support the impression that patients' attitudes towards psychiatric care involve a complex relationship between clinical, personal and socio-cultural characteristics; and that many of the factors that impact on satisfaction with service relate to individual psychological characteristics. The weaknesses in the system, highlighted by the pattern of responses of the participants, indicate possible gaps in the provision of comprehensive psychiatric care in the country and obviate the need for public mental health education and development of services to enhance the quality of care.

Patient-centered care in affective, non-affective, and schizoaffective groups: patients' opinions and attitudes

An outcome evaluation was conducted to obtain psychiatric inpatients' perspectives on acute care mental health treatment and services. The applicability of diagnostic categories based on affective, non-affective, and schizoaffective disorder were considered in the predictability of responses to treatment regimens and the related services provided in an inpatient psychiatric unit. A multidimensional approach was used to survey patients, which included the DAI-30, the BMQ, the SERVQUAL, and the CSQ-8. Overall, findings indicate that inpatient satisfaction could be improved with tailoring treatment to suit their respective symptoms. Furthermore, this exploratory study demonstrates some preliminary support for the inclusion of patients with a diagnosis of schizoaffective disorder as a separate group toward improving acute mental health care while hospitalized.

Relationship of family caregiver burden with quality of care and psychopathology in a sample of Arab subjects with schizophrenia

BACKGROUND

Although the burden experienced by families of people with schizophrenia has long been recognized as one of the most important consequences of the disorder, there are no reports from the Arab world. Following the example of the five-nation European (EPSILON) study, we explored the following research question: How does the relationship between domains of caregiving (as in the Involvement Evaluation Questionnaire--IEQ-EU) and caregiver psychic distress on the one hand, and caregiver's/patient's socio-demographics, clinical features and indices of quality of care, on the other hand, compare with the pattern in the literature?

METHOD

Consecutive family caregivers of outpatients with schizophrenia were interviewed with the IEQ-EU. Patients were interviewed with measures of needs for care, service satisfaction, quality of life (QOL) and psychopathology.

RESULTS

There were 121 caregivers (66.1% men, aged 39.8). The IEQ domain scores (total: 46.9; tension: 13.4; supervision: 7.9; worrying: 12.9; and urging: 16.4) were in the middle of the range for the EU data. In regression analyses, higher burden subscale scores were variously associated with caregiver lower level of education, patient's female gender and younger age, as well as patient's lower subjective QOL and needs for hospital care, and not involving the patient in outdoor activities. Disruptive behavior was the greatest determinant of global rating of burden.

CONCLUSION

Our results indicate that, despite differences in service set-up and culture, the IEQ-EU can be used in Kuwait as it has been used in the western world, to describe the pattern of scores on the dimensions of caregiving. Differences with the international data reflect peculiarities of culture and type of service. Despite generous national social welfare provisions, experience of burden was the norm and was significantly associated with patient's disruptive behavior. The results underscore the need for provision of community-based programs and continued intervention with the families in order to improve the quality of care.

Correlates of quality of life in an Arab schizophrenia sample

OBJECTIVES

We focused on the subjective quality of life (QOL) indicators of the Lancashire quality of life profile, European version (LQoLP-EU) in a Kuwaiti schizophrenia sample. The objectives were: First, to assess the reliability and validity of the questionnaire. Second, to highlight the patients' QOL profile, in comparison with the results of the European five-nation study. Third, to examine the association of perceived needs for care, caregiver burden, service satisfaction, self-esteem and psychopathology, with three indices of global QOL: total life satisfaction or perceived QOL (PQOL) score; general wellbeing (GW) and Cantril's ladder (CL).

METHOD

Consecutive outpatients in stable condition and their family caregivers were interviewed with the LQoLP, and measures of needs for care, service satisfaction, caregiver burden and psychopathology.

RESULTS

There were 130 patients (66.1%m, mean age 36.8). Majority of the patients (56%) felt satisfied with the nine domains of life investigated, and 44.6% felt "averagely" happy. Their clinical severity was moderate (BPRS-18 = 44.4). In exploratory factor analysis (FA), the original domains were mostly replicated. Reliability indices were significant (>0.7). In stepwise regression analyses, the associations of PQOL were more in number and mostly different from those of GW and CL. The correlates of PQOL included, social unmet need (8.1% of variance), staff perception of unmet need (10.3%), general satisfaction with services (11.3%), burden of caregiver supervision (3.7%), self-esteem (2.9%) and positive symptoms (2.6%). Of the nine life domains, health was the most important correlate of GW and CL, indicating the centrality of health status in judgments of subjective QOL. In secondary FA, GW and CL loaded together, but separately from life domains, implying that these are separable parts of the subjective wellbeing construct.

