Health of the Nation Outcome Scales (HoNOS): Implementability, subscale structure and responsiveness in the daily psychiatric hospital routine over the first 18 months

Abstract

The Health of the Nation Outcome Scales (HoNOS) includes 12 items designed to measure the problems patients have when admitted to a psychiatric hospital and to monitor to what extent these problems have diminished at discharge from hospital. The Danish version of the HoNOS was translated from the original English version in accordance with the WHO guidelines for scale translation. The HoNOS was evaluated for inter-staff agreement using a case vignette from the English training sessions. The HoNOS was then applied in a consecutive sample of 1769 inpatients over a period of 18 months. This sample covered 89% of all admissions in this period and was found representative with regard to age and gender. The diagnostic distribution according to ICD-10 showed that half of the patients were listed within schizophrenia and mood disorders. The HoNOS profile, using all 12 items of the scale, showed that schizophrenia was associated with hallucinations or delusional symptoms, with social and cognitive problems; mania with aggressive behaviour, with drinking or drug-taking and with anxiety; whereas depression was associated with suicidal behaviour, physical illness and depressed mood. Long-term stay in hospital was associated with a higher level of psychopathological symptoms at admission for schizophrenia, mania and depression. Among the diagnostic groupings, mania was associated with the greatest improvement in behavioural problems and psychological symptoms. The use of lithium was diagnostically associated with bipolar and schizoaffective disorders. Within these categories, the lithium-treated patients had a greater improvement in behavioural problems and psychological symptoms than the non-lithium-treated. The use of electroconvulsive therapy (ECT) in depressive patients was associated with a HoNOS admission profile of higher scores on psychological problems (delusions and depressed mood) than those seen in the non-ECT-treated depressive patients. The ECT-treated patients had a higher level of improvement at discharge. In conclusion, this first Scandinavian study with HoNOS showed that the scale is easy to implement in the daily routine of a psychiatric ward and that the HoNOS can give useful information about the quality of care in hospitalized patients.