Suicidality and its relationship with depression, alcohol disorders and childhood experiences of violence: results from the ESEMeD study.

BACKGROUND: Suicidality constitutes a major health concern in many countries. The aim of the present paper was to analyse 10 of its risk factors and their interdependence. METHODS: Data on suicidality, mental disorders and experience of childhood violence was collected from 8796 respondents in the European Study of the Epidemiology of Mental Disorders (ESEMeD). The CIDI was used to assess mental disorders. Individuals were randomly divided into two subgroups. In one, a Graphical Markov model to predict suicidality was constructed, in the second, predictors were cross-validated. RESULTS: Lifetime suicidality was predicted mainly by lifetime depression and early experiences of violence, with a pseudo R-square of 12.8%. In addition, alcohol disorders predicted suicidality, but played a minor role compared with the other risk factors in this sample. CONCLUSION: In addition to depression, early experience of violence constitutes an important risk factor of suicidality. LIMITATIONS: This is a cross-sectional and retrospective study assessing risk factors for suicidality, not for suicide itself.

[Concerning the impact of psychological comorbidity for chronic back pain: frequency, reduced earning capacity pension and rehabilitation aftercare in the course of the rehabilitation cohorts 2002­2009]. / Zur Relevanz psychischer Komorbiditäten bei chronischem Rückenschmerz: Häufigkeitsbild, Erwerbsminderungsrenten und Reha-Nachsorge im Zeitverlauf der Reha-Kohorten 2002­2009.

BACKGROUND AND OBJECTIVE: Psychological comorbidities play a key role in the chronification process of back pain. The aim of this longitudinal study is to analyze the diagnostics of psychological comorbidities, their influence on back pain patients and the recommendations of aftercare over the course of time. METHODS: A descriptive analysis of diagnosed psychological comorbidities for the rehabilitation cohorts from 2002 to 2009 was conducted as well as a modelling of Poisson regressions to calculate relative risks and incidence rates. RESULTS: The frequency of at least one psychological comorbidity ranges from 17.6 to 17.9% in the years 2002­2004 and from 18.9 to 20.9% in the years 2005­2009. The risk of reduced earning capacity pension for persons with a comorbid psychological disorder is increasing significantly in almost all rehabilitation cohorts regardless of gender and adjusted for other risk factors compared to persons without comorbid psychological disorders. The number of recommended aftercare procedures is increasing over all cohorts:starting in 2005 with less than 5% of patients to every fourth patient with an aftercare recommendation in 2009. CONCLUSION: The frequencies of psychological comorbidities as reported in the discharge letters for the cohorts of patients in rehabilitation are below the reported frequencies of epidemiological studies. Psychological comorbidities have a considerable impact on pension for reduced earnings capacity. This finding could be useful for recommending aftercare programs.

[Validation of the Patient Classification System Rehabilitee-Management-Categories (RMK) in Patients with Chronic Back Pain in Regular Medical Treatment]. / Validierung der Gültigkeit des Patientenklassifikationsansatzes der Rehabilitanden-Management-Kategorien (RMK) für chronische Rückenerkrankungen im Heilverfahren.

BACKGROUND AND OBJECTIVE: The Rehabilitee-Management-Categories (RMK) have been developed by the Charite - University Medicine Berlin for 10 years. A content- and time-stable classification approach should support health care providers to offer therapy standards that are better adjusted to the needs of patients. At the same time, stability means for healthcare payers that the admission management to clinics with specialised services could be optimized. METHODS: The stability of the RMK classification was tested with the help of latent class analysis (LCA) in independent samples. The data sets are taken from 3 different studies carried out from 2006 to 2011. Only patients with chronic back pain (M40-M54) who were in regular medical treatment provided by the German Pension Fund were included. RESULTS: A statistically stable 4-class solution was found in all samples. Kappa-coefficients from 0.605 to 0.72 showed a good consistence of the RMK-algorithm from the first LCA with the respective latent class analyses. CONCLUSION: The RMK-approach offers possible uses for both healthcare providers and healthcare payers by assessing the need of treatments according to the ICF approach. Among other things, this approach can be used to fulfil the quality guideline in a differing way.