CONCLUSION

The profile of QOL scores was mostly similar to European data. The significant multivariate association with patients/staff perceptions of unmet need for care and service satisfaction indicate the usefulness of staff professional development and service improvement in outcome; and imply that promotion of QOL should be an institutional objective. Our finding about the relationship between the three global measures of QOL has added support to the emerging QOL theory.

Caring for people with depression or with schizophrenia: are the consequences different?

Attention to caregiver consequences has been mainly restricted to caregivers of patients with schizophrenia. The few studies done in depression were conducted on small samples and/or with non-validated instruments. Caregiver consequences in depression and schizophrenia were measured with the validated Involvement Evaluation Questionnaire (IEQ). IEQ scores of caregivers of 252 mainly outpatients with depression and caregivers of 151 mainly outpatients with schizophrenia were compared. IEQ scores were quite similar for depression and schizophrenia. Caregivers of patients with schizophrenia worry more and have more nursing tasks; in case of depression caregivers experience more tension between spouses. In case of many consequences caregivers live close to a patient who has more acute symptoms. They have more additional expenses on behalf of the patient, and report higher distress scores. In case of depression caregivers report less social support, and less coping abilities. Caregiver consequences of depression and schizophrenia are very similar. Differences reflect the context in which caregiving takes place: In schizophrenia mostly elderly mother caring for their ill (adult) child, in depression mostly spouses caring for their partner. Caregivers of patients with depression should be given more attention and support by professionals.

Predictors of general quality of life and the mediating role of health related quality of life in patients with schizophrenia

INTRODUCTION

The concept 'quality of life' (QoL) has become increasingly important as an outcome measure in the evaluation of services and in clinical trials of people with schizophrenia. This study examines the mediating role of health related quality of life (HRQoL) in the prediction of general quality of life (GQoL).

METHOD

QoL and other patient- and illness characteristics (psychopathology, overall functioning, illness history, self-esteem and social integration) were measured in a group of 143 outpatients with schizophrenia. GQoL was measured by the Lancashire Quality of Life Profile and HRQoL was measured by the MOS SF-36. To test the temporal stability of our findings, assessments were performed twice with an 18-month interval.

RESULTS

We found that patient's GQoL is predicted mainly by anxiety and depression and self-esteem and to a lesser extent by global functioning and social integration. At both time intervals HRQoL appeared to be a significant mediator of the relationship between anxiety and depression and self esteem versus patient's GQoL.

CONCLUSIONS

The results of this study are important for mental health professionals, as these provide more insight in the mechanisms by which they could improve the GQoL of their patients with schizophrenia. The results confirm that diagnosis and treatment of anxiety and depression in outpatients with schizophrenia deserves careful attention of clinicians. Also strategies and specific interventions to improve self-esteem of patients with schizophrenia are very important to maximise patient's QoL.

Professional team's choices of intervention towards problems and needs of patients suffering from schizophrenia across six European countries

OBJECTIVES

This article compares in a systematic way the team's intervention choices of professionals across seven European countries: France, Ireland, Italy, the Netherlands, Portugal and Spain towards problems and needs of patients with schizophrenia and relates this to the diversity of psychiatric systems.

METHODS

The clinical and social status of 433 patients was assessed by means of the Schedules for Clinical Assessment in Neuropsychiatry (SCAN) and the Needs for Care Assessment instrument (NFCAS) which was used to determine teams' intervention choices toward the NFCAS problems.

RESULTS

There is no, or little, consensus across Europe on teams' intervention choices towards either the clinical or the social problems and needs of patients suffering from schizophrenic disorders. These comparisons outlined the cultural differences concerning the interventions that were proposed and should be taken into account when interpreting the number of needs and the need status since the need status relies heavily on the interventions proposed. The differences were not connected with the availability of resources; most of the comparisons show differences between centers as well as differences between groups of relatively similar resource countries.

