Global Appraisal Of Individual Needs-Short Screener Research Articles

A history of high-risk and destructive behaviors predict COVID-19 infection: A preliminary study.

The COVID-19 pandemic has heightened mental health concerns, but the temporal relationship between these conditions and SARS-CoV-2 infection has not yet been investigated. Specifically, psychological issues, violent behaviors, and substance abuse problems were reported higher during the COVID-19 pandemic when compared to pre-pandemic levels. However, it is unknown whether a pre-pandemic history of these conditions increase an individual's susceptibility for SARS-CoV-2. To better understand the psychological risks underlying COVID-19, it is important to investigate how destructive and risky behaviors (related to externalizing behaviors, substance use, and crime and violence) may increase a person's susceptibility to COVID-19. Here, we analyzed data from a survey of 366 adults across the United States (ages 18-70); this survey was administered between February and March of 2021. Participants were asked to complete the Global Appraisal of Individual Needs-Short Screener (GAIN-SS) questionnaire which indicates a history of high-risk and destructive behaviors and high likelihood of meeting diagnostic criteria. The GAIN-SS includes seven questions related to externalizing behaviors, eight related to substance use issues, and five related to crime and violence. Responses were given on a temporal scale of "0" (never a given behavior) to "4" (experienced a behavior in the past month). Participants were also asked if they ever tested positive for COVID-19 and/or if they ever received a clinical diagnosis of COVID-19. GAIN-SS responses were compared between those reporting and not reporting COVID-19 to deduce if those reporting COVID-19 experienced GAIN-SS behaviors more recently (Wilcoxon Rank Sum test, α=0.05). Three hypotheses surrounding the temporal relationships between the recency of GAIN-SS behaviors to COVID-19 infection were tested using proportions tests (α=0.05). GAIN-SS behaviors that significantly differed (proportions tests, α=0.05) between COVID-19 responses were included as independent variables in multivariable logistic regression (MVLR) models with iterative downsampling. This was performed to assess how well a history of GAIN-SS behaviors statistically discriminated between those reporting, and not reporting, COVID-19. Those reporting COVID-19 more frequently indicated past GAIN-SS behaviors (Q<.05). Further, the proportion of those reporting COVID-19 was higher (Q<.05) in those also reporting a history of GAIN-SS behaviors; specifically, gambling and selling drugs were common across the three proportion tests. MVLR revealed that GAIN-SS behaviors, particularly gambling, selling drugs, and attention problems, accurately modeled self-reported COVID-19 with model accuracies ranging from 77.42-99.55% ± 4.49-5.86%. That is, those that exhibited destructive and high-risk behaviors prior to, and during, the pandemic could be discriminated from those that did not exhibit these behaviors when modeling self-reported COVID-19. Together, this preliminary study provides insight into how a history of destructive and risky behaviors influence infection susceptibility - offering possible explanations for why some persons may be more susceptible to COVID-19, potentially in relation to reduced adherence to prevention guidelines or seeking vaccination.

Passive exposure to e-cigarette emissions is associated with worsened mental health

BackgroundCigarette smoking, secondhand cigarette smoke (SHS) exposure, and e-cigarette use (“vaping”) are each associated with increased rates of depressive symptoms and other internalizing mental health disorders. The prevalence of vaping has increased greatly, yet the mental health correlates of secondhand exposure to e-cigarette emissions are as yet to be investigated. This study examined the potential adverse mental health outcomes associated with different tobacco exposures (direct and passive), with a particular focus on the mental health correlates of secondhand exposure to e-cigarette emissions.MethodsThe Population Assessment of Tobacco and Health Study data collected from a sample of 16,173 Wave 4 adults were used to test the hypothesis that secondhand e-cigarette emissions exposure is associated with increased odds of internalizing mental health disorders. Individuals were categorized as exclusive cigarette smokers, exclusive e-cigarette users, cigarette and e-cigarette dual users, exclusive noncombustible tobacco users, secondhand smoke exposed non-users, secondhand e-cigarette emissions exposed non-users, and non-users with no current SHS/secondhand e-cigarette aerosol exposure. Adjusted weighted logistic regression analysis was used to investigate the association between exposure type and internalizing problems as assessed by scores on the Global Appraisal of Individual Needs-Short Screener (GAIN-SS), a widely used instrument for assessing mental health problems.ResultsCigarette smokers (AOR = 2.53, 95% CI: 2.19–2.92), e-cigarette users (AOR = 3.14, 2.41–4.09), dual users (AOR = 3.37, 2.85–4.00), noncombustible tobacco users (AOR = 1.48, 1.01–2.17), SHS exposed non-users (AOR = 1.63, 1.37–1.94), and secondhand e-cigarette emissions exposed non-users (AOR = 1.43, 1.03–1.99) were each associated with increased odds of moderate to severe internalizing mental health problems as compared to unexposed non-users. Odds of internalizing problems among SHS and secondhand e-cigarette emissions exposed non-users did not differ (p = 0.46).ConclusionsThis is the first study, to our knowledge, to identify an association between recent secondhand exposure to e-cigarette emissions and mental health problems, and the risk is comparable to that of SHS. Corroboration of this relationship needs further research to explicate directionality and mechanisms underlying this association.

