12 - The time dimension: the outcome phase  pp. 141-152

The time dimension: the outcome phase

By Graham Thornicroft and Michele Tansella

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Defining the outcome phase

Outcome is defined in the Concise Oxford Dictionary as ‘a result, a visible effect’. In this sense an outcome is the final step of the sequence: inputs, processes and outcomes. In healthcare, outcomes are generally considered to be changes in functioning, in morbidity or in mortality [1]. As with inputs and processes, outcomes can be considered at the three levels of the matrix model (seeTables 12.1 and 12.2).

Process measures, or even input measures, are often used as if they are outcomes. This is not only because of confused definitions, but also because our ability to define and measure outcomes in mental health care is not yet well developed. Nevertheless, in the final section of this chapter we shall summarise recent advances in outcome assessment.

Outcomes at the country/regional level

In epidemiology, the classic outcome measures at the population level are mortality and morbidity. Recent work assessing the national and international impact of mental disorders has used a set of standard ‘currencies’, namely disability adjusted life years (DALY), which refers both to mortality and years lived with disability (YLD) [2;3].Table 12.3 shows that when disability outcomes are considered separately from mortality, for young adults worldwide, 7 of the top 20 causes of disability are psychiatric disorders, and the conditions causing greatest disability are unipolar depressive disorder, alcohol-use disorders and schizophrenia.

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