Treatment adequacy for anxiety and depressive disorders in six European countries.

The aims of this study are to describe the adequacy of treatment for anxiety and depressive disorders in Europe and how itdiffers between providers, using data from the ESEMeD study. The overall proportion of adequate treatment was 45.8% (57.4% in the specialised sector and 23.3% in the general medical care sector). Between-country differences were found in treatment adequacy in the specialised setting. Organisational and political aspects may explain these findings.

Risk factors for suicidality in Europe: results from the ESEMED study.

BACKGROUND: Precise knowledge of the epidemiology of suicidality provides necessary information for designing prevention programs. The aims of the present study were to investigate the prevalence and correlates of suicidal ideas and attempts in the general population of Europe. METHODS: The European Study on the Epidemiology of Mental Disorders (ESEMED) is a cross-sectional household survey carried out in a probability representative sample of non-institutionalised adults (aged 18 years or older) of six European countries (Belgium, France, Germany, Italy, the Netherlands and Spain). The Composite International Diagnostic Interview (CIDI 3.0) was administered to 21,425 individuals. RESULTS: Lifetime prevalence of suicidal ideation was 7.8% and of suicidal attempts 1.3%. Being women, younger and divorced or widowed were associated with a higher prevalence of suicide ideation and attempts. Psychiatric diagnoses were strongly related to suicidality. Among them, major depressive episode (Rate ratio 2.9 for lifetime ideas and 4.8 for lifetime attempts), dysthymia (RR 2.0 and 1.6), GAD (RR 1.8 and 2.3 for lifetime), PTSD (RR 1.9 and 2.0) and alcohol dependence (RR 1.7 and 2.5) were the most important. Population attributable risks for lifetime suicidal attempt was 28% for major depression. LIMITATIONS: Information about suicidal ideas and attempts was self reported, psychiatric diagnoses were made using fully structured lay interviews rather than clinician-administered interviews. CONCLUSIONS: In spite of meaningful country variation in prevalence, risk factors for suicidality are consistent in the European countries. Population prevention programmes should focus on early diagnosis and treatment of major depression and alcohol abuse and in those individuals with recent appearance of suicidal ideas.

[Efficacy of an intervention programme on burnout symptoms of partners of depressed patients]. / Wirksamkeit eines Interventionsprogramms auf die Burnout-Belastung von Lebenspartnern depressiv Erkrankter.

AIM OF THE STUDY: A newly developed group intervention programme was evaluated with regard to its effectiveness to decrease the burnout symptoms of the partners of depressed patients. METHODS: Within a period of six months, a group of 66 persons has taken part in the intervention for a total of twelve group sessions. A control group consisted of 50 persons without any intervention. Burnout was assessed using the German version of the Maslach Burnout Inventory (MBI). To evaluate the time effect, the burnout dimensions were used as independent variables in random effects models. RESULTS: Over the analyzed period of time no significant positive effect was measured on any of the assessed burnout dimensions. CONCLUSIONS: An increased inclusion of depressed patients in the intervention as well as an increased intensity and a lowering of the admission threshold for the heavily burdened relatives could increase the effectiveness of the program.

[Health Status of the German population: results of a representative survey using the EuroQol questionnaire]. / Gesundheitszustand der deutschen Bevölkerung: Ergebnisse einer repräsentativen Befragung mit dem EuroQol-Instrument.

