Assessment Of Common Mental Disorders Research Articles

Assessment of Common Mental Disorders in Patients with Alcohol use Disorder

Alcohol use disorder (AUD) is a pattern of alcohol use that involves problems like controlling drinking, being preoccupied with alcohol, continuing to use alcohol even when it causes problems, urge to drink more to get the same effect and having withdrawal symptoms when discontinued abruptly. According to the World Health Organization (WHO), there are approximately two billion alcoholic beverage consumers and 76.3 million people worldwide with diagnosable alcohol-use disorders. Co-occurrence of alcohol use disorders with common mental disorders, such as depression, anxiety, stress and bipolar disorder, is relatively common. Individuals with alcohol-related problems can be more vulnerable to develop mental health disorders and vice versa which is a significant public health concern globally. The purpose of this study was to evaluate AUD as the primary disorder, in which people start drinking alcohol as a social habit and progress to chronic alcoholism, which can lead to the development of common mental disorders (CMD) such as depression, anxiety, and stress. The study was carried in ESIC hospital's inpatient general medicine department in Bengaluru. A self-designed data collection form and validated questionnaires were used to collect data for an educational observational study involving 87 patients. According to the study, 74.7% of 87 AUD patients had minimal anxiety, 72.41% had mild depression, and 59.7% had mild stress. The majority of the AUD population was low-income, illiterate, and self-employed. This study contributes to a better understanding of the relationship between Alcohol Use Disorder (AUD) and Common Mental Disorders (CMD) in relation to patients' socio-demographics which can aid in the early detection of individuals at risk, design targeted interventions, and the implementation of preventive measures to address the co-occurrence of these disorders eventually leading to improved public health outcomes.

Inequalities in Psychiatric Morbidity in Hong Kong and Strategies for Mitigation.

This study explores the social gradient of psychiatric morbidity. The Hong Kong Mental Morbidity Survey (HKMMS), consisting of 5719 Chinese adults aged 16 to 75 years, was used. The Chinese version of the Revised Clinical Interview Schedule (CIS-R) was employed for psychiatric assessment of common mental disorders (CMD). People with a less advantaged socioeconomic position (lower education, lower household income, unemployment, small living area and public rental housing) had a higher prevalence of depression and anxiety disorder. People with lower incomes had worse physical health (OR 2.01, 95% CI 1.05–3.82) and greater odds of having CMD in the presence of a family history of psychiatric illnesses (OR 1.67, 95% CI 1.18–2.36). Unemployment also had a greater impact for those in lower-income groups (OR 2.67; 95% CI 1.85–3.85), whereas no significant association was observed in high-income groups (OR 0.56; 95% CI 0.14–2.17). Mitigating strategies in terms of services and social support should target socially disadvantaged groups with a high risk of psychiatric morbidity. Such strategies include collaboration among government, civil society and business sectors in harnessing community resources.

Community Mental Health Nurses’ Perspective on the Assessment of Common Mental Disorders in Primary Mental Healthcare – A Qualitative Study in Ghana

Community Mental Health Nurses’ Perspective on the Assessment of Common Mental Disorders in Primary Mental Healthcare – A Qualitative Study in Ghana

Preconsult interactive computer-assisted client assessment survey for common mental disorders in a community health centre: a randomized controlled trial.

