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Health and Quality of Life Outcomes
Published in: Health and Quality of Life Outcomes 1/2019

Open Access 01-12-2019 | Research

Assessing the severity of functional impairment of psychiatric disorders: equipercentile linking the mini-ICF-APP and CGI

Authors: Stephan T. Egger, Godehard Weniger, Mario Müller, Julio Bobes, Erich Seifritz, Stefan Vetter

Published in: Health and Quality of Life Outcomes | Issue 1/2019

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Abstract

Background

The assessment of functioning and impairment due to psychiatric illness has been acknowledged to be crucial for research and practice. This led to the development of the mini-ICF-APP, which provides a reliable and time-efficient measure of functioning and impairment. Although its use is increasing, it remains unclear how it reflects severity and how change might be interpreted from a clinical perspective.

Methods

In a clinical sample of 3067 individuals hospitalized for mental health treatment, we used an equipercentile approach to link the mini-ICF-APP with the Clinical Global Impression scale (CGI) at admission and discharge. We linked the mini-ICF-APP sum score to the CGI-S scale and the mini-ICF-APP proportional change between admission and discharge to the CGI-I scale.

Results

The mini-ICF-APP and CGI scales showed a Spearman correlation of 0.50 (p < .000). CGI-S: “borderline-ill” corresponded to a mini-ICF-APP score 1–2; “mildly-ill” to 3–7; “moderately-ill” to 8–15; “markedly-ill” to 16–24; “severely-ill” to 25–37; and “extremely-ill” to a score ≥ 38. The Spearman correlation between the percentage change of mini-ICF-APP sum score and the CGI-I was 0.32 (p > .000); “no-change” in the CGI-I corresponded to an increase or decrease of 2%; “minimally-improved” to a mini-ICF-APP reduction of 3–30%; “much-improved” to a reduction of 31–63%; “very-much-improved” to a reduction of ≥64% “minimally-worse” to an increase of 3–34% “much-worse” to an increase of 35–67%; and finally “very-much-worse” with an increase of ≥68%.

