Psychometric evaluation of the Ward Atmosphere Scale in a Russian psychiatric hospital.

AIM: The aim of the study was to evaluate the psychometric properties of the 10 subscales of the Ward Atmosphere Scale (WAS) in a Russian psychiatric hospital. METHODS: A total of 212 patients and 96 staff members at five wards for acute psychiatric patients completed the WAS. We calculated Cronbach's alpha, the Corrected Item Total Subscale Correlation (CITC), and item-revised subscale intercorrelations. RESULTS: By removing a total of 32 items, the psychometric properties for all subscales except "Autonomy", reached an acceptable level for the patient scores. Although several of the revised subscales were highly intercorrelated, the specificity of the items of the revised scales appeared acceptable. CONCLUSIONS: The revised WAS version appeared applicable within this Russian psychiatric hospital context. Several of the items that were dropped appeared inapplicable because of differences between Russian and Western culture and psychiatry.

Correcting biases in psychiatric diagnostic practice in Northwest Russia: comparing the impact of a general educational program and a specific diagnostic training program.

BACKGROUND: A general education in psychiatry does not necessary lead to good diagnostic skills. Specific training programs in diagnostic coding are established to facilitate implementation of ICD-10 coding practices. However, studies comparing the impact of these two different educational approaches on diagnostic skills are lacking. The aim of the current study was to find out if a specific training program in diagnostic coding improves the diagnostic skills better than a general education program, and if a national bias in diagnostic patterns can be minimised by a specific training in diagnostic coding. METHODS: A pre post design study with two groups was carried in the county of Archangelsk, Russia. The control group (39 psychiatrists) took the required course (general educational program), while the intervention group (45 psychiatrists) were given a specific training in diagnostic coding. Their diagnostic skills before and after education were assessed using 12 written case-vignettes selected from the entire spectrum of psychiatric disorders. RESULTS: There was a significant improvement in diagnostic skills in both the intervention group and the control group. However, the intervention group improved significantly more than did the control group. The national bias was partly corrected in the intervention group but not to the same degree in the control group. When analyzing both groups together, among the background factors only the current working place impacted the outcome of the intervention. CONCLUSION: Establishing an internationally accepted diagnosis seems to be a special skill that requires specific training and needs to be an explicit part of the professional educational activities of psychiatrists. It does not appear that that skill is honed without specific training. The issue of national diagnostic biases should be taken into account in comparative cross-cultural studies of almost any character. The mechanisms of such biases are complex and need further consideration in future research. Future research should also address the question as to whether the observed improvement in diagnostic skills after specific training actually leads to changes in routine diagnostic practice.

The Barents project in psychiatry: a systematic comparative mental health services study between Northern Norway and Archangelsk County.

BACKGROUND: There is virtually no readily accessible systematically recorded evidence on how the organization of mental health services in Europe's largest country, Russia, may differ from other national systems. This study systematically compares the mental health services in Archangelsk County and Northern Norway using instruments developed for trans-cultural use. METHODS: The European Service Mapping Schedule (ESMS) and The International Classification of Mental Health Care (ICMHC) were used to describe: (i) resources, organisation and utilisation of the services; (ii) their decentralisation and differentiation; (iii) some interventions delivered by the mental health service units (n = 132) in both regions. RESULTS: The Norwegian services are more decentralised and differentiated, while the Russian services are largely hospital-based. The GPs are of considerable importance to the Norwegian services, functioning as gatekeepers-both centrally and peripherally. In contrast, the GP model is still poorly established in Archangelsk County. There are more units for long term stay in the Russian services than in Norway. General health care and taking over daily living activities are more organised in Archangelsk County, while psychopharmacological treatment and psychosocial interventions are more developed in Norway. CONCLUSION: The study has revealed several differences in resources, organisation and utilisation of the mental health services between the two compared areas. The very large variations indicate that underlying local patterns of service delivering must be further investigated and taken into account in the planning of the services development.