Access disparities for mental health care exist for vulnerable ethnocultural and immigrant groups. Community health centres that serve these groups could be supported further by interactive, computer-based, self-assessments. An interactive computer-assisted client assessment survey (iCCAS) tool was developed for preconsult assessment of common mental disorders (using the Patient Health Questionnaire [PHQ-9], Generalized Anxiety Disorder 7-item [GAD-7] scale, Primary Care Post-traumatic Stress Disorder [PTSD-PC] screen and CAGE [concern/cut-down, anger, guilt and eye-opener] questionnaire), with point-of-care reports. The pilot randomized controlled trial recruited adult patients, fluent in English or Spanish, who were seeing a physician or nurse practitioner at the partnering community health centre in Toronto. Randomization into iCCAS or usual care was computer generated, and allocation was concealed in sequentially numbered, opaque envelopes that were opened after consent. The objectives were to examine the interventions' efficacy in improving mental health discussion (primary) and symptom detection (secondary). Data were collected by exit survey and chart review. Of the 1248 patients assessed, 190 were eligible for participation. Of these, 148 were randomly assigned (response rate 78%). The iCCAS (n = 75) and usual care (n = 72) groups were similar in sociodemographics; 98% were immigrants, and 68% were women. Mental health discussion occurred for 58.7% of patients in the iCCAS group and 40.3% in the usual care group (p ≤ 0.05). The effect remained significant while controlling for potential covariates (language, sex, education, employment) in generalized linear mixed model (GLMM; adjusted odds ratio [OR] 2.2; 95% confidence interval [CI] 1.1-4.5). Mental health symptom detection occurred for 38.7% of patients in the iCCAS group and 27.8% in the usual care group (p > 0.05). The effect was not significant beyond potential covariates in GLMM (adjusted OR 1.9; 95% CI 0.9-4.1). The studied intervention holds potential for community health centres to improve mental health discussion. Further research with larger samples should examine the impact on detection and enhance generalizability. Trial registration: ClinicalTrials.gov, no: NCT02023957, registered on Dec. 12, 2013.

Probable Post Traumatic Stress Disorder in Kenya and Its Associated Risk Factors: A Cross-Sectional Household Survey.

This study aimed to assess the prevalence of probable post-traumatic stress disorder (PTSD), and its associated risk factors in a general household population in Kenya. Data were drawn from a cross-sectional household survey of mental disorders and their associated risk factors. The participants received a structured epidemiological assessment of common mental disorders, and symptoms of PTSD, accompanied by additional sections on socio-demographic data, life events, social networks, social supports, disability/activities of daily living, quality of life, use of health services, and service use. The study found that 48% had experienced a severe trauma, and an overall prevalence rate of 10.6% of probable PTSD, defined as a score of six or more on the trauma screening questionnaire (TSQ). The conditional probability of PTSD was 0.26. Risk factors include being female, single, self-employed, having experienced recent life events, having a common mental disorder (CMD)and living in an institution before age 16. The study indicates that probable PTSD is prevalent in this rural area of Kenya. The findings are relevant for the training of front line health workers, their support and supervision, for health management information systems, and for mental health promotion in state boarding schools.

Medically unexplained and explained physical symptoms in the general population: association with prevalent and incident mental disorders.

BackgroundClinical studies have shown that Medically Unexplained Symptoms (MUS) are related to common mental disorders. It is unknown how often common mental disorders occur in subjects who have explained physical symptoms (PHY), MUS or both, in the general population, what the incidence rates are, and whether there is a difference between PHY and MUS in this respect.AimTo study the prevalence and incidence rates of mood, anxiety and substance use disorders in groups with PHY, MUS and combined MUS and PHY compared to a no-symptoms reference group in the general population.MethodData were derived from the Netherlands Mental Health Survey and Incidence Study-2 (NEMESIS-2), a nationally representative face-to-face survey of the general population aged 18-64 years. We selected subjects with explained physical symptoms only (n=1952), with MUS only (n=177), with both MUS and PHY (n=209), and a reference group with no physical symptoms (n=4168). The assessment of common mental disorders was through the Composite International Diagnostic Interview 3.0. Multivariate logistic regression analyses were used to examine the association between group membership and the prevalence and first-incidence rates of comorbid mental disorders, adjusted for socio-demographic characteristics.ResultsMUS were associated with the highest prevalence rates of mood and anxiety disorders, and combined MUS and PHY with the highest prevalence rates of substance disorder. Combined MUS and PHY were associated with a higher incidence rate of mood disorder only (OR 2.9 (95%CI:1.27,6.74)).ConclusionIn the general population, PHY, MUS and the combination of both are related to mood and anxiety disorder, but odds are highest for combined MUS and PHY in relation to substance use disorder. Combined MUS and PHY are related to a greater incidence of mood disorder. These findings warrant further research into possibilities to improve recognition and early intervention in subjects with combined MUS and PHY.

