Estudio psicométrico de la Escala de valoración de los Niveles de Atención Requerida para personas con Trastorno Mental Grave (ENAR-TMG) / Psychometric study of the Required Care Levels for People with Severe Mental Disorder Assessment Scale (ENAR-TMG)

Introducción: Las personas con trastorno mental grave (TMG) presentan importantes dificultades en la vida cotidiana que conllevan la necesidad de una ayuda continuada. Estas necesidades no son fácilmente evaluables con los instrumentos actuales. Por ello se propone una escala multidimensional que evalúa los diferentes niveles de necesidad de atención, y se estudia el comportamiento psicométrico de dicho instrumento. Método: Ciento treinta y nueve pacientes (58% hombres) con trastorno mental grave fueron evaluados con la Escala de valoración de los Niveles de Atención Requerida para personas con Trastorno Mental Grave (ENAR-TMG) y las versiones españolas del Camberwell Assessment of Needy la Health of the Nation Outcome Scales. Se examinó el comportamiento psicométrico de la ENAR-TMG: a) aportando evidencias de validez basadas en su estructura interna y en la relación con otras variables, y b) estimando la consistencia interna, la estabilidad temporal, la fiabilidad entre evaluadores y la sensibilidad al cambio de las puntuaciones de la ENAR-TMG. Resultados: Con respecto a las evidencias de validez, cada una de las dimensiones teóricas del instrumento mostró una estructura unifactorial y, menos en un caso, una correlación significativa y positiva con las escalas Camberwell Assessment of Need (rango de r: 0,143-0,557) y Health of the Nation Outcome Scales (rango de r: 0,241-0,474). Asimismo, las puntuaciones de cada una de dichas dimensiones mostraron una consistencia interna aceptable (rango de coeficientes alfa ordinal: 0,682-0,804), unas excelentes fiabilidades test-retest (rango de coeficientes de correlación intraclase: 0,889-0,999) y entre evaluadores (rango de coeficientes de correlación intraclase: 0,926-0,972), y una sensibilidad al cambio satisfactoria (rango de ita2: 0,003-0,103). Conclusiones: El adecuado comportamiento psicométrico de la ENAR-TMG la convierte en un prometedor instrumento para la evaluación del estado y las necesidades de las personas con trastorno mental grave

Introduction: People with severe mental disorder have significant difficulties in everyday life that involve the need for continued support. These needs are not easily measurable with the currently available tools. Therefore, a multidimensional scale that assesses the different levels of need for care is proposed, including a study of its psychometric properties. Method: One-hundred and thirty-nine patients (58% men) with a severe mental disorder were assessed using the Required Care Levels for People with Severe Mental Disorder Assessment Scale (ENAR-TMG), the Camberwell Assessment of Need scale, and the Health of the Nation Outcome Scales. ENAR-TMG's psychometric features were examined by: a) evaluating 2 sources of validity evidence (evidence based on internal structure and evidence based on relations to other variables), and b) estimating the internal consistency, temporal stability, inter-rater reliability, and sensitivity to change of scores of the ENAR-TMG's subscales. Results Exploratory factor analyses revealed a one-factor structure for each of the theoretical dimensions of the scale, in which all but one showed a significant and positive correlation with the Camberwell Assessment of Need (range of r: 0.143-0.557) and Health of the Nation Outcome Scales (range of r: 0.241-0.474) scales. ENAR-TMG subscale scores showed acceptable internal consistency (range of ordinal alfa coefficients: 0.682-0.804), excellent test-retest (range of intraclass correlation coefficients: 0.889-0.999) and inter-rater reliabilities (range of intraclass correlation coefficients: 0.926-0.972), and satisfactory sensitivity to treatment-related changes (range of ita2: 0.003-0.103). Conclusions The satisfactory psychometric behaviour of the ENAR-TMG makes the scale a promising tool to assess global functioning in people with a severe mental disorder

Descriptive study of evolution experienced by users of mental health residence, after 10 years of operation.

INTRODUCTION: The transformation of the social-health benefits system must demonstrate efficiency. The objective of the current work is to evaluate the evolution of those living in a residence during the first 10 years of its operation. METHOD: Of the 205 patients used in the assessment, 93 were admitted. The evolutionary study was done with the 62 patients that were cared for between 2002-2012. The variables studied include the ENAR-CPB Scale, days hospitalized, community activities, a satisfaction survey and QOL. RESULTS: After the assessment process only 45% of those proposed for admission were actually admitted. Resident rotation is 3.4% annually. Many leave the program after being referred to a long-term psychiatric hospital; 14.5% leave the residence in order to have a more autonomous life. After living 2 years in the residence there is a general improvement in the majority of residents, which is maintained after 5 years as well. This improvement is maintained even after 10 years, however a general loss of capacities is experienced. CONCLUSIONS: Living in a Residence favors improvement in the quality of life, both subjectively as well as objectively. Institutional treatment consists of working with the patients in a way that treats them as individuals, so they can go about their lives and perform their tasks with creativity. In order for this to be possible, an individualized and flexible model is required.

