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PARADISE24fin assessment tool to measure psychosocial difficulties

PARADISE24 is a research-based general tool for assessing the intensity and scope of common psychosocial difficulties.

The PARADISE24fin questionnaire includes the 24 original questions on psychosocial difficulties with five response options, instructions for self-assessment and an additional column to mark desired areas of change to enhance the usefulness of the tool in clinical practise. The questionnaire is freely available for use.

Link to the questionnaire in English: PARADISE24fin in English (pdf)     
Link to the questionnaire and instructions in Finnish: PARADISE24fin in Finnish (pdf) and https://terveysportti.fi/dtk/tmi/koti

You can also test your own situation and receive feedback here (AddictionLink).

We try to list all peer-reviewed publications about this instrument. If you notice that something is missing or you have another translation of the questionnaire, please send an email to tuuli.pitkanen @ a-klinikka.fi

Twitter @PARADISE24fin


Levola, J., Aranko, A. & Pitkänen, T. (2021). Psychosocial difficulties and treatment retention in inpatient detoxification programmes. Nordisk alkohol- & narkotikatidskrift : NAT, 38(5), 434-449. https://doi.org/10.1177/14550725211021263

Pitkänen, T., Levola, J. M., de la Fuente, J. & Cabello, M. (2020). Identifying psychosocial difficulties of inpatients with substance use disorders: Evaluation of the usefulness of the PARADISE24 for clinical practise. Disability and rehabilitation, 42(1), 130-136. https://doi.org/10.1080/09638288.2018.1493543

Cabello, M., de la Fuente, J., Ayuso Mateos JL & Pitkänen, T. (2019). Longitudinal properties of the PARADISE24fin questionnaire in treatment of substance use disorders. Addictive Behaviors 95 (2019) 125-128 https://doi.org/10.1016/j.addbeh.2019.03.009

Pitkänen, T., Levola, J., de la Fuente, J. & Cabello, M. (2018). Identifying psychosocial difficulties of inpatients with substance use disorders: evaluation of the usefulness of the PARADISE24 for clinical practise. Disability and Rehabilitation. Published online 5.9.2018.

de la Fuente, J., Cabello, M., Levola, J., Caballero FF., Ayuso-Mateos, JL. & Pitkänen, T (2018). Validity of the PARADISE24 questionnaire in people with substance use disorders: A measure to assess psychosocial difficulties. Drug and Alcohol Dependence 187:66-71. 

Heinonen, M & Pitkänen, T. (2017). Substance use and psychosocial functioning of patients in opioid substitution treatment. In Finnish. Tietopuu Tutkimussarja 3/2017: 1-16. Summary in English page 16 (pdf)

Twomey, C., Cieza, A. & Baldwin, D.S. (2017). Utility of functioning in predicting costs of care for patients with mood and anxiety disorders: a prospective cohort study. Int Clin Psychopharmacol. 

Schiavolin, S., Raggi, A., Quintas, R., Cerniauskaite, M., Giovannetti, A. M., Covelli, V., Romito, L., Elia, A. E., Carella, F., Soliveri, P. & Leonardi, M. (2017): Psychosocial difficulties in patients with Parkinson’s disease. International Journal of Rehabilitation Research 40 (2): 112–118.

Quintas, R., Cerniauskaite, M., Giovannetti, A. M., Schiavolin, S., Raggi, A., Covelli, V., Villani, F., Didato, G., Deleo, F., Franceschetti, S., Binelli, S., Canafoglia, L., Casazza, M. & Leonardi, M. (2016): PARADISE 24 instrument: An observational study on psychosocial difficulties, quality of life, and disability levels in patients with epilepsy. Epilepsy and Behavior. Vol. 64(A): 160–165. 

Raggi, A., Covelli, V., Schiavolin, S., Giovannetti, A. M., Cerniauskaite, M., Quintas, R., Leonardi, M., Sabariego, C., Grazzi, L.& D’Amico, D. (2016): Psychosocial difficulties in patients with episodic migraine: a cross-sectional study, Neurological Sciences: Official Journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology 37 (12): 1979-1986.  

Giovannetti, A.M., Schiavolin, S., Raggi, A., Quintas, R., Cerniauskaite, M., Confalonieri, P., Mantegazza, R., Torri Clerici, V., Antozzi, C., Brenna, G. & Leonardi, M. (2016): Psychosocial difficulties of individuals with multiple sclerosis. International Journal of Rehabilitation Research 39 (4): 339-345.

Publications about the creation of the instrument

Cieza A, Anczewska M, Ayuso-Mateos, JL, Baker M, Bickenbach J, Chatterji S, Hartley S, Leonardi M, Pitkänen T, and the PARADISE Consortium (2015) Understanding the impact of brain disorders: towards a ‘horizontal epidemiology’ of psychosocial difficulties and their determinants. PloS ONE.  