Multidimensional structures of comprehensive accessibility of community support for people with mental disorders in Japan: A nationwide investigation

The purpose of this study was to define the concept of comprehensive accessibility of community support for people with mental disorders and to clarify the multidimensional structures of comprehensive accessibility. We developed a self-administered questionnaire consisting of 47 items. A complete list of the municipalities in Japan was prepared, and the questionnaire was mailed to 3310 municipalities. Principal component analyses were applied to valid data in order to analyse the index and multidimensional structures of comprehensive accessibility. As a result, 14 principal components of community support for people with mental disorders were extracted. These principal components were interpreted as the scales for the evaluation of comprehensive accessibility. The two first principal component scores were interpreted as the index indicating the level of comprehensive accessibility. The other 12 principal components were interpreted as the scales constituting the multidimensional space of comprehensive accessibility.

Main determinants of Global Assessment of Functioning score in schizophrenia: a European multicenter study

BACKGROUND

The Global Assessment of Functioning (GAF) scale is a measure widely used to assess the outcome of patients with schizophrenia. However, little is known about the importance of clinical and psychosocial variables in determining its final score. The aim of this paper is to identify which factors predict GAF scores of patients with schizophrenia and their variability in 5 different European settings.

METHOD

A representative sample of 404 patients with schizophrenia was assessed with the GAF. A multiple regression analysis was performed to identify predictors of the GAF scores.

RESULTS

Clinical factors are the main determinants of GAF score. However, the analysis also showed that social and functioning factors were also significantly associated with GAF scores. Finally, the study showed the presence of intercenter differences in the factors, mainly in social functioning.

CONCLUSIONS

The GAF is a useful and easy-to-apply measure of global functioning, independent of cross-cultural differences. Clinical factors are the main determinants of its score, although social functioning variables also have a lesser effect.

Needs and quality of life among patients with schizophrenia in five European centres: what is the impact of global functioning scores?

BACKGROUND

Global assessment of functioning, quality of life (QOL) and patient needs have been discussed as inter-related domains important for care planning and outcome assessment in care for the severely mentally ill. The study was conducted to investigate relationships of functioning level, subjective QOL and unmet needs in a cross-sectional study of 404 patients with schizophrenia spectrum disorders in five European centres with a focus on the patient group with low function scores.

METHODS

Patient groups with low, medium and high function scores were compared with regard to subjective QOL and unmet needs. QOL variability was assessed in subgroups according to function scores. Regression analyses were used to examine the impact of illness-related and other unmet patient needs on QOL. The influence of individual needs in the low and medium/high function score subgroup was compared.

RESULTS

QOL increased and unmet needs decreased from the low to high function score subgroup. There was greater QOL variability in patients with low function scores compared to those with medium and high function scores, with some low-function score patients having relatively high QOL. In the low function score subgroup, both illness-related and other needs had an impact on QOL, whereas non-illness needs influenced QOL in medium and high function score patients.

CONCLUSION

Scores of functioning level, in people with schizophrenia spectrum disorders, are related to QOL in a complex way, and types of unmet need impinge on the relationship. In order to improve QOL in people with low function scores, both illness-related and other needs should be met.

Comparison of Quality of Life for People with Schizophrenia and Mental Health of Caregivers Between Community-Based and Hospital-based Services

This study is a comparison of the quality of life and family stress levels in community-based and hospital-based services for people with schizophrenia. Fiscal considerations of the health insurance industry in Taiwan require the evaluation of a community support program versus the traditional, hospital-centered program for reform of mental health policy concerning schizophrenia. The study involved 52 schizophrenic patients, 27 in a community-based program and 25 in a hospital-based treatment model, and was conducted from January to December 2001 in the psychiatric department of a general teaching hospital in southern Taiwan. Outcomes were determined using the World Health Organization quality of life questionnaire (WHOQoL-BREF, Taiwan version), Brief Psychiatric Rating Scale (BPRS), General Health Questionnaire (Chinese version), rate of loss to follow-up, job conditions, and social function. Comparisons of quality of life and caregiver mental health between the two groups were accomplished using descriptive analysis, independent sample t test, and the generalized estimating equation-I. No significant differences between the two groups were found in quality of life or family mental stress according to the General Health Questionnaire after controlling for sex, age, disease duration, full IQ, and total BPRS score. Long disease duration predicted a hospital setting, while a high IQ was predictive of a community setting. We found no decrease in quality of life for schizophrenic patients in a hospital-based program and no increase in family mental stress among the community-based group. To improve patients' quality of life and the mental health of caregivers in both services, it is important to ameliorate severe symptoms associated with schizophrenia.