Conclusions

Our findings improve understanding of the clinical meaning of the mini-ICF-APP sum score and percentage change in patients hospitalized for treatment.
Literature
1.
Lynskey MT, Strang J. The global burden of drug use and mental disorders. Lancet. 2013;382(9904):1540–2.PubMedCrossRef
2.
Wang PS, Angermeyer M, Borges G, Bruffaerts R, Chiu WT, De Girolamo G, et al. Delay and failure in treatment seeking after first onset of mental disorders in the World Health Organization's world mental health survey initiative. World Psychiatry. 2007;6(3):177.PubMedPubMedCentral
3.
Whiteford HA, Degenhardt L, Rehm J, Baxter AJ, Ferrari AJ, Erskine HE, et al. Global burden of disease attributable to mental and substance use disorders: findings from the global burden of disease study 2010. Lancet. 2013;382(9904):1575–86.PubMedCrossRef
4.
Vos T, Allen C, Arora M, Barber RM, Bhutta ZA, Brown A, et al. Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990–2015: a systematic analysis for the global burden of disease study 2015. Lancet. 2016;388(10053):1545–602.CrossRef
5.
Kassebaum NJ, Arora M, Barber RM, Bhutta ZA, Brown J, Carter A, et al. Global, regional, and national disability-adjusted life-years (DALYs) for 315 diseases and injuries and healthy life expectancy (HALE), 1990–2015: a systematic analysis for the global burden of disease study 2015. Lancet. 2016;388(10053):1603–58.CrossRef
6.
Insel TR, Cuthbert BN. Brain disorders? Precisely Science. 2015;348(6234):499–500.PubMed
7.
8.
Kendler KS. Setting boundaries for psychiatric disorders: editorial. Am J Psychiatr. 1999;156(12):1845.PubMed
9.
Angold A, Costello EJ, Farmer EMZ, Burns BJ, Erkanli A. Impaired but undiagnosed. J Am Acad Child Adolesc Psychiatry. 1999;38(2):129–37.PubMedCrossRef
10.
Timimi S. No more psychiatric labels: why formal psychiatric diagnostic systems should be abolished. Int J Clin Health Psychol. 2014;14(3):208–15.CrossRef
11.
Frances AJ, Nardo JM. ICD-11 should not repeat the mistakes made by DSM-5. Br J Psychiatry. 2013;203(1):1–2.PubMedCrossRef
12.
Cuthbert B, Insel T. The data of diagnosis: new approaches to psychiatric classification. Psychiatry. 2010;73(4):311–4.PubMedCrossRef
13.
Linden M, Baron S. The "mini-ICF-rating for mental disorders (mini-ICF-P)". A short instrument for the assessment of disabilities in mental disorders. Rehabilitation. 2005;44(3):144–51.PubMedCrossRef
14.
Baron S, Linden M. Analyzing the effectiveness of inpatient psychosomatic rehabilitation using the mini-ICF-APP. Rehabilitation. 2009;48(3):145–53.PubMedCrossRef
15.
Linden M, Baron S, Muschalla B. Relationship between work-related attitudes, performance and capacities according to the ICF in patients with mental disorders. Psychopathology. 2010;43(4):262–7.PubMedCrossRef
16.
Balestrieri M, Isola M, Bonn R, Tam T, Vio A, Linden M, et al. Validation of the Italian version of mini-ICF-APP, a short instrument for rating activity and participation restrictions in psychiatric disorders. Epidemiology and psychiatric sciences. 2013;22(1):81–91.PubMedCrossRef
17.
Molodynski A, Linden M, Juckel G, Yeeles K, Anderson C, Vazquez-Montes M, et al. The reliability, validity, and applicability of an English language version of the mini-ICF-APP. Soc Psychiatry Psychiatr Epidemiol. 2013;48:1347–54.PubMedCrossRef
18.
Pinna F, Fiorillo A, Tusconi M, Guiso B, Carpiniello B. Assessment of functioning in patients with schizophrenia and schizoaffective disorder with the mini-ICF-APP: a validation study in Italy. Int J Ment Heal Syst. 2015;9:37.CrossRef
19.
Muschalla B. Psychological capacity limitations according to mini-ICF-APP are differently related with sick leave in patients from different professional fields. J Psychosom Res. 2019;124:109741.PubMedCrossRef
20.
Muschalla B, Rau H, Willmund GD, Knaevelsrud C. Work disability in soldiers with posttraumatic stress disorder, posttraumatic embitterment disorder, and not-event-related common mental disorders. Psychol Trauma. 2018;10(1):30–5.PubMedCrossRef
