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Health of the nation outcome scales for psychiatry: Are they valid?

The study investigates the performance of the recently developed Health of the Nation Outcome Scales (HoNOS) by validating scores against three other well-validated instruments for assessing psychiatric symptoms and social functioning. A consecutive sample of 100 admissions to an acute psychiatric ward were assessed at admission and discharge. Scores on the HoNOS were compared to those on the Brief Psychiatric Rating Scale, Symptom Checklist 90-Revised and the Social Adjustment Scale. Only half the correlations between HoNOS scales and the psychometric measures were significant and these were not particularly high (range 0.21-0.55 for significant correlations). Overall HoNOS scores were relatively low despite the high level of morbidity in the sample. This study casts doubt on the validity of the HoNOS. Modifications to the scales are needed with clearer anchoring definitions for the scale points and a specified training programme to ensure accurate use. Further studies of validity are required.