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 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.

Is a self-rated instrument appropriate to assess mentalization in patients with mental disorders? Development and first validation of the mentalization questionnaire (MZQ).

The purpose of this study was to develop and validate a self-rating scale for a differentiated assessment of mentalization. A pool of 40 items was developed and evaluated on n=434 inpatients with mental disorders at three time points. Symptom severity, self-injuring behavior, suicidal tendency and attachment style were also assessed. A varimax-rotated factor analysis supported the extraction of four factors. The model fit was checked by confirmatory factor analysis. Internal consistency of the mentalization questionnaire (MZQ) was .81. The relation between symptom severity and MZQ scores was found to be significant, and significant group differences were found between patients displaying self-injuring behavior and those who did not as well as between patients with and without suicide attempts. The MZQ can be considered as a practicable self-rated instrument with acceptable reliability and sufficient validity to assess at least aspects of mentalization in patients with mental disorders.

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.

Does a more specified version of the HoNOS (Health of the Nation Outcome Scales) increase psychometric properties of the inventory?

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

Is the Health of the Nation Outcome Scales appropriate for the assessment of symptom severity in patients with substance-related disorders?

The Health of the Nation Outcome Scales (HoNOS) is an internationally established clinician-rated instrument. The aim of the study was to assess the psychometric properties in inpatients with substance-related disorders. The HoNOS was applied in a multicenter, consecutive sample of 417 inpatients. Interrater reliability coefficients, confirmatory factor analysis, and regression tree analyses were calculated to assess the reliability and validity of the HoNOS. The factor validity of the HoNOS and its total score could not be confirmed. After training, all items of the HoNOS revealed sufficient values of interrater reliabilities. As the results of the regression tree analyses showed, the single items of the HoNOS were one of the most important predictor of service utilization. The HoNOS can be recommended for obtaining detailed ratings of the problems of inpatients with substance-related disorders as a clinical application in routine mental health care at present. Further studies should include comparisons of HoNOS and Addiction Severity Index.

The validity of the German version of the Health of the Nation Outcome Scales (HoNOS-D): a clinician-rating for the differential assessment of the severity of mental disorders.

The Health of the Nation Outcome Scales (HoNOS) is an internationally-established clinician-rating instrument for the differential assessment of the severity of patients with mental disorders. The aim of this study was to examine the validity of the German version of the HoNOS (HoNOS-D). Evaluation of validity, including factor validity, convergent and discriminant validity and sensitivity to change, was conducted on a large, virtually representative, clinical sample of patients with mental disorders in inpatient psychotherapy (Study 1, N = 3169). Additional assessment of criterion-based validity was completed using another clinical sample of patients with mental disorders (Study 2, N = 55). Although factor validity of the HoNOS-D and its total score could not be confirmed as expected, the majority of single items of the HoNOS-D proved to be valid in terms of convergent validity, criterion-based validity and sensitivity to change. Hence, single items, rather than the total score of the HoNOS-D, can be recommended for obtaining a picture of the impairment of patients with mental disorders in the clinical setting.