Abstract
Background: A good therapeutic relationship between patient and psychiatrist is vital for effective mental health care. However, no instruments to assess this relationship are available in Japan. This study aimed to develop a Japanese version of a Scale To Assess Therapeutic Relationship (STAR-J), which measures such relationships from the viewpoints of both the patient (STAR-J-P) and clinician (STAR-J-C). We examined the tool’s psychometric properties, including factor structure, internal consistency, convergent validity, and test-retest reliability among psychiatric outpatients and psychiatrists. Methods: Study participants comprised 139 outpatients and 10 psychiatrists. Exploratory factor analysis was conducted to investigate factor structure; to confirm cross-validity, confirmatory factor analysis was conducted using a different sample constituting 195 participants in an assertive community treatment program and their 91 case managers. Cronbach’s alpha was used to assess internal consistency. For STAR-J-P only, the intra-class correlation coefficient (ICC) was computed for 17 patients to determine test-retest reliability. Spearman’s correlation coefficients were calculated to examine convergent validity with service satisfaction, empowerment, and medication adherence. Results: We identified a two-factor structure for STAR-J-P and a one-factor structure for STAR-J-C. Cronbach’s alphas for the two STAR-J-P factors were 0.897 and 0.645, and that for the STAR-J-C factor was 0.949. The ICCs for STAR-J-P factors 1 and 2 were 0.765 and 0.630, respectively. STAR-J-P and STAR-J-C were not significantly correlated. STAR-J-P factors 1 and 2 showed significant correlations with service satisfaction (factor 1: ρ = 0.648, p < 0.001; factor 2: ρ = 0.238, p = 0.005) and medication adherence (factor 1: ρ = 0.508, p < 0.001; factor 2: ρ = 0.347, p < 0.001), but only factor 1 showed a significant relationship with empowerment (ρ = 0.283, p = 0.001). STAR-J-C was significantly correlated only with empowerment (ρ = 0.207, p = 0.017). Conclusions: STAR-J appears to be a useful instrument for assessing therapeutic relationships in the Japanese psychiatric outpatient setting. Further studies should test its validity and applicability in different mental health service settings.
Highlights
Over the past two decades, the subjective therapeutic relationship between psychiatric patients and clinicians has gradually become a meaningful outcome in mental health treatment [1], and the assessment of patient evaluations of the benefits of treatment has been important in mental health services [2, 3]
We aimed to develop a Japanese version of Scale To Assess Therapeutic Relationship (STAR) (STAR-J) and to examine its psychometric properties, including factor structure, internal consistency, testretest reliability, and convergent validity among outpatients and psychiatrists in outpatient service settings
We conducted a cross-sectional questionnaire survey in an outpatient setting at one psychiatric hospital located in Tokyo and two psychiatric clinics located in Tokyo and Chiba, Japan, to assess the factor structure, convergent validity, and internal consistency of STAR-J-P and C, and the test-retest reliability of STAR-J-P
Summary
Over the past two decades, the subjective therapeutic relationship between psychiatric patients and clinicians has gradually become a meaningful outcome in mental health treatment [1], and the assessment of patient evaluations of the benefits of treatment has been important in mental health services [2, 3]. A good patientclinician relationship has been found to be important for decision-making, and for developing better patientreported outcomes such as service satisfaction [7], empowerment [8], medication adherence [9, 10], and other clinical outcomes [11] in mental health service settings worldwide These findings indicate that evaluating the patient-clinician therapeutic relationship has become increasingly essential for assessing the quality and effects of mental health services. We aimed to develop a Japanese version of STAR (STAR-J) and to examine its psychometric properties, including factor structure, internal consistency, testretest reliability, and convergent validity among outpatients and psychiatrists in outpatient service settings. We examined the tool’s psychometric properties, including factor structure, internal consistency, convergent validity, and test-retest reliability among psychiatric outpatients and psychiatrists
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