Family caregiving in depression: impact on caregivers' daily life, distress, and help seeking

BACKGROUND

Attention to caregiving consequences has been mainly restricted to schizophrenia, although studies suggest that relatives of depressed patients also experience considerable distress. These studies, however, were conducted on small samples or with nonvalidated instruments. In our study, the caregiving consequences of 260 spouses and relatives of depressed patients were assessed with a well-validated 31-item questionnaire, the Involvement Evaluation Questionnaire (IEQ).

METHODS

The IEQ was mailed to spouses and relatives of patients with major depression, dysthymic disorder, or other depressive disorders. Other instruments used were the Ways of Coping Checklist (WCC), a Dutch Social Support Questionnaire, and the Zung Self-rating Depression Scale (SDS).

RESULTS

About 25-50% of caregivers worried about the patient's general health, treatment, safety, and future. They had to urge the patient to undertake activities, or took over tasks. There were relational strains, and they felt burdened, especially when the patient was in an acute phase. Caregivers often felt distressed and had to visit a (mental) health practitioner. Also, children were affected; caregivers reported high levels of difficult behavior, loss of appetite, sleeplessness, less playing, and less attention at school. Caregiving consequences occur less often than in schizophrenia, but the patterns are quite comparable.

CONCLUSIONS

Caregiving consequences in depression occur frequently and cause distress in caregivers and patient's children. Attention should be paid to support relatives and spouses of depressed patients. Special attention should be paid to patient's children.

Inter-rater reliability of the Brief Psychiatric Rating Scale and the Groningen Social Disabilities Schedule in a European multi-site randomized controlled trial on the effectiveness of acute psychiatric day hospitals

The objectives of this study were to report the inter-rater reliability of the Brief Psychiatric Rating Scale (BPRS 4.0) and the Groningen Social Disabilities Schedule (GSDS-II) as assessed in a randomized controlled trial on the effectiveness of psychiatric day hospitals spanning five sites in countries of Central and Western Europe. Following brief training sessions, videotaped BPRS-interviews and written GSDS-vignettes were rated by clinically experienced researchers from all participating sites. Inter-rater reliability often proved to be poor for items assessing the severity of both psychopathology and social dysfunction, but findings suggest that both instruments allow for the assessment of the presence or absence of specific psychopathological symptoms or social disabilities. Inter-rater reliability at subscale level proved to be good for both instruments. Results indicate that, with a brief training session and proper use of the instruments, psychopathology and social disabilities can be reliably assessed within cross-national research studies. The results are of particular interest given that the need to conduct cross-national multi-site studies including countries with different cultural backgrounds increases.

Gender differences in living with schizophrenia. A cross-sectional European multi-site study

The EPSILON project (European Psychistric Services: Inputs Linked to Outcomes and Needs) is a cross-sectional study of the clinical and social characteristics, needs, satisfaction with services, quality of life, and service utilisation and costs for people with schizophrenia in five European sites (Amsterdam, Copenhagen, London, Santander, and Verona). This study examined five hypotheses: (1) Men will have more total needs and more unmet needs for: 'accommodation', 'substance misuse', 'psychotic symptoms', 'harm to others', and 'sexual expression', whereas women will have more total needs and more unmet needs in the domains of 'childcare' and 'harm to self'. (2) Caregivers of male patients will show higher rates of psychological distress, and higher scores for 'supervision' and 'urging' than caregivers of female patients. (3) Male and female patients will show similar levels of satisfaction with services, both in total scores and subscores. (4) Male patients will show lower objective quality of life, but similar subjective quality of life compared with women. (5) Service utilization for men and women will differ, and patterns will vary by site. The results confirmed hypotheses 1 (in part) and 3, but failed to support hypotheses 2, 4 and 5. Graphical models were used to generate hypotheses for future research. The implications for planning separate services for male and female schizophrenic patients are discussed.

Quality of life in patients with schizophrenia in five European countries: the EPSILON study

OBJECTIVE

To compare subjective quality of life (QOL) and objective QOL indicators in patients with schizophrenia from five European sites: Amsterdam, Copenhagen, London, Santander and Verona.

METHOD

A representative sample of 404 patients with schizophrenia, in contact with mental health services, was randomly selected and evaluated with the Lancashire Quality of Life Profile (EU).

