Skip to main content

Advertisement

SpringerLink
Log in

Development and Validation of the Health of the Nation Outcome Scales-Residential Facility (HoNOS-RF)

  • Original Paper
  • Published:
Psychiatric Quarterly Aims and scope Submit manuscript

Abstract

The Health of the Nation Outcome Scale (HoNOS) (Lora et al. Epidemiol Psichiatr Soc 10(3):198–212, 2001) is widely used. However, clinicians have expressed concerns about its ability to describe severe mentally ill patients, as it does not consider some relevant clinical aspects. This study aims to develop and validate the HoNOS-Residential Facility (HoNOS-RF) in order to pursue a thorough assessment of patients admitted to psychiatric residential facilities (RFs). The final version of the HoNOS-RF was administered to 409 patients admitted to four RFs. Exploratory factor analysis, Cronbach’ alpha (α), Intraclass Correlation Coefficients (ICC) were used to assess construct validity, internal consistency and reliability, respectively. Concurrent criterion validity was assessed through correlations with the Brief Psychiatric Rating Scale-Expanded Version (BPRS-E) (Roncone et al. Acta Psychiatric Scand 100(3):229–36, 1999), Personal and Social Performance Scale (PSP) (Morosini et al. Acta Psychiatric Scand 101(4): 323–29, 2000), and comparisons across diagnostic groups. The final version of the HoNOS-RF consisted of 31 items, grouped into the following eight factors (overall explaining 55% of the total variability): personal and interpersonal functioning; environment; behavior and burden of care; cognitive function; somatic problems; anxiety-depression symptoms; psychotic symptoms; and other psychiatric symptoms. The scale showed high internal consistency (α = .807), and the correlations with PSP and BPRS-E ranged from adequate to moderate. The ICCs were in the excellent range for almost all items. These findings support the validity and the reliability of the HoNOS-RF, thus it may be a useful tool for the assessment of patients admitted to RFs, as it addresses clinical aspects that were mostly not included in the original version.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Nasrallah HA, Targum SD, Tandon R, McCombs JS, Ross R. Defining and measuring clinical effectiveness in the treatment of schizophrenia. Psychiatr Serv. 2005;56(3):273–82.

    Article  PubMed  Google Scholar 

  2. Greer TL, Kurian BT, Trivedi MH. Defining and measuring functional recovery from depression. CNS Drugs. 2010;24(4):267–84.

    Article  CAS  PubMed  Google Scholar 

  3. Emsley R, Chiliza B, Asmal L, Lehloenya K. The concepts of remission and recovery in schizophrenia. Curr Opin Psychiatry. 2011;24(2):114–21.

    PubMed  Google Scholar 

  4. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Arlington: American Psychiatric Publishing; 2013.

    Book  Google Scholar 

  5. San L, Ciudad A, Alvarez E, Bobes J, Gilaberte I. Symptomatic remission and social/vocational functioning in outpatients with schizophrenia: prevalence and associations in a cross-sectional study. Eur Psychiatry. 2007;22(8):490–8.

    Article  PubMed  Google Scholar 

  6. de Girolamo G, Bassi M, Neri G, Ruggeri M, Santone G, Picardi A. The current state of mental health care in Italy: problems, perspectives, and lessons to learn. Eur Arch Psychiatry Clin Neurosci. 2007;257:83–91.

    Article  PubMed  Google Scholar 

  7. Solomon DA, Leon AC, Coryell W, Posternak M, Endicott J, Keller MB. Predicting recovery from episodes of major depression. J Affect Disord. 2008;107(1–3):285–91.

    Article  PubMed  Google Scholar 

  8. de Girolamo G, Picardi A, Micciolo R, Falloon I, Fioritti A, Morosini P. The PROGRES Group. Residential care in Italy: a national survey of non-hospital facilities. Br J Psychiatry. 2002;81:220–5.

    Article  Google Scholar 

  9. Slade M. What outcomes to measure in routine mental health services, and how to assess them: a systematic review. Aust N Z J Psychiatry. 2002;36(6):743–53.

    Article  PubMed  Google Scholar 

  10. Burns T, Patrick D. Social functioning as an outcome measure in schizophrenia studies. Acta Psychiatr Scand. 2007;116(6):403–18.