PURPOSE: The EuroQol questionnaire (EQ-5D) is an instrument for subjectively describing and valuing health states. The purpose of this study was to measure the health status of the German population using the EQ-5D and to analyse the influence of sociodemographic factors. METHODS: As part of the European Study of the Epidemiology of Mental Disorders (ESEMeD) a representative sample of the non-institutionalised population aged 18 and above in Germany was surveyed by personal computer-based interviews in 2002/2003. Besides questions relating to the prevalence of psychiatric disorders and their risk factors, the health status of 3552 respondents was recorded using the EQ-5D. Frequency and factors of influence on problems in the EuroQol items mobility, self-care, usual activities, pain/discomfort, anxiety/depression as well as the valuation of health state on the visual analog scale (VAS) were analysed. RESULTS: 36 % of the respondents report problems in at least one of the EuroQol items; most frequent were problems in the dimension pain/discomfort (28 %), followed by mobility (17 %), everyday activities (10 %), anxiety/depression (4 %) and self-care (3 %). The mean VAS score was 77.4. Except for anxiety/depression the frequency of problems increased significantly with age and decreased with income. Women reported significantly more problems than men with regard to pain/discomfort and self-care. Having received more than 9 years of school education and being employed was associated with significantly fewer problems in all dimensions of the EuroQol. Living with a partner was associated with significantly fewer problems in the dimensions of self-care, usual activities and anxiety/depression. Multivariate analyses confirmed the effect of age, school education and employment on the frequency of problems, whereas for living with a partner only effects on self-care and anxiety/depression, and for gender only effects on pain/discomfort were confirmed. Income had no effect on frequency of problems in multivariate analyses. Young age, more than 9 years of school education, employment and living with a partner had a significantly positive effect on VAS score in multivariate analyses, while gender and income had no effect. CONCLUSIONS: The EQ-5D is a simple health state classification system, that can be used to detect variations in the health status of a population. This study provides EQ-5D-norm values for the German population.

12-Month comorbidity patterns and associated factors in Europe: results from the European Study of the Epidemiology of Mental Disorders (ESEMeD) project.

OBJECTIVE: Comorbidity patterns of 12-month mood, anxiety and alcohol disorders and socio-demographic factors associated with comorbidity were studied among the general population of six European countries. METHOD: Data were derived from the European Study of the Epidemiology of Mental Disorders (ESEMeD), a cross-sectional psychiatric epidemiological study in a representative sample of adults aged 18 years or older in Belgium, France, Germany, Italy, the Netherlands and Spain. The diagnostic instrument used was the Composite International Diagnostic Interview (WMH-CIDI). Data are based on 21 425 completed interviews. RESULTS: In general, high associations were found within the separate anxiety disorders and between mood and anxiety disorders. Lowest comorbidity associations were found for specific phobia and alcohol abuse-the disorders with the least functional disabilities. Comorbidity patterns were consistent cross-nationally. Associated factors for comorbidity of mood and anxiety disorders were female gender, younger age, lower educational level, higher degree of urbanicity, not living with a partner and unemployment. Only younger people were at greater risk for comorbidity of alcohol disorder with mood, anxiety disorders or both. CONCLUSION: High levels of comorbidity are found in the general population. Comorbidity is more common in specific groups. To reduce psychiatric burden, early intervention in populations with a primary disorder is important to prevent comorbidity.

Sampling and methods of the European Study of the Epidemiology of Mental Disorders (ESEMeD) project.

OBJECTIVE: The European Study of Epidemiology of Mental Disorders (ESEMeD) project was designed to evaluate the prevalence, the impact and the treatment patterns in Europe. This paper presents an overview of the methods implemented in the project. METHOD: ESEMeD is a cross-sectional study in a representative sample of 21 425 adults, 18 or older, from the general population of Belgium, France, Germany, Italy, the Netherlands and Spain. The Composite International Diagnostic Interview (WMH-CIDI) was administered by home interviews from January 2001 to August 2003 using Computer Assisted Personal Interview (CAPI) technology. Data quality was controlled to ensure reliability and validity of the information obtained. RESULTS: Response rate varied from 78.6% in Spain to 45.9% in France. Less than 4% of the individuals had errors in the checking procedures performed. CONCLUSION: The sampling methodologies, comprehensive psychiatric instruments and quality control procedures used have rendered the ESEMeD database a unique and important source of information about the prevalence, the disability burden and unmet medical needs of mental disorders within Europe.

