Brief Screening Tool for Stepped-Care Management of Mental and Substance Use Disorders.

Journal: Psychiatric services (Washington, D.C.)

Volume: 72

Issue: 8

Year of Publication: 2021

Affiliated Institutions:  Department of Psychiatry, New York State Psychiatric Institute and Columbia University Vagelos College of Physicians and Surgeons, New York City (Lovero, Basaraba, Greene, Fiks Salem, Mootz, Duarte, Wall, Wainberg); Department of Biostatistics, Columbia University Mailman School of Public Health, New York City (Basaraba, Wall); Health Directorate of Maputo City, Ministry of Health, Maputo, Mozambique (Khan, Mabunda); Universidade Eduardo Mondlane School of Medicine, Maputo, Mozambique (Khan, Mabunda, dos Santos, Fumo, Mandlate, Mocumbi, Gouveia); Health Directorate of Nampula Province, Ministry of Health, Nampula, Mozambique (Suleman, Feliciano); Nampula Psychiatric Hospital, Nampula, Mozambique (Suleman, Feliciano); Department of Mental Health, Ministry of Health, Maputo, Mozambique (dos Santos, Fumo, Mandlate, Gouveia); National Institutes of Health, Marracuene, Mozambique (Mocumbi); Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia (Oquendo).

Abstract summary 

Stepped mental health care requires a rapid method for nonspecialists to detect illness. This study aimed to develop and validate a brief instrument, the Mental Wellness Tool (mwTool), for identification and classification.Cross-sectional development and validation samples included adults at six health facilities in Mozambique. Mini International Neuropsychiatric Interview diagnoses were the criterion standard. Candidate items were from nine mental disorder and functioning assessments. Regression modeling and expert consultation determined best items for identifying any mental disorder and classifying positives into disorder categories (severe mental disorder, common mental disorder, substance use disorder, and suicide risk). For validation, sensitivity and specificity were calculated for any mental disorder (index and proxy respondents) and disorder categories (index).From the development sample (911 participants, mean±SD age=32.0±11 years, 63% female), 13 items were selected-three with 0.83 sensitivity (95% confidence interval [CI]=0.79-0.86) for any mental disorder and 10 additional items classifying participants with a specificity that ranged from 0.72 (severe mental disorder) to 0.90 (suicide risk). For validation (453 participants, age 31±11 years, 65% female), sensitivity for any mental disorder was 0.94 (95% CI=0.89-0.97) with index responses and 0.73 (95% CI=0.58-0.85) with family proxy responses. Specificity for categories ranged from 0.47 (severe mental disorder) to 0.93 (suicide risk). Removing one item increased severe mental disorder specificity to 0.63 (95% CI=0.58-0.68).The mwTool performed well for identification of any mental disorder with index and proxy responses to three items and for classification into treatment categories with index responses to nine additional items.

Authors & Co-authors:  Lovero Kathryn L KL Basaraba Cale C Khan Saida S Suleman Antonio A Mabunda Dirceu D Feliciano Paulino P Dos Santos Palmira P Fumo Wilza W Mandlate Flavio F Greene M Claire MC Fiks Salem Andre A Mootz Jennifer J JJ Mocumbi Ana Olga AO Duarte Cristiane S CS Gouveia Lidia L Oquendo Maria A MA Wall Melanie M MM Wainberg Milton L ML

Study Outcome 

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Statistics
Citations :  Whiteford HA, Degenhardt L, Rehm J, et al. Global burden of disease attributable to mental and substance use disorders: findings from the Global Burden of Disease Study 2010. Lancet. 2013;382(9904):1575–1586.
Authors :  18
Identifiers
Doi : 10.1176/appi.ps.202000504
SSN : 1557-9700
Study Population
Male,Female
Mesh Terms
Adult
Other Terms
Diagnosis/classification (DSM);Stepped care;low-resource;screening;task-shifting
Study Design
Study Approach
Country of Study
Mozambique
Publication Country
United States