Gender invariance of the Self-Reporting Questionnaire (SRQ-20)

The World Health Organization 20-item Self-Reporting Questionnaire is a quick, low-cost screening instrument for measuring common mental disorders and has been applied in community-based health surveys in developing countries. It was originally designed as a general single factor tool for assessing mental distress associated with several common mental disorders. However, studies have also examined alternate multi-factor solutions for the Self-Reporting Questionnaire–20 across diverse study populations. A cross-sectional household survey was conducted in August and September 2009 among adults living in five urban communities in Johannesburg, South Africa ( n = 360). The Self-Reporting Questionnaire–20 was used to assess common mental disorders in the past month. Confirmatory factor analysis was applied to compare three competing models (one-, two-, and three-factor models). All three models fit the data well. Gender invariance was tested on the one-factor model based on its extensive application in clinical and research settings. Our findings did not support gender invariance. The differences in factor loadings between male and female subgroups suggest that the application of the Self-Reporting Questionnaire–20 may be more suited to women and therefore should be used cautiously for the assessment of common mental disorders in South Africa urban populations.

Validation of clinical symptom IRT scores for diagnosis and severity assessment of common mental disorders.

We studied the validity and responsiveness of an item response theory (IRT) scoring method for assessing major depressive episode (MDE) and generalized anxiety disorder (GAD) severity based on direct assessment of DSM-IV-TR symptoms. Prospective cohort study (baseline, 1-month, 3-months assessments) of patients seeking help for incident or aggravated mood or anxiety symptoms from primary, outpatient and inpatient mental health centers (N = 244; 67.81 % active cases - 100 % under psychiatric treatment). The drop-out rate at 3 months was 24.89 %. Patients were assessed at each follow-up for presence/absence of DSM-IV symptoms of MDE (nine symptoms) and GAD (eight symptoms). IRT scores for depression (INS-D) and anxiety (INS-G), based on response patterns, were obtained by means of a 2-parameter model. Diagnostic accuracy was assessed with receiver operating characteristic analysis, using a blinded MINI interview as gold standard. Scores' construct validity was compared with external clinician-administered (Hamilton Depression Rating Scale, HRSD; Hamilton Anxiety Rating Scale, HAM-A) and self-reported severity measures (PHQ-9; Beck Anxiety Inventory-Subjective Aspects, BAI-Sub). Responsiveness was analyzed based on the evolution of HRSD and HAM-A scores. Both severity scores showed excellent reliability (INS-D: 0.92; INS-G: 0.93) and yielded high diagnostic accuracy (INS-D: AUC = 0.96; INS-G: AUC = 0.91) with respect to MINI diagnoses. INS-D and INS-G had higher correlations with clinician-administered measures of the same disorder (INS-D-HRSD: 0.73; INS-G-HAM-A: 0.53) than with self-reported measures (INS-D-PHQ-9: 0.69; INS-G-BAI-Sub: 0.49). Patients who recovered during follow-up showed important decreases in severity (Cohen's d INS-D:-1.38; INS-G: -1.75). About 90 % variance of INS-D and INS-G score changes over time was associated with changes in clinical status. INS-D and INS-G are short reliable, valid, and responsive measures that can be used for diagnostic and severity assessment of mood and anxiety disorders in outpatient care.