Prevalence of mental disorders in Europe: results from the European Study of the Epidemiology of Mental Disorders (ESEMeD) project.

OBJECTIVE: To describe the 12-month and lifetime prevalence rates of mood, anxiety and alcohol disorders in six European countries. METHOD: A representative random sample of non-institutionalized inhabitants from Belgium, France, Germany, Italy, the Netherlands and Spain aged 18 or older (n = 21425) were interviewed between January 2001 and August 2003. DSM-IV disorders were assessed by lay interviewers using a revised version of the Composite International Diagnostic Interview (WMH-CIDI). RESULTS: Fourteen per cent reported a lifetime history of any mood disorder, 13.6% any anxiety disorder and 5.2% a lifetime history of any alcohol disorder. More than 6% reported any anxiety disorder, 4.2% any mood disorder, and 1.0% any alcohol disorder in the last year. Major depression and specific phobia were the most common single mental disorders. Women were twice as likely to suffer 12-month mood and anxiety disorders as men, while men were more likely to suffer alcohol abuse disorders. CONCLUSION: ESEMeD is the first study to highlight the magnitude of mental disorders in the six European countries studied. Mental disorders were frequent, more common in female, unemployed, disabled persons, or persons who were never married or previously married. Younger persons were also more likely to have mental disorders, indicating an early age of onset for mood, anxiety and alcohol disorders.

Disability and quality of life impact of mental disorders in Europe: results from the European Study of the Epidemiology of Mental Disorders (ESEMeD) project.

OBJECTIVE: This manuscript examines the impact of mental health state and specific mental and physical disorders on work role disability and quality of life in six European countries. METHOD: The ESEMeD study was conducted in: Belgium, France, Germany, Italy, the Netherlands and Spain. Individuals aged 18 years and over who were not institutionalized were eligible for an in-home computer-assisted interview. Common mental disorders, work loss days (WLD) in the past month and quality of life (QoL) were assessed, using the WMH-2000 version of the CIDI, the WHODAS-II, and the mental and physical component scores (MCS, PCS) of the 12-item short form, respectively. The presence of five chronic physical disorders: arthritis, heart disease, lung disease, diabetes and neurological disease was also assessed. Multivariate regression techniques were used to identify the independent association of mental and physical disorders while controlling for gender, age and country. RESULTS: In each country, WLD and loss of QoL increased with the number of disorders. Most mental disorders had approximately 1.0 SD-unit lower mean MCS and lost three to four times more work days, compared with people without any 12-month mental disorder. The 10 disorders with the highest independent impact on WLD were: neurological disease, panic disorder, PTSD, major depressive episode, dysthymia, specific phobia, social phobia, arthritis, agoraphobia and heart disease. The impact of mental vs. physical disorders on QoL was specific, with mental disorders impacting more on MCS and physical disorders more on PCS. Compared to physical disorders, mental disorders had generally stronger 'cross-domain' effects. CONCLUSION: The results suggest that mental disorders are important determinants of work role disability and quality of life, often outnumbering the impact of common chronic physical disorders.

Use of mental health services in Europe: results from the European Study of the Epidemiology of Mental Disorders (ESEMeD) project.

