Dr. Per Bech is Professor of Psychiatry and director of Psychiatric Research Unit Mental Health Centre North Zealand, University of Copenhagen. Working psychometrically for four decades he is undoubtedly one of the most important psychometricians in action.
In his short and easy-to-read book, he summarises his 40-year-work with SCL-90, HAM-A, HAM-D, and BPRS, side-effect scales and quality of life.
Professor Bech has many original contributions in Psychiatry. One of them was the introduction of Rasch parametric item response model in clinical Psychiatry initially in a demonstration of the scalability of personality items in 1978; 3 years later he used Rasch analysis to propose the six items Hamilton Depression Scale, probably one of the most synthetic and psychometrically robust scales for evaluating depressive symptoms.
Professor Bech proposes a friendly and clinically relevant rationale of measured-based care: the pharmacopsychometric triangle. In this model the first vertex represents the clinical effect, the second represents the side effects of medications and the third, the well-being vertex. For each vertex, he proposed short scales developed through items banks using Rasch analysis.
The book Measurement-Based Care in Mental Disorders is composed of 10 chapters.
In chapter 1, Professor Bech discusses ‘Negative Mental Health’ reinforcing the importance of severity scales for measurement-based care and also the importance of small scales with selected good items to evaluate the whole span of psychopathological dimensions. In chapter 2, the same rationale was applied for personality dimensions using the 90 items of Eysenck Personality subscales as an item bank for personality traits. In chapter 3, the Hopkins Symptom Checklist (SCL-90) was considered an item bank for patient-reported outcomes measurement concerning interpersonal sensitivity, neurasthenia, anxiety, depression, hostility, and psychoticism. In chapter 4, Professor Bech proposed that if we take the items of the three more popular clinical scales in psychiatry (HAM-A, HAM-D, and BPRS) as an item bank we can also extract the core items organising them as clinician-administered symptom-orientated scales. In chapter 5 the same rational was used for positive mental health contrasting with the first four chapters based on negative mental health. The development of the WHO-5 was described. Chapter 6 is one of the most synthetic and brilliant chapters when the pharmacopsychometric triangle is explained. In chapter 7, Diagnostic rating scales, Professor Bech made an attempt to integrate quantitative aspects of rating scales with qualitative aspects of the diagnostic process, associating for example ICD-10 depression and the SCL-90 scales. Chapter 8 is centered in Social Functioning and Disability. Chapters 9 and 10 are closing chapters where Professor Bech explicitly states the importance of measurement-based care not only for research purposes but for clinical management: ‘easy-to-use scales collected for measurement-based care has been retrospectively tested in research trials, but over the past few decades, they have been recommended for use in practical evaluation plans’.
Short and sensible instruments for measurement-based care is a very good strategy of optimising the time spent during an interview with a patient. With shorter instruments, clinicians would be able to both spend more time with an empathic human contact and also measure the care provided.
Professor Bech’ s new book is a gift for both researchers and clinicians.
