Evaluating the Health of the Nation Outcome Scales - Reliability and validity in a three-year follow-up of first-onset psychosis

Background The HoNOS has been developed as a routine measure of outcomes in mental health. Aims To explore the validity and interrater reliability of HoNOS in a first onset psychosis follow-up study. Method Between 1992 and 1994 we ascertained a cohort of all persons with first-onset psychosis. We re-assessed these people at 3 years (n=166) with several outcome scales, including HoNOS. Patients' keyworkers also completed the HoNOS. We estimated concurrent validity by calculating correlations between HoNOS and other scales, and interrater reliability. Results Researcher HoNOS correlated highly with other scales (0.46 < rho < 0.86; P < 0.001). Keyworker HoNOS correlations were lower (0.41 < rho < 0.51 ; P < 0.05), but still significant for all scores except the HoNOS-social subscale (0.12 < rho < 0.28). Agreements between researcher and keyworker HoNOS were modest (0.47 < ICC < 0.85). Conclusions In this research cohort HoNOS correlates well with established outcome scales. Keyworker ratings show similar, but weaker, relationships; its use in routine settings may require further training for calibration of severity. Declaration of interest Supported by Trent National Health Service Executive.