OBJECTIVE: Comprehensive information about access and patterns of use of mental health services in Europe is lacking. We present the first results of the use of health services for mental disorders in six European countries as part of the ESEMeD project. METHOD: The study was conducted in: Belgium, France, Germany, Italy, the Netherlands and Spain. Individuals aged 18 years and over who were not institutionalized were eligible for an computer-assisted interview done at home. The 21 425 participants were asked to report how frequently they consulted formal health services due to their emotions or mental health, the type of professional they consulted and the treatment they received as a result of their consultation in the previous year. RESULTS: An average of 6.4% of the total sample had consulted formal health services in the previous 12 months. Of the participants with a 12-month mental disorder, 25.7% had consulted a formal health service during that period. This proportion was higher for individuals with a mood disorder (36.5%, 95% CI 32.5-40.5) than for those with anxiety disorders (26.1%, 95% CI 23.1-29.1). Among individuals with a 12-month mental disorder who had contacted the health services 12 months previously, approximately two-thirds had contacted a mental health professional. Among those with a 12-month mental disorder consulting formal health services, 21.2% received no treatment. CONCLUSION: The ESEMeD results suggest that the use of health services is limited among individuals with mental disorders in the European countries studied. The factors associated with this limited access and their implications deserve further research.

Psychotropic drug utilization in Europe: results from the European Study of the Epidemiology of Mental Disorders (ESEMeD) project.

OBJECTIVE: To assess psychotropic drug utilization in the general population of six European countries, and the pattern of use in individuals with different DSM-IV diagnoses of 12-month mental disorders. METHOD: Data were derived from the European Study of the Epidemiology of Mental Disorders (ESEMeD/MHEDEA 2000), a cross-sectional psychiatric epidemiological study in a representative sample of 21 425 adults aged 18 or older from six European countries (e.g. Belgium, France, Germany, Italy, the Netherlands and Spain). Individuals were asked about any psychotropic drug use in the past 12 months, even if they used the drug(s) just once. A colour booklet containing high-quality pictures of psychotropic drugs commonly used to treat mental disorders was provided to help respondents recall drug use. RESULTS: Psychotropic drug utilization is generally low in individuals with any 12-month mental disorder (32.6%). The extent of psychotropic drug utilization varied according to the specific DSM-IV diagnosis. Among individuals with a 12-month diagnosis of pure major depression, only 21.2% had received any antidepressants within the same period; the exclusive use of antidepressants was even lower (4.6%), while more individuals took only anxiolytics (18.4%). CONCLUSION: These data question the appropriateness of current pharmacological treatments, particularly for major depression, in which under-treatment is coupled with the high use of non-specific medications, such as anxiolytics.

The European Study of the Epidemiology of Mental Disorders (ESEMeD/MHEDEA 2000) project: rationale and methods.

The European Study of the Epidemiology of Mental Disorders (ESEMeD/MHEDEA 2000) is a new cross-sectional study investigating the prevalence and the associated factors of mental disorders, as well as their effect on health-related quality of life and the use of services in six European countries. This paper describes the rationale, methods and the plan for the analysis of the project. A total of 22,000 individuals representative of the non-institutionalized population aged 18 and over from Belgium, France, Germany, Italy, the Netherlands and Spain are being interviewed in their homes. Trained interviewers use a computer-assisted personal interview (CAPI) including the most recent version of the Composite International Diagnostic Interview (CIDI, 2000), a well-established epidemiological survey for assessing mental disorders. This is the first international study using the standardized up-to-date methodology for epidemiological assessment. Sizeable differences in prevalence, impact and level of need that is met by the health services are expected. The analysis of these differences should facilitate the monitoring of ongoing mental health reform initiatives in Europe and provide new research hypotheses.

[Pharmacoeconomical model for cost calculation using a study on prophylaxis of nausea and vomiting in the postoperative phase as an example. Cost effectiveness analysis of a tropisetron supplemented desflurane anaesthesia in comparison to a propofol total intravenous anaesthesia (TIVA)]. / Pharmakoökonomische Modelle zur Kostenberechnung dargestellt am Beispiel einer Studie zur Prophylaxe von Ubelkeit und Erbrechen in der postoperativen Phase Kosten-Wirksamkeits-Analyse einer Tropisetron-supplementierten Desfluran-Anästhesie im Vergleich zu einer Propofol-TIVA.

