An International Pilot Study of Self-Reported Quality of Life in Outpatient and Inpatient Mental Health Settings.

Introduction: Measuring quality of life (QoL) is essential to understand how clients perceive their care. In practice, many instruments are in place to identify mental health diagnoses and measure treatment outcomes, but there are fewer standardized instruments to routinely collect information about self-reported QoL, especially across different mental health settings. Moreover, existing tools have been criticized for being built from the perspective of care professionals rather than the users' perspective. The 23-item Self-Reported interRAI-QoL Survey for Mental Health and Addictions (interRAI SQoL-MHA) tackles these issues, as it is based on self-reported measures and has proven validity across settings and countries. Objective: The aim of this study is to assess and compare QoL across settings and explore associations between dimensions of self-reported QoL and some items from the interRAI SQoL-MHA in a multinational sample. Settings: Inpatient and community mental health services. Methods: Data were collected from organizations in Belgium, Finland, Russia, Brazil, Rwanda, Canada and Hong Kong. Logistic regression models were constructed using each domain scale of the interRAI SQoL-MHA (relationship, support, hope, activities and relationship with staff) as dependent variables. Results: A total of 2,474 people (51.2% female, 56.7% of age 45 or older) were included in the study. A benchmark analysis showed the samples that performed above the benchmark line or below. The models yielded significant odds ratios among the domain scales, as well as for the items of the interRAI SQoL-MHA, with positive associations for the items "work and education opportunities" and "satisfied with services", and inverse associations for the items "financial difficulties" and for the inpatient setting. Conclusion: The analysis of associations between the determinants offers relevant information to improve mental health care and clients' perceived quality of life. Information about the determinants can help policymakers to design interventions to improve care outcomes, as well as provide more possibilities for integration into the community. The interRAI SQoL-MHA is innovative, as it can be linked to the third generation interRAI MH and Community MH-instruments, to be used in different mental health care settings, combining the objective and subjective QoL domains.

interRAI Subjective Quality of Life Scale for Mental Health and Addiction Settings: A Self-Reported Measure Developed From a Multi-National Study.

Background: Measuring Quality of Life (QoL) in mental health using self-reported items is important for evaluating the quality of service and understanding the person's experience of the care received. Objective: The aim of this research was to develop and validate a self-reported QoL instrument for inpatient and community mental health settings. Methods: Data were collected from diverse research sites in Canada, Belgium, Russia, Finland, Brazil, and Hong Kong, using the 37-item interRAI Quality of Life Survey for Mental Health and Addictions. The survey was administrated to 2,218 participants from inpatient and community mental health settings, assisted living, and the general community. We randomly divided the sample into a training and a test sample (70 and 30%, respectively). We conducted principal component analysis (PCA) and exploratory factor analysis (EFA) using the training sample to identify potential factor structure. Confirmatory factor analysis (CFA) models were then fitted to finalize and externally validate the measurement model using training and test data, respectively. Results: PCA, EFA, and CFA of the training sample collectively suggested a 23-item scale measuring four latent constructs: well-being and hope (8 items), relationship (7 items), support (5 items), and activity (3 items). This model was supported by the CFA of the test sample. The goodness-of-fit statistics root mean square error, comparative fit index and Tucker-Lewis index were 0.03, 1.00, and 0.99, respectively. Estimated Cronbach's alpha based on the test data was 0.92. Raw Cronbach's alpha values for the subscales were 0.86 for well-being and hope, 0.86 for relationship, 0.69 for support, and 0.72 for activity. Conclusions: The interRAI SQoL-MHA scale is a valid instrument to measure QoL in mental health settings. The instrument will support the evaluation of the quality of care and can also be used for future research to produce SQoL-MHA values on a quality adjusted-life-year scale, facilitating the evaluation of various mental health interventions.

The interRAI Suite of Mental Health Assessment Instruments: An Integrated System for the Continuum of Care.

The lives of persons living with mental illness are affected by psychological, biological, social, economic, and environmental factors over the life course. It is therefore unlikely that simple preventive strategies, clinical treatments, therapeutic interventions, or policy options will succeed as singular solutions for the challenges of mental illness. Persons living with mental illness receive services and supports in multiple settings across the health care continuum that are often fragmented, uncoordinated, and inadequately responsive. Appropriate assessment is an important tool that health systems must deploy to respond to the strengths, preferences, and needs of persons with mental illness. However, standard approaches are often focused on measurement of psychiatric symptoms without taking a broader perspective to address issues like growth, development, and aging; physical health and disability; social relationships; economic resources; housing; substance use; involvement with criminal justice; stigma; and recovery. Using conglomerations of instruments to cover more domains is impractical, inconsistent, and incomplete while posing considerable assessment burden. interRAI mental health instruments were developed by a network of over 100 researchers, clinicians, and policy experts from over 35 nations. This includes assessment systems for adults in inpatient psychiatry, community mental health, emergency departments, mobile crisis teams, and long-term care settings, as well as a screening system for police officers. A similar set of instruments is available for child/youth mental health. The instruments form an integrated mental health information system because they share a common assessment language, conceptual basis, clinical emphasis, data collection approach, data elements, and care planning protocols. The key applications of these instruments include care planning, outcome measurement, quality improvement, and resource allocation. The composition of these instruments and psychometric properties are reviewed, and examples related to homeless are used to illustrate the various applications of these assessment systems.