Estudio descriptivo de la evolución experimentada por los usuarios de una residencia de salud mental, tras 10 años de funcionamiento / Descriptive study of evolution experienced by users of mental health residence, after 10 years of operation

Introducción. La transformación del sistema de prestaciones socio-sanitarias tiene que demostrar eficiencia. El objetivo de este trabajo es evaluar la evolución de los residentes atendidos en una residencia durante sus primeros 10 años de funcionamiento. Método. De 205 personas que optaron por plaza de residencia, 93 fueron admitidos. El estudio evolutivo se realiza con 62 pacientes atendidos entre 2002-2012. Las variables estudiadas incluyen la Escala ENAR-CPB, días de hospitalización, actividades comunitarias, encuesta de satisfacción y QOL. Resultados. Tras el proceso de valoración sólo ingresan un 45% de los usuarios propuestos. La rotación de residentes es del 3,4% anual, siendo la derivación a un recurso de hospitalización psiquiátrica de larga estancia la mayor causa de baja del programa. El 14,5%, en cambio, deja la residencia por un proyecto de vida más autónomo. A los 2 años de ingreso la mejoría es mayoritaria, a los 5 se mantiene y a los 10 se produce una pérdida general de capacidades, pero manteniéndose una mejoría respecto al momento del ingreso. Conclusiones. Vivir en una residencia favorece la mejoría en la calidad de vida de los residentes; tanto subjetiva como objetivamente. El tratamiento institucional consiste en ir trabajando con los usuarios y negociar desde su singularidad el modo de que no se sometan y puedan ejecutar creativamente su tarea. Para ello es necesario un modelo de intervención individualizado y flexible (AU)

Introduction. The transformation of the social-health benefits system must demonstrate efficiency. The objective of the current work is to evaluate the evolution of those living in a residence during the first 10 years of its operation. Method. Of the 205 patients used in the assessment, 93 were admitted. The evolutionary study was done with the 62 patients that were cared for between 2002-2012. The variables studied include the ENAR-CPB Scale, days hospitalized, community activities, a satisfaction survey and QOL. Results. After the assessment process only 45% of those proposed for admission were actually admitted. Resident rotation is 3.4% annually. Many leave the program after being referred to a long-term psychiatric hospital; 14.5% leave the residence in order to have a more autonomous life. After living 2 years in the residence there is a general improvement in the majority of residents, which is maintained after 5 years as well. This improvement is maintained even after 10 years, however a general loss of capacities is experienced. Conclusions.Living in a Residence favors improvement in the quality of life, both subjectively as well as objectively. Institutional treatment consists of working with the patients in a way that treats them as individuals, so they can go about their lives and perform their tasks with creativity. In order for this to be possible, an individualized and flexible model is required (AU)

Psychometric study of the Required Care Levels for People with Severe Mental Disorder Assessment Scale (ENAR-TMG). / Estudio psicométrico de la Escala de valoración de los Niveles de Atención Requerida para personas con Trastorno Mental Grave (ENAR-TMG).

INTRODUCTION: People with severe mental disorder have significant difficulties in everyday life that involve the need for continued support. These needs are not easily measurable with the currently available tools. Therefore, a multidimensional scale that assesses the different levels of need for care is proposed, including a study of its psychometric properties. METHOD: One-hundred and thirty-nine patients (58% men) with a severe mental disorder were assessed using the Required Care Levels for People with Severe Mental Disorder Assessment Scale (ENAR-TMG), the Camberwell Assessment of Need scale, and the Health of the Nation Outcome Scales. ENAR-TMG's psychometric features were examined by: a) evaluating 2 sources of validity evidence (evidence based on internal structure and evidence based on relations to other variables), and b) estimating the internal consistency, temporal stability, inter-rater reliability, and sensitivity to change of scores of the ENAR-TMG's subscales. RESULTS: Exploratory factor analyses revealed a one-factor structure for each of the theoretical dimensions of the scale, in which all but one showed a significant and positive correlation with the Camberwell Assessment of Need (range of r: 0.143-0.557) and Health of the Nation Outcome Scales (range of r: 0.241-0.474) scales. ENAR-TMG subscale scores showed acceptable internal consistency (range of ordinal α coefficients: 0.682-0.804), excellent test-retest (range of intraclass correlation coefficients: 0.889-0.999) and inter-rater reliabilities (range of intraclass correlation coefficients: 0.926-0.972), and satisfactory sensitivity to treatment-related changes (range of η2: 0.003-0.103). CONCLUSIONS: The satisfactory psychometric behaviour of the ENAR-TMG makes the scale a promising tool to assess global functioning in people with a severe mental disorder.

Benefits of a Secondary Prevention Program in Suicide.

BACKGROUND: The effectiveness of suicide intervention programs has not been assessed with experimental designs. AIM: To determine the risk of suicide reattempts in patients engaged in a secondary prevention program. METHOD: We included 154 patients with suicidal behavior in a quasi-experimental study with a nontreatment concurrent control group. In all, 77 patients with suicidal behavior underwent the Suicide Behavior Prevention Program (SBPP), which includes specialized early assistance during a period of 3-6 months. A matched sample of patients with suicidal behavior (n = 77) was selected without undergoing any specific suicide prevention program. Data on sociodemographics, clinical characteristics, and suicidal behavior were collected at baseline (before SBPP) and at 12 months. RESULTS: After 12 months, SBPP patients showed a 67% lower relative risk of reattempt (χ2 = 11.75, p = .001, RR = 0.33 95% CI = 0.17-0.66). Cox proportional hazards models revealed that patients under SBPP made a new suicidal attempt significantly much later than control patients did (Cox regression = 0.293, 95% CI = 0.138-0.624, p = .001). The effect was even stronger among first attempters. LIMITATIONS: Sampling was naturalistic and patients were not randomized. CONCLUSION: The SBPP was effective in delaying and preventing suicide reattempts at least within the first year after the suicide behavior. In light of our results, implementation of suicide prevention programs is strongly advisable.

Estudio comparativo coste-eficiencia en un dispositivo residencial para enfermos con trastorno mental severo / A comparative cost/efficiency study in a residential unit for patients with severe mental disorder

Funcionamiento de las Residencias para personas con trastorno mental severo, basado en su eficiencia y coste económico (AU)

The functioning of the residential program from Severe mental illness, based on the study of its efficiency and economic cost (AU)