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Clinically Meaningful Change in Mental Health Functioning Based on Patient Self-Report and Clinician Assessment
Eisen SV, Seal P, Spiro AS, Glickman M, Rosenheck R, Herz L, Furlong P, Silva L, McCoy L. Clinically Meaningful Change in Mental Health Functioning Based on Patient Self-Report and Clinician Assessment. Poster session presented at: VA HSR&D National Meeting; 2007 Feb 16; Arlington, VA.
Objectives: The Veterans Health Administration (VHA) currently uses a unidimensional clinician rating, the Global Assessment of Functioning Scale (GAF), to monitor outcomes of mental health services. However, principles for assessment of mental health outcomes suggest that the patient’s perspective should be included in outcomes monitoring systems. The objective of this study was to assess the utility of three widely used, standardized, patient self-report mental health outcome measures and the GAF among VHA patients treated in mental health specialty programs. The three self-report instruments were: the veterans SF-36, the Brief Symptom Inventory (BSI), and the Behavior and Symptom Identification Scale (BASIS-24).
Methods: Veterans were recruited to participate in a mental health outcome study from the mental health clinics or triage centers at two VA medical centers (Bedford and Boston, MA). 449 inpatients were enrolled in the study and completed baseline self-report assessments within 48 hours of admission. Repeat assessments were obtained before discharge for 327 of these patients (73%). GAF ratings at admission and discharge were obtained from the Austin GAF file, bed section file, and the computerized patient record system (CPRS). We assessed sensitivity by examining statistical significance and clinical meaningfulness of change during an acute inpatient psychiatric hospitalization. Based on the literature, we used one standard error of measurement (SEM) as the criteria for clinically meaningful change.
Results: At the aggregate level, psychiatric inpatients showed statistically significant change from admission to discharge on all of the mental health self-report measures and on the GAF, with effect sizes ranging from .24 to .72 for the self-report measures. Effect size for the GAF was 2.0. At the individual level, clinically meaningful improvement occurred in 31% to 65% of patients on the self-report measures and for 81% of patients on the GAF rating. Scores on all three self-report measures were moderately correlated with each other, but had little or no correlation with GAF ratings.
Implications: Self-report mental health assessments provide more modest estimates of improvement following acute inpatient treatment than GAF ratings made by clinicians.
Impacts: Incorporation of self-report mental health outcome measures may complement and supplement GAF ratings.