Development and psychometric evaluation of the Transdiagnostic Decision Tool:matched care for patients with a mental disorder in need of highly specialised care

BackgroundEarly identification of patients with mental health problems in need of highly specialised care could enhance the timely provision of appropriate care and improve the clinical and cost-effectiveness of treatment strategies. Recent research on the development and psychometric evaluation of diagnosis-specific decision-support algorithms suggested that the treatment allocation of patients to highly specialised mental healthcare settings may be guided by a core set of transdiagnostic patient factors.AimsTo develop and psychometrically evaluate a transdiagnostic decision tool to facilitate the uniform assessment of highly specialised mental healthcare need in heterogeneous patient groups. Method The Transdiagnostic Decision Tool was developed based on an analysis of transdiagnostic items of earlier developed diagnosis-specific decision tools. The Transdiagnostic Decision Tool was psychometrically evaluated in 505 patients with a somatic symptom disorder or post-traumatic stress disorder. Feasibility, interrater reliability, convergent validity and criterion validity were assessed. In order to evaluate convergent validity, the five-level EuroQol five-dimensional questionnaire (EQ-5D-5L) and the ICEpop CAPability measure for Adults (ICECAP-A) were administered.ResultsThe six-item clinician-administered Transdiagnostic Decision Tool demonstrated excellent feasibility and acceptable interrater reliability. Spearman's rank correlations between the Transdiagnostic Decision Tool and ICECAP-A (-0.335), EQ-5D-5L index (-0.386) and EQ-5D-visual analogue scale (-0.348) supported convergent validity. The area under the curve was 0.81 and a cut-off value of &gt;= 3 was found to represent the optimal cut-off value.ConclusionsThe Transdiagnostic Decision Tool demonstrated solid psychometric properties and showed promise as a measure for the early detection of patients in need of highly specialised mental healthcare.</p

Picturing disturbed body experience:A comparison of body drawings in persons with somatoform disorder and a general population sample

People with somatic symptom disorder or somatoform disorder are considered to have a troubled relationship to their body that is hard to assess with self-report questionnaires alone. To examine the potential value of own-body drawings as an assessment tool, objective features of drawings from 179 patients referred to treatment for somatoform disorder, were compared to those of 173 age-and-sex matched persons from the general population. While two factors had been found in the somatoform disorder sample, in the general population only the factor that reflected 'details' in own-body drawings was replicated. The two samples did not score differently on this factor. The general population sample showed a less strong association between objective body drawings scores on this 'details' factor and self-reported scores of body experience than the somatoform disorder sample. Moreover, the phenomenological contents of the drawings were more oriented towards health or appearance than the mostly mixed or unclear orientation of persons with somatoform disorder. Because the objective scoring of body drawings did not differ between groups while the contents of body drawings appeared to differ, the results suggest that this objective scoring of body drawings is not appropriate to distinguish people with and without somatoform disorder

Body drawings as an assessment tool in somatoform disorder

As part of the assessment of somatoform disorder, body drawings may provide complementary information to augment self-report questionnaires. This study examined the psychometric quality of observer ratings of objective characteristics of 180 own body drawings made by persons referred to treatment for somatoform disorder and 67 post-treatment drawings. Physical features of the drawings such as eyes, hands, size and angle of perception, were scored. These observer ratings were correlated with participants' responses on the Dresden Body Image Questionnaire (DBIQ-35) and with a single assessment by art therapists of the clients' relationships to their bodies. Changes in the observer ratings before and after therapy were evaluated. Inter-rater reliability was adequate to excellent for ten observer ratings and the art therapist ratings. Categorical principal components analysis of observer ratings indicated a 2-factor structure comprising details (factor 1, alpha = 0.76) and basic elements (factor 2, alpha = 0.73). Both factors correlated with the art therapists' rating (Spearman's rho = -0.53 and rho = -0.36) but not with DBIQ-35 scales. Factor scores improved after therapy. Assessment of objective characteristics of body drawings in clients with somatoform disorder indicates reliability, sensitivity to change and initial validity. These assessments may help to improve evaluation of client characteristics and treatment effectiveness