    Article  CAS  PubMed  Google Scholar 

  11. Figueira ML, Brissos S. Measuring psychosocial outcomes in schizophrenia patients. Curr Opin Psychiatry. 2011;24(2):91–9.

    PubMed  Google Scholar 

  12. Jones SH, Thornicroft G, Coffey M, Dunn G. A brief mental health outcome scale: reliability and validity of the global assessment of functioning (GAF). Br J Psychiatry. 1995;166(5):654–9.

    Article  CAS  PubMed  Google Scholar 

  13. Endicott J, Spitzer RL, Fleiss JL, Cohen J. The global assessment scale. A procedure for measuring overall severity of psychiatric disturbance. Arch Gen Psychiatry. 1976;33:766–71.

    Article  CAS  PubMed  Google Scholar 

  14. Wing JK, Beevor AS, Curtis RH, Park SB, Hadden S, Burns A. Health of the nation outcome scales (HoNOS). Research and development. Br J Psychiatry. 1998;172:11–8.

    Article  CAS  PubMed  Google Scholar 

  15. Morosini PL, Magliano L, Brambilla L, Ugolini S, Pioli R. Development, reliability and acceptability of a new version of the DSM-IV social and occupational functioning assessment scale (SOFAS) to assess routine social functioning. Acta Psychiatr Scand. 2000;101(4):323–9.

    CAS  PubMed  Google Scholar 

  16. Salvi G, Leese M, Slade M. Routine use of mental health outcome assessments: choosing the measure. Br J Psychiatry. 2005;186:146–52.

    Article  PubMed  Google Scholar 

  17. Pirkis JE, Burgess PM, Kirk PK, Gibaldi L. A review of the psychometric properties of the health of the nation outcome scales (HoNOS) family of measures. Health Qual Life Outcomes. 2005;28:3–76.

    Google Scholar 

  18. Lora A, Bai G, Bianchi S, Bolongaro G, Civenti G, Erlicher A, et al. The Italian version of HoNOS (health of the nation outcome scales), a scale for evaluating the outcomes and the severity in mental health services. Epidemiol Psichiatr Soc. 2001;10(3):198–212.

    Article  Google Scholar 

  19. Morosini P, Gigantesco A, Mazzarda A, Gibaldi L. HoNOS-Rome: an extended, customized, and longitudinal oriented version of the HoNOS. Epidemiol Psichiatr Soc. 2003;12(1):53–62.

    Article  PubMed  Google Scholar 

  20. Speak BL, Muncer SJ. Factorial structure of the health of the nation outcome scales: an ordinal confirmatory factor analysis using a national sample of clinician ratings in England. Int J Ment Health Nurs. 2016;25(1):87–98.

    Article  PubMed  Google Scholar 

  21. Lovaglio PG, Monzani E. Validation aspects of the health of the nation outcome scales. Int J Ment Heal Syst. 2011;6:5–20.

    Google Scholar 

  22. de Girolamo G, Candini V, Buizza C, Ferrari C, Boero ME, Giobbio GM, et al. Is psychiatric residential facility discharge possible and predictable? A multivariate analytical approach applied to a prospective study in Italy. Soc Psychiatry Psychiatr Epidemiol. 2011;49(1):157–67.

    Article  Google Scholar 

  23. Goldman LS. Comorbid medical illness in psychiatric patients. Curr Psychiatry Rep. 2000;2(3):256–63.

    Article  CAS  PubMed  Google Scholar 

  24. Salokangas RK. Medical problems in schizophrenia patients living in the community (alternative facilities). Curr Opin Psychiatry. 2007;20(4):402–5.

    Article  PubMed  Google Scholar 

  25. Desai PR, Lawson KA, Barner JC, Rascati KL. Identifying patient characteristics associated with high schizophrenia-related direct medical costs in community-dwelling patients. J Manag Care Pharm. 2013;19(6):468–77.

    PubMed  Google Scholar 

  26. Gigantesco A, Picardi A, de Girolamo G, Morosini P. Discriminant ability and criterion validity of the HoNOS in Italian psychiatric residential facilities. Psychopathology. 2007;40(2):111–5.

