阶梯式精神和物质使用障碍管理的简要筛查工具。

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

机构信息

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).

出版信息

Psychiatr Serv. 2021 Aug 1;72(8):891-897. doi: 10.1176/appi.ps.202000504. Epub 2021 May 17.

DOI:10.1176/appi.ps.202000504

PMID:33993717

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8328865/

Abstract

OBJECTIVE

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.

METHODS

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).

RESULTS

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).

CONCLUSIONS

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.

摘要

目的

阶梯式精神卫生保健需要非专业人员快速识别疾病。本研究旨在开发和验证一种简短的工具，即心理健康工具（mwTool），用于识别和分类。

方法

横断面开发和验证样本包括莫桑比克六家卫生机构的成年人。迷你国际神经精神访谈诊断为标准。候选项目来自九种精神障碍和功能评估。回归模型和专家咨询确定了用于识别任何精神障碍并将阳性病例分类为障碍类别的最佳项目（严重精神障碍、常见精神障碍、物质使用障碍和自杀风险）。为了验证，计算了任何精神障碍（指数和代理应答者）和障碍类别（指数）的敏感性和特异性。

结果

从开发样本（911 名参与者，平均年龄±标准差为 32.0±11 岁，63%为女性）中，选择了 13 项，其中三项具有 0.83 的敏感性（95%置信区间[CI]为 0.79-0.86）用于任何精神障碍，以及 10 项其他项目将参与者分类为具有特异性范围为 0.72（严重精神障碍）至 0.90（自杀风险）。对于验证（453 名参与者，年龄 31±11 岁，65%为女性），任何精神障碍的敏感性为 0.94（95% CI=0.89-0.97），采用指数应答，0.73（95% CI=0.58-0.85）采用家庭代理应答。类别的特异性范围为 0.47（严重精神障碍）至 0.93（自杀风险）。删除一项可将严重精神障碍的特异性提高到 0.63（95% CI=0.58-0.68）。