AIM OF THE STUDY: Postoperative nausea and vomiting (PONV) are among the most frequent complications after general anaesthesia. Avoiding these symptoms is of utmost importance for most patients; PONV is not only a major source of discomfort for patients but also a cause of additional costs for the patients and the health care provider. The economical impact of PONV will become even more important in the near future because the number of surgical procedures performed on an ambulatory basis is increasing. The following article gives a short overview of the terminology and measures used in pharmacoeconomical studies concerning PONV. Furthermore the economical aspects of a low-flow anaesthesia supplemented with the 5-HT(3)-antagonist tropisetron compared with a total intravenous anaesthesia (TIVA) using propofol are described. METHODS: For this comparison a decision analysis was performed using data of a randomised control trial on 150 female patients undergoing major gynaecological surgery. The patients were randomised to receive a total intravenous anaesthesia with propofol-alfentanil or a balanced anaesthesia with desfluran (fresh gas flow 1 l.min(-1)) supplemented by 2 mg tropisetron at the end of surgery. RESULTS: Indirect costs associated with anaesthesia using desflurane-tropisetron (4.94 Euro) are not different from that of propofol-TIVA (4.81 Euro) because of a similar incidence of PONV in the PACU. Furthermore, the total cost for 100 min general anaesthesia is higher in the desflurane-tropisetron group (30.94 Euro) compared with the TIVA group (24.55 Euro) due to the decreasing acquisition costs of propofol in the last 2 years. CONCLUSION: Total intravenous anaesthesia with propofol is more cost-efficient than balanced anaesthesia with desflurane and additional tropisetron as a prophylactic antiemetic.

[Instruments for the economical evaluation of psychiatric service systems: methodological foundations of the European standardisation and the German adaptation]. / Instrumente zur gesundheitsökonomischen Evaluation psychiatrischer Versorgungssysteme: Methodische Grundlagen der europäischen Standardisierung und der deutschsprachigen Adaptation.

OBJECTIVE: In the project "Cost-effectiveness of psychiatric service systems. A European comparison" a German version of instruments for the assessment of needs for services (CAN-EU), service satisfaction (VSSS-EU) relatives' burden of care (IEQ-EU) and costs of psychiatric services (CSSRI-EU) was developed in close cooperation with the EPSILON Study group. METHOD: The English original versions of the instruments were translated into German and a back-translation into the original language was carried out by a second translator. The back-translation was screened by the first author of the original version. The German versions of all instruments were tested for comprehensibility and practicability by means of focus groups. The internal consistency of all instruments were tested on a representative sample of 307 patients with schizophrenia according to ICD-10 F20. Test-retest reliability and inter-rater reliability was tested by a sub-sample of 50 patients. RESULTS: Psychometric properties of the translated instruments will be presented and discussed. CONCLUSIONS: Statistical methods for the assessment of the reliability coefficients were identical with those of the EPSILON study, therefore the psychometric properties of the German version of the CAN-EU are directly comparable with the other European versions of the instrument.

[The standardized assessment of the need for treatment and support in severe mental illness: the development and testing of the German version of the Camberwell assessment of Need-EU]. / Die standardisierte Erfassung des Behandlungs- und Unterstützungsbedarfs bei schweren psychischen Erkrankungen - Entwicklung und Erprobung der deutschsprachigen Version des Camberwell Assessment of Need-EU

OBJECTIVE: The development and the psychometric testing of the German version of the Camberwell Assessment of Need-EU will be presented. METHOD: The internal consistency of the subscales total needs, met needs and unmet needs was tested by the application of the CAN-EU on a representative sample of 307 patients with schizophrenia according to ICD-10 F20.0. Test-retest-reliability and inter-rater-reliability was tested with a sub-sample of 41 patients. RESULTS: The internal consistency and the test-retest-reliability of the German version of the CAN-EU is satisfying and slightly higher in comparison with the other European versions. The inter-rater-reliability is also satisfying but smaller in comparison with the other European versions. CONCLUSIONS: In general, the psychometric properties of the German version of the CAN-EU are satisfying but the lower inter-rater-reliability in comparison with the other European versions suggests that more precise coding rules for the German version of the CAN-EU must be formulated to improve the inter-rater agreement of the instrument.

