Abstract
BackgroundA computer assisted interview, the GMHAT/PC has been developed to assist General Practitioners and other Health Professionals to make a quick, convenient and comprehensive standardised mental health assessment. It has proved to be a reliable and valid tool in our previous studies involving General Practitioners and Nurses. Little is known about its use in cardiac rehabilitation settings.AimThe study aims to assess the feasibility of using a computer assisted diagnostic interview by nurses for patients attending Cardiac Rehabilitation Clinics and to examine the level of agreement between the GMHAT/PC diagnosis and a Psychiatrist clinical diagnosis. Prevalence of mental illness was also measured.DesignCross sectional validation and feasibility study.MethodsNurses using GMHAT/PC examined consecutive patients presenting to a cardiac rehabilitation centre. A total of 118 patients were assessed by nurses and consultant psychiatrist in cardiac rehabilitation centres. The kappa coefficient (κ), sensitivity, and specificity of the GMHAT/PC diagnosis were analysed as measures of validity. The time taken for the interview as well as feedback from patients and interviewers were indicators of feasibility. Data on prevalence of mental disorders in an outpatient cardiac rehabilitation setting was collected.ResultsThe mean duration of the interview was 14 minutes. Feedback from patients and interviewers indicated good practical feasibility. The agreement between GMHAT/PC interview-based diagnoses and consultant psychiatrists' ICD-10 criteria-based clinical diagnosis was good or excellent (κ = 0.76, sensitivity = 0.73, specificity = 0.90). The prevalence of mental disorders in this group was 22%, predominantly depression. Very few cases were on treatment.ConclusionGMHAT/PC can assist nurses in making accurate mental health assessments and diagnoses in a cardiac rehabilitation setting and is acceptable to cardiac patients. It can successfully be used to gather epidemiological data and help in managing mental health problems in this group of patients.
Highlights
A computer assisted interview, the Global Mental Health Assessment Tool (GMHAT)/PC has been developed to assist General Practitioners and other Health Professionals to make a quick, convenient and comprehensive standardised mental health assessment
Mental health problems are represented with three diagnoses amongst the ten leading causes of disability worldwide [1]
The twelve-month prevalence and odds of major depression are high in individuals with chronic medical conditions such as coronary artery disease and congestive heart failure, and major depression is associated with significant increases in utilisation of health services, lost productivity and functional disability [6]
Summary
A computer assisted interview, the GMHAT/PC has been developed to assist General Practitioners and other Health Professionals to make a quick, convenient and comprehensive standardised mental health assessment. Mental health problems are represented with three diagnoses (depression, schizophrenia and bipolar-affective disorder) amongst the ten leading causes of disability worldwide [1]. The prevalence of depression in cardiac diseases has been estimated at around 15% [2,3]. Though less well studied the prevalence of generalised anxiety disorder has been estimated in the range of 7 to 24% in cardiac outpatients [4,5]. There is a dearth of studies looking at a full range of psychiatric disorders in this patient group. The twelve-month prevalence and odds of major depression are high in individuals with chronic medical conditions such as coronary artery disease and congestive heart failure, and major depression is associated with significant increases in utilisation of health services, lost productivity and functional disability [6]. The National Service Framework for cardiac care in the UK recommends screening patients for psychological illnesses [7]
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