Martin Michael S, Wamboldt Ashley D, O'Connor Shannon L, Fortier Julie, Simpson Alexander I F
Mental Health Branch, Correctional Service of Canada, Ottawa, Ontario, Canada.
Crim Behav Ment Health. 2013 Feb;23(1):6-17. doi: 10.1002/cbm.1853. Epub 2013 Jan 25.
There are high rates of mental disorder in correctional environments, so effective mental health screening is needed. Implementation of the computerised mental health screen of the Correctional Service of Canada has led to improved identification of offenders with mental health needs but with high rates of false positives.
The goal of this study is to evaluate the use of an iterative classification tree (ICT) approach to mental health screening compared with a simple binary approach using cut-off scores on screening tools.
A total of 504 consecutive admissions to federal prison completed the screen and were also interviewed by a mental health professional. Relationships between screening results and more extended assessment and clinical team discussion were tested.
The ICT was more parsimonious in identifying probable 'cases' than standard binary screening. ICT was also highly accurate at detecting mental health needs (AUC=0.87, 95% CI 0.84-0.90). The model identified 118 (23.4%) offenders as likely to need further assessment or treatment, 87% of whom were confirmed cases at clinical interview. Of the 244 (48.4%) offenders who were screened out, only 9% were clinically assessed as requiring further assessment or treatment. Standard binary screening was characterised by more false positives and a comparable false negative rate.
The use of ICTs to interpret screening data on the mental health of prisoners needs further evaluation in independent samples in Canada and elsewhere. This first evaluation of the application of such an approach offers the prospect of more effective and efficient use of the scarce resource of mental health services in prisons. Although not required, the use of computers can increase the ease of implementing an ICT model.
惩教机构中精神障碍的发生率很高，因此需要有效的心理健康筛查。加拿大惩教服务局实施的计算机化心理健康筛查已使对有心理健康需求的罪犯的识别有所改善，但假阳性率很高。
本研究的目的是评估与使用筛查工具的临界值的简单二元方法相比，迭代分类树（ICT）方法在心理健康筛查中的应用。
共有504名连续入住联邦监狱的人员完成了筛查，并接受了心理健康专业人员的访谈。测试了筛查结果与更广泛评估及临床团队讨论之间的关系。
与标准二元筛查相比，ICT在识别可能的“病例”方面更为简洁。ICT在检测心理健康需求方面也非常准确（AUC = 0.87，95%CI 0.84 - 0.90）。该模型识别出118名（23.4%）罪犯可能需要进一步评估或治疗，其中87%在临床访谈中被确认为病例。在被筛查排除的244名（48.4%）罪犯中，只有9%在临床评估中被认为需要进一步评估或治疗。标准二元筛查的特点是假阳性更多，假阴性率相当。
在加拿大和其他地方的独立样本中，使用ICT解释囚犯心理健康筛查数据需要进一步评估。对这种方法应用的首次评估为更有效和高效地利用监狱中稀缺心理健康服务资源提供了前景。虽然不是必需的，但使用计算机可以增加实施ICT模型的便利性。
