Validation of an outcome scale for use in adult psychiatric practice

Objective-To clarify the usefulness, acceptability; sensitivity, and validi ty of version 4 of the Health of the Nation Outcome Scale (HoNOS), a scale developed to meet the requirement for a clinically acceptable outcome scale for routine use in mental illness services. Design-Patients with a range of mental illnesses were rated on the HoNOS at the beginning and end of an episode by interviews with mental health profe ssionals. Subjects-934 patients from eight diagnostic categories were rated by 129 me ntal health professionals at 17 sites; 250 were also rated on a range of co mparison scales. Outcome measures-Comparison of patients' scores at the beginning and end of an episode using individual item scores, dimensional subscores, and the to tal score. Results-HoNOS scores decreased by almost 50% between the beginning and end of episodes. They varied with the severity of the setting and discriminant analysis showed that the HoNOS had a moderate level of discriminatory power . Correlation analysis showed acceptable levels of agreement with independe nt scales, although the accuracy of ratings of some items at the beginning of an episode was affected by information deficits. Conclusion-The findings indicate that HoNOS is sensitive to change across t ime and to differences in illness type and severity, and has a sufficient d egree of both construct and criterion related validity to fulfil the requir ements of a mental health outcome scale for routine use in clinical setting s.