Cognitive functioning and expressed emotion among patients with first-episode severe psychiatric disorders.

Expressed emotion (EE) in families is able to predict the clinical outcome of patients with schizophrenia and mood disorders. However, the origins of EE and its interactions with the patient's clinical characteristics are not clear. In this respect, cognitive functioning of schizophrenic and mood-disorder patients has yielded contradictory results. In this cross-sectional study, we examined a sample of 42 consecutive first-episode patients with schizophrenia-related psychoses and severe mood disorders. Forty-two relatives were interviewed with the Five-Minute Speech Sample method. The relationships between EE and 3 clusters of patient-related variables (sociodemography, performance in cognitive tests, and psychopathology) were analyzed with stepwise regression analysis. With the exception of premorbid adjustment in childhood, only the cognitive variables were significantly associated with EE after controlling for the effect of the other variables. High EE was significantly associated with good performance in cognitive tests. Our results favor the attribution hypothesis of EE instead of the hypothesis that patient psychopathology would explain EE. Good cognitive functioning may lead to higher EE scores because of the higher expectations by the relatives.

Structure of needs among persons with schizophrenia.

BACKGROUND: The importance of needs assessment for service development has been widely recognised. Several studies have focused on the associations between ratings of needs by patients and staff and have found clear differences, especially concerning the unmet needs. METHODS: The present study is part of a Nordic Multicentre study that investigates the life and care of outpatients with a schizophrenia group illness in all the Nordic countries. The aim of this paper is to study the patterns of needs as identified by patients and staff according to the Camberwell Assessment of Needs (CAN). Quality of life, level of functioning, and psychiatric symptoms were assessed. RESULTS: The sample includes 300 patients, 194 (65%) men and 106 (35%) women. The factor analysis identified five factors for patients and four factors for staff in the questionnaire on ratings of needs. In four of the five patient-related factors a meaningful interpretation was possible, and the factors were named skills, illness, coping, and substance abuse. The staff-related factors were named skills, impairment, symptom, and substance abuse. There were significant associations between the sum scores constructed from the factors and measures of functioning level and symptoms. CONCLUSIONS: It seems that the sum factor reflecting secondary needs was the most important of the identified factors among both patient and staff ratings. The item-by-item comparisons in previous studies have emphasised differences between patient and staff ratings, but our analysis of the structure of needs also found similarities in the structures and in the associations between the identified sum scores and measures of symptoms, functioning level, and quality of life.

Schizophrenia and contact with health and social services: a Nordic multi-centre study.

BACKGROUND: In a Nordic multi-centre study investigating the life and care situation of persons with schizophrenia living in the community, factors explaining use of health and social services were examined. METHOD: Four hundred and eighteen individuals with schizophrenia from 10 sites were interviewed about their contact with different services (support functions within and outside the mental health services, general practitioners (GPs), physicians in the mental health, psychotherapy, day-care and inpatient treatment), psychopathology, social network and needs for care. RESULTS: Physicians and support contacts within the mental health system were most used and GPs and psychotherapy least. Three groups of variables were stabile predictors of contact: rural-urban differences, diagnoses (hebephrenic schizophrenia associated with less contact with physicians in the mental services and more with GPs) and health needs as experienced by the patients. No differences between the centres with regard to total service use were found, but the patterns of contact reflected urban-rural variance. A low number of health needs predicted contact with physicians within the mental health services, whereas a high number of such needs was related to contact with GPs and support functions within the mental health services. Social relations exhibited the highest number of unmet needs. CONCLUSIONS: Contact with physicians working in the mental health services was much more common than contact with GPs. Based on a broad spectre of demographic, clinical and network variables, it was not possible to find models that explained substantial parts of the variance of service use. Patterns of contact were different in rural, town and city-surroundings, and with the exception of psychotherapy, the rural pattern was characterized by use of less specialized services. The importance of health needs and diagnosis as predictors of contact illustrate the profound and lasting effects on health of having a diagnosis of schizophrenia.

Expressed emotion is not associated with disorder severity in first-episode mental disorder.

A family atmosphere characterized by expressed emotion (EE) is a robust predictor of clinical outcome of patients with schizophrenia and mood disorders. However, there is ongoing discussion as to whether EE is more a cause of clinical outcome or a parental reaction to disorder severity. This cross-sectional study examines a sample of 42 consecutive first-episode patients from a defined geographical area with severe mental disorders (schizophrenia-related disorders, psychotic mood disorders, and non-psychotic mood disorders). Their 42 relatives were interviewed, and the relationships between EE variables derived with the five-minute speech sample method (FMSS) and the patients' demographic, premorbid and clinical measures were analyzed. A high EE score was found in 40% of the relatives. High EE was associated with the interviewed relative's not being a spouse and the patient's being young and unmarried. It was not associated with premorbid characteristics, symptom dimensions or the diagnostic group of the patient. These results do not support the hypothesis that EE is a reaction to the clinical features of the patient. Instead, demographic factors may partly mediate the effect of EE on prognosis.