    Article  CAS  PubMed  Google Scholar 

  27. Roncone R, Ventura J, Impallomeni M, Falloon IR, Morosini PL, Chiaravalle E, et al. Reliability of an Italian standardized and expanded brief psychiatric rating scale (BPRS 4.0) in raters with high vs. low clinical experience. Acta Psychiatr Scand. 1999;100(3):229–36.

    Article  CAS  PubMed  Google Scholar 

  28. Ruggeri M, Koeter M, Schene A, Bonetto C, Vàzquez-Barquero JL, Becker T, et al. Factor solution of the BPRS-expanded version in schizophrenic outpatients living in five European countries. Schizophr Res. 2005;75(1):107–17.

    Article  PubMed  Google Scholar 

  29. Parabiaghi A, Lasalvia A, Bonetto C, Cristofalo D, Marrella G, Tansella M, et al. Predictors of changes in caregiving burden in people with schizophrenia: a 3-year follow-up study in a community mental health service. Acta Psychiatr Scand Suppl. 2007;437:66–76.

    Article  Google Scholar 

  30. Goldney RD, Fisher LJ, Walmsley SH. The health of the nation outcome scales in psychiatric hospitalisation: a multicentre study examining outcome and prediction of length of stay. Aust N Z J Psychiatry. 1998;32(2):199–205.

    Article  CAS  PubMed  Google Scholar 

  31. Rossi R, Blaco R, Castelli C, Civenti G, Cocchi A, Contini A, et al. Il costo dei pazienti psichiatrici per classi di gravità. Epidemiol Psichiatr Soc. 1999;8:198–208.

    Article  CAS  PubMed  Google Scholar 

  32. Kisely S, Campbell LA, Cartwright J, Cox M, Campbell J. Do the health of the nation outcome scales measure outcome? Can J Psychiatr. 2010;55(7):431–9.

    Article  Google Scholar 

  33. Golay P, Basterrechea L, Conus P, Bonsack C. Internal and predictive validity of the French Health of the Nation Outcome Scales: need for future directions. PLoS One. 2016;1(8):e0160360.

    Article  Google Scholar 

  34. De Santi K, Lasalvia A, D'Astore C, Ruggeri M. Outcomes from Italian community psychiatric services studies. J Nerv Ment Dis. 2014;202(6):501–6.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

We would thank Prof. Pierluigi Morosini for his valuable contribution in the development of the scale and, overall, for the conception of the study. Moreover, we would thank the following mental health educators for their effort in data collection: Acquati Arianna, Aliprandi Silvia, Bertocchi Elena, Bertolino Silvana, Bindoni Roberto, Bosetti Alessia, Ciccolella Giusi, Colla Franca, Giacomelli Paola, Maffetti Katia, Marcassoli Ivan, Ruggeri Elena, Scala Davide, Soave Stefano, Sordi Federica.

Author information

Authors and Affiliations

  1. Psychiatry Unit, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, via Pilastroni 4, Brescia, Italy

    Laura Pedrini, Mariangela Lanfredi, Sonia Andreose, Pasquale Basso, Rossella Beneduce, Rosaria Pioli, Luciana Rillosi, Giuseppe Rossi, Roberta Rossi & Giovanni Battista Tura

  2. Service of Statistics, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, via Pilastroni 4, 25125, Brescia, Italy

    Clarissa Ferrari

Authors
  1. Laura Pedrini
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mariangela Lanfredi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Clarissa Ferrari
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Sonia Andreose
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Pasquale Basso
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Rossella Beneduce
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Rosaria Pioli
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Luciana Rillosi
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Giuseppe Rossi
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Roberta Rossi
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Giovanni Battista Tura
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Laura Pedrini.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

The study was approved by the local ethics committee, thus, all procedures were in accordance with the ethical standards of the national research committee and with the 1964 Helsinki declaration and its later amendments.

Electronic supplementary material

ESM 1

(DOCX 68 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Pedrini, L., Lanfredi, M., Ferrari, C. et al. Development and Validation of the Health of the Nation Outcome Scales-Residential Facility (HoNOS-RF). Psychiatr Q 89, 461–473 (2018). https://doi.org/10.1007/s11126-017-9548-1

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11126-017-9548-1

Keywords

Search

Navigation