The Reliable Change Index (RCI) of the WHO-5 in primary prevention of mental disorders. A measurement-based pilot study in positive psychiatry

Introduction: Primary prevention of mental disorders is a major issue in positive psychiatry. Adjustment disorder is one of the very few discrete mental disorders linked to an etiological factor, namely psychosocial stressors given rise to a maladaptive reaction with a course of symptoms vanishing with the removal of the stressor. We have focused on a measurement-based method to prevent the development of an adjustment disorder. Aim: The aim of this study has been to analyze from an ongoing Worklife Barometer Survey in which the World Health Organization Well-Being Scale (WHO-5) has been applied to prevent distress leading to an adjustment disorder. Methods: Persons identified with a decrease of 15 points in their repeatedly WHO-5 ratings over three months were through a brief psychological intervention by experienced psychologists. The Reliable Change Index (RCI) was used to determine the clinically meaningful change in the WHO-5 ratings. Results: Within the group who received the psychological intervention (N = 1338), 35% of the persons were identified by the RCI analysis to have developed a clinically reliable change in the WHO-5 at the time of the intervention. The remaining 65% of the persons obtained changes in the WHO-5 which might be considered as spontaneous fluctuations. In the month after the intervention, the persons with a clinically reliable change in the WHO-5 were restored. Conclusion: In this measurement-based pilot study, the repeatedly WHO-5 ratings identified a group of persons with a clinically reliable change in WHO-5 and a clinically significant improvement after a brief psychological intervention.