21.
Habermeyer B, Kaiser S, Kawohl W, Seifritz E. Assement of incapacity to work and the mini-ICF-APP. Neuropsychiatrie. 2017;31(4):182–6.PubMedCrossRef
22.
Canela C, Schleifer R, Dube A, Hengartner MP, Ebner G, Seifritz E, et al. Assessment of functioning when conducting occupational capacity evaluations--what is "evidence-based"? Psychiatr Prax. 2016;43(2):74–81.PubMed
23.
Nierenberg AA, DeCecco LM. Definitions of antidepressant treatment response, remission, nonresponse, partial response, and other relevant outcomes: a focus on treatment-resistant depression. J Clin Psychiatry. 2001;62(Suppl 16):5–9.PubMed
24.
Samara MT, Engel RR, Millier A, Kandenwein J, Toumi M, Leucht S. Equipercentile linking of scales measuring functioning and symptoms: examining the GAF, SOFAS, CGI-S, and PANSS. Eur Neuropsychopharmacol. 2014;24(11):1767–72.PubMedCrossRef
25.
Leucht S, Kane JM, Etschel E, Kissling W, Hamann J, Engel RR. Linking the PANSS, BPRS, and CGI: clinical implications. Neuropsychopharmacology : official publication of the American College of Neuropsychopharmacology. 2006;31(10):2318–25.CrossRef
26.
Bobo WV, Anglero GC, Jenkins G, Hall-Flavin DK, Weinshilboum R, Biernacka JM. Validation of the 17-item Hamilton depression rating scale definition of response for adults with major depressive disorder using equipercentile linking to clinical global impression scale ratings: analysis of Pharmacogenomic research network antidepressant medication Pharmacogenomic study (PGRN-AMPS) data. Hum Psychopharmacol Clin Exp. 2016;31(3):185–92.CrossRef
27.
WHO. The ICD-10 classification of mental and behavioural disorders: clinical descriptions and diagnostic guidelines. Geneva: World Health Organization; 1992.
28.
Guy W. ECDEU assessment manual for psychopharmacology. Rockville, Maryland: US Department of Health, Education, and Welfare, Public Health Service, Alcohol, Drug Abuse, and Mental Health Administration, National Institute of Mental Health, Psychopharmacology Research Branch, Division of Extramural Research Programs; 1976.
29.
Spielmans GI, McFall JP. A comparative meta-analysis of clinical global impressions change in antidepressant trials. J Nerv Ment Dis. 2006;194(11):845–52.PubMedCrossRef
30.
Busner J, Targum SD. The clinical global impressions scale: applying a research tool in clinical practice. Psychiatry. 2007;4(7):28.PubMedPubMedCentral
31.
Rush A Jr, First MB, Blacker DE. Handbook of psychiatric measures. Philadelphia: American Psychiatric Publishing, Inc.; 2008.
32.
Berk M, Ng F, Dodd S, Callaly T, Campbell S, Bernardo M, et al. The validity of the CGI severity and improvement scales as measures of clinical effectiveness suitable for routine clinical use. J Eval Clin Pract. 2008;14(6):979–83.PubMedCrossRef
33.
WHO. International classification of functioning disability and health (ICF). Geneva: World Health Organization; 2001.
34.
35.
González J, Wiberg M. Applying test equating methods: using R. Cham, Switzerland: Springer; 2017.CrossRef
36.
Rowland JP, Yeeles K, Anderson C, Catalão R, Morley H, Molodynski A. Is it possible to measure social and occupational functioning in a CMHT? Progress in Neurology and Psychiatry. 2014;18(5):21–5.CrossRef
37.
Duff K. Evidence-based indicators of neuropsychological change in the individual patient: relevant concepts and methods. Arch Clin Neuropsychol. 2012;27(3):248–61.PubMedPubMedCentralCrossRef
38.
Evans C, Margison F, Barkham M. The contribution of reliable and clinically significant change methods to evidence-based mental health. Evidence Based Mental Health. 1998;1(3):70–2.CrossRef
39.
Schennach-Wolff R, Obermeier M, Seemüller F, Jäger M, Schmauss M, Laux G, et al. Does clinical judgment of baseline severity and changes in psychopathology depend on the patient population? J Clin Psychopharmacol. 2010;30(6):726–31.PubMedCrossRef
40.
