Validation of a brief mental health screening tool for common mental disorders in primary healthcare
Validation of a brief mental health screening tool for common mental disorders in primary healthcare
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DOI：
10.7196/samj.2019.v109i4.13664
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发表时间：
2019-04-01
期刊：
影响因子：
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通讯作者：
Petersen, I
中科院分区：
文献类型：
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作者：
Bhana, A;Mntambo, N;Petersen, I
背景将抑郁症、焦虑症和酗酒等常见精神障碍的护理纳入初级卫生保健应有助于减少南非的四重疾病负担。CMD损害了治疗依从性、健康行为改变和疾病的自我管理。在初级保健中，通过简单、易于管理的筛查可以促进对精神障碍的适当识别，从而提高特异性。建立一个七项简明心理健康（BMH）筛查工具评估初级保健患者CMD阳性症状的标准有效性。在南非夸祖鲁-纳塔尔省阿马朱巴区纽卡斯尔分区的10家诊所，从所有年龄≥ 18岁的患者中招募了1 214名参与者，为期2周。在使用BMH工具进行筛选之前，确认患者提供了基本的传记信息。初级保健护士对这一评估仍然一无所知。使用成人初级保健（APC）指南的PHC护士发起的评估是比较BMH工具性能的金标准。使用80%的特异性标准来建立临界点。特异性优于敏感性，以确保排除那些没有CMD症状的患者，并减少过度筛查。在参与者中，72%是女性。AUD-C（酗酒）表现良好（曲线下面积（AUC）0.91（95%置信区间（CI）0.88 - 0.95），临界点>= 4，Cronbach α 0.87）; PHQ-2（抑郁症）表现得相当好（AUC 0.72（95% CI 0.65 - 0.78），临界点>= 3，α 0.71）; GAD-2（焦虑）表现可接受（AUC 0.69（95% CI 0.58 - 0.80），临界点>= 3，α 0.62）。使用较高的截止分数，真正没有CMD症状的患者具有> 90%的阴性预测值（NPV）。总体而言，26%的患者有CMD阳性症状，而使用APC指南的患者为8%。使用更高的特异性指数，阳性预测值和NPV表明，在更高的临界点值，BMH不仅有助于识别酒精滥用，抑郁和焦虑症状的个体，而且还识别了大多数没有症状的人（真阴性），因此不会给护士带来需要评估的假阳性的负担。研究是必要的，以评估是否使用这样一个简短而有效的筛选工具是可推广到其他诊所的情况下，以及如何最好的心理健康筛查应引入到日常的诊所运作和实践。
Background. Integrating care for common mental disorders (CMDs) such as depression, anxiety and alcohol abuse into primary healthcare (PHC) should assist in reducing South Africa (SA)'s quadruple burden of disease. CMDs compromise treatment adherence, health behaviour change and self-management of illnesses. Appropriate identification of mental disorders in primary care can be facilitated by brief, easy-to-administer screening that promotes high specificity.Objectives. To establish the criterion-based validity of a seven-item Brief Mental Health (BMH) screening tool for assessing positive symptoms of CMDs in primary care patients.Methods. A total of 1 214 participants were recruited from all patients aged >= 18 years visiting 10 clinics as part of routine care in the Newcastle subdistrict of Amajuba District in KwaZulu-Natal Province, SA, over a period of 2 weeks. Consenting patients provided basic biographical information prior to screening with the BMH tool. PHC nurses remained blind to this assessment. PHC nurse-initiated assessment using the Adult Primary Care (APC) guidelines was the gold standard against which the performance of the BMH tool was compared. A specificity standard of 80% was used to establish cut-points. Specificity was favoured over sensitivity to ensure that those who did not have CMD symptoms were excluded, as well as to reduce over-referrals.Results. Of the participants, 72% were female. The AUD-C (alcohol abuse) performed well (area under the curve (AUC) 0.91 (95% confidence interval (CI) 0.88 -0.95), cut-point >= 4, Cronbach alpha 0.87); PHQ-2 (depression) performed reasonably well (AUC 0.72 (95% CI 0.65 -0.78), cut-point >= 3, alpha 0.71); and GAD-2 (anxiety) performance was acceptable (AUC 0.69 (95% CI 0.58 - 0.80), cut-point >= 3, alpha 0.62). Using the higher cut-off scores, patients who truly did not have CMD symptoms had negative predictive values (NPVs) of >90%. Overall, 26% of patients had CMD positive symptoms relative to 8% using the APC guidelines.Conclusions. Using a higher specificity index, the positive predictive value and NPV show that at higher cut-point values the BMH not only helps identify individuals with alcohol misuse, depression and anxiety symptoms but also identifies a majority of those who do not have symptoms (true negatives), thus not overburdening nurses with false positives needing assessment. Research is needed to assess whether use of such a short and valid screening tool is generalisable to other clinic contexts as well as how mental health screening should best be introduced into routine clinic functioning and practice.