Cieza A, Sabariego C, Anczewska, M, Ballert C, Bickenbach J, Cabello M, Giovannetti A, Kaskela T, Leonardi M, Mellor B, Pitkänen T, Raggi A, Świtaj P, Chatterji S and the PARADISE Consortium (2015). PARADISE 24: a measure to assess the impact of brain disorders on people’s lives based on the hypothesis of ‘horizontal epidemiology’. PloS ONE

Pitkänen T, Levola J, Tourunen J, Kaskela T, Holopainen A (2016). Common psychosocial difficulties among brain disorders: the research bases for PARADISE24 questionnaire. In Finnish. Report series of The Social Insurance Institution of Finland, 143: Abstract and Summary (p.142-146) in English (pdf)

PARADISE-project 2010 - 2013

The selection of the 24 questions concerning common psychosocial difficulties was made in the EU-funded project Psychosocial Factors Relevant to Brain Disorders in Europe (PARADISE) led by Dr. Alarcos Cieza in 2010 - 2013. Systematic literature reviews, focus groups and personal interviews were conducted for nine disorders. The project covered dementia, depression, epilepsy, migraines, multiple sclerosis, Parkinson’s disease, schizophrenia, stroke, and substance dependency. Psychosocial difficulties were classified and linked to the International Classification of Functioning, Disability and Health (ICF). The aim was to identify common psychosocial difficulties and to create a general instrument that can be used in the treatment and study of several disorders.

Results of the PARADISE project doubtless support the horizontal epidemiology hypothesis so that an important impact in clinical practice, research and policy making are expected and encouraged. Consequences and needed implementation actions for clinicians, researchers and policy makers have been specifically formulated and worked out in the light of each of the five PARADISE recommendations (pdf).

The major dissemination activity of the PARADISE project was its successful Final Stakeholder Conference held in Brussels on February 20th, 2013, in which the PARADISE consortium presented and discussed the five PARADISE Recommendations and the PARADISE 24 protocol, to major European players in brain disorder research and policy development, the European Commission, WHO, and the European Brain Council, as well as to prominent researchers and other stakeholders.

Final report summary. 
Results in brief.

Other peer-reviewed publications in connection to the PARADISE project

Kamenov, K, Cabello, M, Caballeri, FF, Cieza, A, Sabariego, C, Anczewska, M, Pitkänen, T, Raggi, A, Ayuso-Mateos, JL. (2016) Factors related to social support in neurological and mental disordersPLoS ONE.

Coenen M, Cabello M, Umlauf S, Ayuso-Mateos JL, Anczewska M, Tourunen J, Leonardi M, Cieza A & PARADISE Consortium (2016): Psychosocial difficulties from the perspective of persons with neuropsychiatric disorders, Disability and Rehabilitation, 38(12):1134-45.

Sabariego, C., Coenen, M., Ballert, C., Cabello, M., Leonardi, M., Anczewska, M., Pitkänen, T., Raggi, A., Mellor, B., Covelli, V., Świtaj, P., Levola, J., Schiavolin, S., Chrostek, A., Bickenbach, J., Chatterji, S., Cieza, A. (2015) Determinants of psychosocial difficulties experienced by persons with brain disorders: towards a ‘horizontal epidemiology’ approach. PloS ONE. 

Hartley, S, McArthur, M, Coenen, M, Cabello, M, Covelli, V, Roszczynska-Michta, J, Pitkänen, T Bickenbach; J. & Cieza, A. (2014). Narratives reflecting the lived experiences of people with brain disorders: common psychosocial difficulties and determinants. PloS ONE. 

Levola, J., Aalto, M., Holopainen, A., Cieza, A. & Pitkänen, T. (2014). Health-related quality of life in alcohol dependence: A systematic literature review with a specific focus on the role of depression and other psychopathology. Nordic Journal of Psychiatry 2014:68(6): 369–384.

Levola, J., Holopainen, A., Kaskela, T., Sabariego, C., Tourunen, J., Cieza, A. & Pitkänen, T. (2014). Psychosocial difficulties in alcohol dependence: a systematic review of activity limitations and participation restrictions. Disability and Rehabilitation 2014;36(15):1227-39.

Cabello, M., Mellor-Marsa, B., Sabariego, C., Cieza, A., Bickenbach, J..and Ayuso-Mateos, J.L. (2012). Psychosocial features of depression: a systematic literature review. J Affect Disord 141(1): 22-33.

Quintas, R., Raggi, A., Giovannetti,A.M., Pagani, M., Sabariego, C., Cieza, A. and Leonardi, M. (2012). Psychosocial difficulties in people with epilepsy: a systematic review of literature from 2005 until 2010Epilepsy Behav 25(1): 60-67.

Raggi, A., Giovannetti, A.M., Quintas, R., D'Amico, D., Cieza, A., Sabariego, C., Bickenbach, J.E. and Leonardi, M. (2012). A systematic review of the psychosocial difficulties relevant to patients with migraineJ Headache Pain .

Switaj, P., Anczewska, M., Chrostek, A., Sabariego, C., Cieza, A., Bickenbach, J. and Chatterji, S. (2012). Disability and schizophrenia: a systematic review of experienced psychosocial difficulties. BMC Psychiatry.

The work continues

The A-Clinic Foundation, a large Finnish NGO in the field of addictions, has actively furthered the work of the consortium in co-operation with researchers at Universidad Autonoma de Madrid (UAM) and with support from the leader of the consortium. Since 2014, A-Clinic Ltd has used PARADISE24fin in treatment and provided data for investigating properties and usability of the instrument. Close co-operation has been helpful when creating technical and practical solutions.

The PARADISE24 has provided a solution for a need to assess and make visible changes in psychosocial well-being. We have succeeded in promoting the use of the PARADISE24 instrument in treatment and in activities of NGOs and advanced the use of the results in clinical work as well as in planning and evaluating interventions, and in decision and policy making. Currently, the PARADISE24fin questionnaire is widely used. Several organizations have utilized the results for making psychosocial burden and effectiveness of their work visible for decision makers.

More information in Finnish