Leucht S. Measurements of response, remission, and recovery in schizophrenia and examples for their clinical application. J Clin Psychiatry. 2014;75(Suppl 1):8–14.PubMedCrossRef
41.
Zimmerman M, Morgan TA, Stanton K. The severity of psychiatric disorders.\ World psychiatry : official journal of the World Psychiatric Association (WPA). 2018;17(3):258–75.PubMedCentralCrossRef
42.
Gift TE, Strauss JS, Harder DW. The severity of psychiatric disorder. Psychiatry Res. 1980;3(1):31–40.PubMedCrossRef
43.
Zimmerman M, Balling C, Chelminski I, Dalrymple K. Understanding the severity of depression: which symptoms of depression are the best indicators of depression severity? Compr Psychiatry. 2018;87:84–8.PubMedCrossRef
44.
Faravelli C, Servi P, Arends JA, Strik WK. Number of symptoms, quantification, and qualification of depression. Compr Psychiatry. 1996;37(5):307–15.PubMedCrossRef
45.
Garcia-Velazquez R, Jokela M, Rosenstrom TH. Symptom severity and disability in psychiatric disorders: the U.S. collaborative psychiatric epidemiology survey. J Affect Disord. 2017;222:204–10.PubMedCrossRef
46.
Leucht S, Engel RR, Davis JM, Kissling W, Meyer Zur Capellen K, Schmauss M, et al. Equipercentile linking of the brief psychiatric rating scale and the clinical global impression scale in a catchment area. European neuropsychopharmacology : the journal of the European College of Neuropsychopharmacology. 2012;22(7):501–5.CrossRef
47.
Leucht S, Kane JM, Kissling W, Hamann J, Etschel E, Engel R. Clinical implications of brief psychiatric rating scale scores. Br J Psychiatry. 2005;187:366–71.PubMedCrossRef
48.
Gross AL, Inouye SK, Rebok GW, Brandt J, Crane PK, Parisi JM, et al. Parallel but not equivalent: challenges and solutions for repeated assessment of cognition over time. J Clin Exp Neuropsychol. 2012;34(7):758–72.PubMedPubMedCentralCrossRef
49.
Wong A, Black SE, Yiu SYP, Au LWC, Lau AYL, Soo YOY, et al. Converting MMSE to MoCA and MoCA 5-minute protocol in an educationally heterogeneous sample with stroke or transient ischemic attack. International journal of geriatric psychiatry. 2018;33(5):729–34.PubMedCrossRef
50.
Wee HL, Yeo KK, Chong KJ, Khoo EYH, Cheung YB. Mean rank, Equipercentile, and regression mapping of World Health Organization quality of life brief (WHOQOL-BREF) to EuroQoL 5 dimensions 5 levels (EQ-5D-5L) utilities. Medical decision making : an international journal of the Society for Medical Decision Making. 2018;38(3):319–33.CrossRef
51.
Scheffels JF, Kraling H, Kalbe E, Kessler J. Conversions of cognitive screenings : mini-mental state examination vs. Montreal cognitive assessment vs. DemTect. Nervenarzt. 2018;89(12):1371–7.PubMedCrossRef
52.
Saczynski JS, Inouye SK, Guess J, Jones RN, Fong TG, Nemeth E, et al. The Montreal cognitive assessment: creating a crosswalk with the mini-mental state examination. J Am Geriatr Soc. 2015;63(11):2370–4.PubMedPubMedCentralCrossRef
53.
Leucht S, Fennema H, Engel R, Kaspers-Janssen M, Lepping P, Szegedi A. What does the HAMD mean? J Affect Disord. 2013;148(2–3):243–8.PubMedCrossRef
54.
Leucht S, Fennema H, Engel RR, Kaspers-Janssen M, Lepping P, Szegedi A. What does the MADRS mean? Equipercentile linking with the CGI using a company database of mirtazapine studies. J Affect Disord. 2017;210:287–93.PubMedCrossRef
55.
Wang PS, Aguilar-Gaxiola S, Alonso J, Angermeyer MC, Borges G, Bromet EJ, et al. Use of mental health services for anxiety, mood, and substance disorders in 17 countries in the WHO world mental health surveys. Lancet. 2007;370(9590):841–50.PubMedPubMedCentralCrossRef
Metadata
Title
Assessing the severity of functional impairment of psychiatric disorders: equipercentile linking the mini-ICF-APP and CGI
Authors
Stephan T. Egger
Godehard Weniger
Mario Müller
Julio Bobes
Erich Seifritz
Stefan Vetter
Publication date
01-12-2019
Publisher
BioMed Central
Published in
Health and Quality of Life Outcomes / Issue 1/2019
Electronic ISSN: 1477-7525
DOI
https://doi.org/10.1186/s12955-019-1235-5

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