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Rasch Validation and Cross-Validation of the Health of Nation Outcome Scales for Monitoring of Psychiatric Disability in Traumatized Refugees in Western Psychiatric Care

There are no validated measures of psychiatric disability for traumatized refugees in Western psychiatric care. This is a serious shortcoming as it precludes monitoring of global treatment outcomes in this group, as well as appropriate matching of treatment needs to the disability levels. Using Rasch analysis, we evaluated the psychometrics of the Health of Nation Outcome Scales (HoNOS) in pretreatment data of consecutive refugee patients (N = 448) from a Danish psychiatric clinic. Then, we carried out a cross-validation of the pretreatment HoNOS model on posttreatment data from the same group. A revised 10-item HoNOS fit the Rasch model at pretreatment and also showed excellent fit within the cross-validation data. Culture, gender, and need for translation did not exert serious bias on the measure’s performance. The results establish good monitoring properties of the 10-item HoNOS as the first validated measure of psychiatric disability for traumatized refugees in Western psychiatric care.