The subscale structure and clinical utility of the Health of the Nation Outcome Scale

Abstract

Background: The Health of the Nation Outcome Scale (HoNOS) has been adopted with enthusiasm by service providers and clinicians, but criticism regarding the appropriate factor structure has emerged.Aims: The current study aimed to determine an appropriate factor structure that is both psychometrically sound and clinically meaningful.Method: HoNOS data for 6475 inpatients at admission and 6308 at discharge from an Australian psychiatric clinic were assessed in two studies.Results: The results of confirmatory factor analyses support the use of a new four factor model that includes anti-social, physical and psychological impairment, symptom, and socio-economic factors. The four factor structure demonstrated greater sensitivity to change than alternatives and factorial stability. In addition, the model is both parsimonious and clinically useful.Conclusions: When administering the HoNOS for patients with mood and/or anxiety disorders, it appears the new four factor model is an appropriate means of interpreting scores.