RESULTS

The level of satisfaction in certain domains, religion, family and social relations appears to be associated with local style of living and culture while work, finances, and safety were more independent from local variations. In addition to the severity of symptoms, frequency of contacts with family, friendship and age appear as predictors of QOL, all of them influenced by the characteristics of the surroundings.

CONCLUSION

The centres participating in the study presented differences in subjective measures of QOL, objective indicators and also in service provision and styles of living.

Reliability of the Camberwell Assessment of Need--European Version. EPSILON Study 6. European Psychiatric Services: Inputs Linked to Outcome Domains and Needs

BACKGROUND

The five-country European Psychiatric Services: Inputs Linked to Outcome Domains and Needs (EPSILON) Study aimed to develop standardised and reliable outcome instruments for people with schizophrenia. This paper reports reliability findings for the Camberwell Assessment of Need--European Version (CAN-EU).

METHOD

The CAN-EU was administered in each country, at two points in time to assess test-retest reliability, and was rated by two interviewers at the first administration. Cronbach's alpha, test-retest reliability and interrater reliability were compared between the five sites. Reliability coefficients and standard errors of measurement for summary scores were estimated.

RESULTS

Sites varied in levels and spread of needs. Alphas were 0.48, 0.58 and 0.64 for total, met and unmet needs respectively. Test-retest reliability estimates, pooled over sites, were 0.85 for the total needs, 0.69 for met needs and 0.78 for unmet needs. Pooled estimates for interrater reliability were higher, at 0.94, 0.85 and 0.79 for total, met and unmet needs respectively. There were statistically significant differences in interrater reliability between sites.

CONCLUSION

The results confirm the feasibility of using CAN-EU across sites in Europe and its psychometric adequacy.

Quality of life in schizophrenia: development, reliability and internal consistency of the Lancashire Quality of Life Profile--European Version. EPSILON Study 8. European Psychiatric Services: Inputs Linked to Outcome Domains and Needs

BACKGROUND

This paper, part of the European Psychiatric Services: Inputs Linked to Outcome Domains and Needs (EPSILON) Study, reports the development, reliability and internal consistency of the Lancashire Quality of Life Profile--European Version (LQoLP-EU) in a representative sample of people with schizophrenia from five European sites.

METHOD

The LQoLP-EU was administered to a total sample of 404 patients to check its internal consistency, and a sub-sample of 294 patients was interviewed a second time within 7-15 days to verify its test-retest reliability.

RESULTS

Internal consistency of the total domains, perceived QoL scale (Life Satisfaction Scale, LSS) was good at 0.87. Of the nine subjective QoL domains Work and Leisure showed the lowest internal consistency (0.30 and 0.56 respectively), the values of the remaining sub-scales ranging between 0.62 and 0.88. The pooled ICC score for LSS was 0.82, and for the nine subjective QoL domain sub-scales it ranged from 0.61 (Safety) to 0.75 (Living Situation). There were significant differences between the sites in alpha and ICCs for sub-scales, but not for the LSS.

CONCLUSION

The LQoLP-EU has good internal consistency and reliability in the five European centres.

Caregiving in schizophrenia: development, internal consistency and reliability of the Involvement Evaluation Questionnaire--European Version. EPSILON Study 4. European Psychiatric Services: Inputs Linked to Outcome Domains and Needs

BACKGROUND

In international research on the consequences of psychiatric illnesses for relatives of patients, the need for an internationally standardised measure has been identified.

AIMS

To test the internal consistency and the test-retest reliability of the Involvement Evaluation Questionnaire (IEQ) in five European countries.

METHOD

The IEQ was administered twice to a sample of relatives or friends of patients with an ICD-10 diagnosis of schizophrenia. Reliability was tested using Cronbach's alpha, intraclass correlation coefficients and standard error of measurement. Reliability estimates were tested between sites.

RESULTS

Test sample sizes ranged from 30 to 90 across sites, and retest sample sizes ranged from 21 to 77. Cronbach's alpha values of IEQ sub-scales and sumscore were substantial at most sites; but at two, alpha values were moderate. Intraclass correlation coefficients were substantial to high at all sites. The standard errors of measurement differed across sites, indicating differences in performance.

CONCLUSION

The reliability of the IEQ in five languages varies across sites, but is sufficiently high in at least four out of five.