Validity of the self reporting questionnaire-20 in epidemiological studies with older adults

This study examined the validity of the self-reporting questionnaire (SRQ-20) in a population-based survey with older adults in Sao Paulo, Brazil. The study sample consisted of 2,008 individuals aged 65 years or more who were living in an economically disadvantaged area of the city. The geriatric mental state (GMS) was used as the gold standard for the assessment of common mental disorders (CMD). The optimal SRQ-20 threshold for case definition was 4/5 (sensitivity = 76.1%, specificity = 74.6%, area under ROC curve = 0.82). Women, older participants and those with lower income were more likely to be misclassified by the questionnaire. The inclusion of older persons with dementia or psychosis did not change the ability of the SRQ-20 to identify cases of CMD. The SRQ-20 may be a useful instrument to be used in large epidemiological studies in resource-poor settings for the identification of cases of depression and anxiety in later life. The performance of the SRQ-20 among older adults was similar to that observed with the adult population in Brazil.

Assessing Explanatory Models for Common Mental Disorders

This article addresses the clinical implications of 3 questions: (1) Can a simple checklist, suitable for use by practitioners, assess all components of explanatory models (EMs) for mental distress? (2) Are perceived causes of mental distress actually related to treatment preferences? (3) Are EMs influenced uniquely by ethnic group, or are they more closely associated with the presence of common mental disorders? From February 2003 to January 2004, we investigated EMs for mental distress among 79 Bangladeshi, 85 black Caribbean, and 97 white British people who reported difficulties in the preceding month. EMs were assessed by a self-report checklist that inquired about the identity, causes, timeline, consequences, controllability, and preferred treatments for mental distress. Common mental disorders were assessed using the Clinical Interview Schedule (revised). Independent of ethnic group, people with common mental disorders were more likely to give spiritual causal explanations (odds ratio [OR] = 3.1, 95% CI = 1.9 to 4.9), to report behavioral (OR = 2.2, 95% CI = 1.3 to 3.8) and financial consequences (OR = 3.3, 95% CI = 1.8 to 6), and to prefer complementary treatments (OR = 4.6, 95% CI = 2.3 to 9.1). Compared with black Caribbean and white British subjects, Bangladeshi subjects more often gave spiritual or physical causal explanations. Compared with white British subjects, Bangladeshi and black Caribbean subjects preferred medical and spiritual treatments, whereas white British subjects, as compared with the other 2 ethnic groups, preferred self-management and social treatments. Causal explanations did not always relate to the corresponding treatment preferences. EMs can be assessed by a simple checklist, show variations by ethnic group, and are associated with common mental disorders. Identifying EMs may strengthen the assessment of common mental disorders.

Validation of two survey diagnostic interviews among primary care attendees: a comparison of CIS-R and CIDI with SCAN ICD-10 diagnostic categories

The most widely used survey measures in psychiatry, the Composite International Diagnostic Interview (CIDI) and the Clinical Interview Schedule-Revised (CIS-R) have generated estimates of psychiatric morbidity that show considerable variation. Doubts have been raised regarding the validity of these structured lay interviewer assessments. There have been no direct comparisons of the performances of these instruments against a common, established criterion. A total of 105 unselected primary care attendees were each interviewed with CIDI, CIS-R and SCAN in a single sitting with random order of administration. SCAN was administered by a SCAN trained psychiatrist, and CIDI and CIS-R by a public health doctor. Concordance was estimated for all ICD-10 neurotic disorders. We assessed the overall discriminability of the CIS-R morbidity scale using a receiver operating characteristic (ROC) analysis. The concordance for CIDI for ICD-10 diagnoses was moderate to excellent (kappa= 0.58-0.97). Concordance for CIS-R ranged between poor and moderate (kappa = 0.10-0.65). The area under the ROC curve for the CIS-R morbidity scale with respect to any ICD-10 disorder [0.87 (95% CI 0.79-0-95)] indicated good overall discriminability, but poor sensitivity (44%) and high specificity (97%) at the usual CIS-R cut-point of 11/12. Among primary care attendees the CIDI is a highly valid assessment of common mental disorders, and the CIS-R is moderately valid. Previous studies may have underestimated validity. Against the criteria of all ICD-10 diagnoses (including less severe depressive and anxiety disorders) a much lower CIS-R cut-point is required than that which is usually advocated.