[German adaptation of the client sociodemographic and service receipt inventory - an instrument for the cost of mental health care]. / Die deutsche Version des Client Sociodemographic and Service Receipt Inventory - Ein Instrument zur Erfassung psychiatrischer Versorgungskosten

AIM: Psychiatric health services research has to consider health economic points of view more than before as a result of the present-day financial problems in our health care system. Therefore an instrument was developed, which is suitable for the evaluation of cost of mental health care in Germany. METHOD: The Client Sociodemographic and Service Receipt Inventory (CSSRI-EU), which was developed in the UK, was adapted to the German situation and for the first time used in a cost-effectiveness-analysis of mental health care. The adaptation process of the instrument and the practical application are explained and pros and cons considered. RESULTS: The German adaptation of the CSSRI-EU has proven effective in practical application. The instrument offers feasible solutions for many problems with the cost of mental health care. The instrument can be used for the calculation of direct and indirect costs and gives information about service utilization and medication profiles of the clients. CONCLUSION: The German adaptation of the CSSRI-EU is a feasible instrument for the evaluation of the cost of mental health care in Germany.

[The German adaptation of the Verona Service Satisfaction Scale: an instrument for patients' satisfaction with mental health care]. / Die deutsche Version der Verona Service Satisfaction Scale (VSSS-54) - Ein Instrument zur Erfassung der Patientenzufriedenheit mit psychiatrischer Behandlung -

UNLABELLED: The German Adaptation of the Verona Service Satisfaction Scale: An Instrument for Patients' Satisfaction with Mental Health Care. AIM: Measuring effectiveness and quality of care became an important topic in psychiatry. Considering that objective criteria were not sufficient in the past, the subjective perspective gained growing interest. Client satisfaction is an important variable to evaluate psychiatric care. Patient satisfaction can influence treatment outcome as well as it determines the psychiatric system itself. METHOD: The Italian original version of the Verona Service Satisfaction Scale (VSSS-54) was translated and adapted to the German language. The instrument has been tested in the project "Cost-effectiveness of psychiatric service systems". The process of development, the psychometric testing and the practical application of the German version will be presented in this paper. Additional advantages and disadvantages are discussed. RESULTS: As psychometric properties of the instrument correspond to conventional standards, they are comparable with the results of an international study. The drop out of items cannot be controlled, therefore analysing the data is difficult. CONCLUSION: Although the VSSS shows various methodological limitations, it is at the moment an appropriate instrument for measuring patient satisfaction in the German language.

[The assessment of burden on relatives of mentally ill people: the German version of the involvement evaluation questionnaire (IEQ-EU)]. / Die Erfassung der Belastung der Angehörigen psychisch erkrankter Menschen - Die deutsche Version des Involvement Evaluation Questionnaires (IEQ-EU)

AIMS: The German Version of the Involvement Evaluation Questionnaire (IEQ-EU), developed for the assessment of burden on relatives of mentally ill people will be presented. Also the results of the reliability analysis will be presented. METHOD: After translation and adaptation of the Dutch version of the IEQ-EU into German, the instrument was tested in the study "Cost-effectiveness of psychiatric service systems". RESULTS: The internal consistency was tested on a sub-sample of 138 relatives and the Test-Retest-Reliability on a sub-sample of 37 relatives. The internal consistency (Cronbachs alpha) is moderate or good and slightly lower in comparison with the other European versions. With the exception of one subscale the results for the intraclass correlation coefficient are equal to the European versions. CONCLUSIONS: The IEQ-EU is an instrument with moderate or good psychometric properties. It covers all important domains, is easy to understand and not time-consuming.