Mediational pathways of tobacco use among adult daily smokers with psychiatric symptoms in the Population Assessment of Tobacco and Health (PATH) survey

IntroductionIndividuals with psychiatric conditions suffer disproportionately from tobacco-related morbidity and mortality, but the factors driving this relationship remain unclear. We used data from the Population Assessment of Tobacco and Health (PATH) to investigate whether associations between internalizing psychiatric symptoms and change in smoking heaviness (as measured by cigarettes per day (CPD) were mediated by self-reported respiratory symptoms, smoking risk perceptions, and cigarette dependence. MethodsThis study used data from PATH Waves 1 through 4 (2013–2017, n = 4,152). Psychiatric symptoms were indexed with the internalizing sub-scale of the Global Appraisal of Individual Needs-Short Screener (GAIN‐SS) among daily smokers. We fit auto-regressive structural equation models (SEM) to data from Wave 1–3 and 2–4 to determine the direct and indirect associations between internalizing symptom scores and CPD through each mediator. ResultsThe association between internalizing symptoms and CPD was mediated by cigarette dependence (indirect: B = 0.004, SE = 0.041, p = 0.023) and respiratory symptom severity (indirect: B = 0.018, SE = 0.097, p < 0.001). Internalizing symptoms predicted higher harm perceptions (B = 0.056, SE = 0.035, p < 0.001) but the indirect relationship with CPD was non-significant. Findings from Waves 2–4 replicated these results. ConclusionOur results indicate that cigarette dependence and respiratory symptom severity partially mediate the relationship between internalizing symptoms and CPD but risk perceptions were not significant predictors in our models. This suggests that efforts to reduce smoking among people with internalizing disorders should focus on decreasing nicotine dependence and increasing awareness of respiratory symptoms to encourage a quit attempt or switch to a less harmful source of nicotine.

Differences in Psychosocial Distress by Gender and Length of Residency in Criminal Justice System Involved Men and Women in a Sober Living Environment

ABSTRACTSymptoms of mental health and substance use disorders are prevalent for individuals involved in the criminal justice system (CJS). The purpose of this study was to examine the association between psychosocial distress for CJS-involved men and women residing in sober living environments. Participants were residents of North Carolina Oxford Houses who indicated previous involvement in the criminal justice system (N = 353). With the Global Appraisal of Individual Needs-Short Screener (GAIN-SS), three types of psychosocial distress were operationally defined using the past-year symptom count on the subscales of (1) internalizing mental health disorders, (2) externalizing mental health disorders, and (3) substance use disorders. A multiple linear regression was conducted for each of these three psychological distress variables. Results of each linear regression analysis revealed gender and length of stay were significantly associated with increased symptom counts in both men and women. An interaction effect between gender and length of stay was also observed. That is, for each of three subscales, the simple slope tests revealed a significant negative association between length of residency at Oxford House and subscale scores for females and males, but the length of residency at Oxford House was more strongly related to the subscales scores for females.

Test Review: Global Appraisal of Individual Needs–Short Screener (GAIN-SS)

Test Review: <i>Global Appraisal of Individual Needs–Short Screener (GAIN-SS)</i>

Reliability of the GAIN-SS, CRAFTT and PESQ screening instruments for substance use among South African adolescents.

IntroductionScreening for adolescent substance use can assist with the early identification of substance-related problems and guide the provision of appropriate services. As such, psychometrically sound screening tools are needed. The aim of this study was to compare the reliability of the CRAFFT, Global Appraisal of Individual Needs-Short Screener (GAIN-SS) substance use subscale and Personal Experience Screening Questionnaire (PESQ) among adolescents from disadvantaged communities in Cape Town, South Africa.MethodsAdolescents aged 12–19 years (n = 231) completed the three screeners at two points in time.ResultsFindings show that all three of the screeners had adequate internal consistency (Cronbach α ≥ 0.8). Test-retest reliability was similar for all three screeners, with intraclass correlation coefficient values slightly higher for the PESQ (0.82, 95% CI: 0.77–0.86) than for the GAIN-SS substance use subscale (0.79, 95% CI: 0.73–0.84) and CRAFFT (0.76; 95% CI: 0.66–0.83). Kappa values indicated that the GAIN-SS substance use subscale and CRAFFT had moderate levels of agreement, while the PESQ had substantial levels of agreement for identifying those who had moderate or higher substance use risks at Time 1 and Time 2.ConclusionThe findings indicate that all of these short screeners seem to have acceptable reliability when used in this population. All of the three screeners are appropriately reliable when used with adolescents from disadvantaged communities in Cape Town, but the PESQ performed slightly better. Future studies should also include the assessment of validity of these screeners in this context.

"Do you think you have mental health problems?": advantages and disadvantages of a single screening question for mental disorder in substance use disorder treatment.

Mental disorders are common among people presenting for the treatment of substance-related problems, and guidelines recommend systematic screening for these conditions. However, even short screens impose a considerable burden on clients and staff. In this study, we evaluated the performance of a single screening question (SSQ) relative to longer instruments. We analyzed a sample of 544 adults recruited from outpatient substance use disorder treatment centers in Ontario, Canada. Clients were asked a simple SSQ, followed by the Kessler Screening Scale for Psychological Distress (K6) and the Global Appraisal of Individual Needs Short Screener (GAIN-SS). Caseness was ascertained using the Structured Clinical Interview for DSMIV (SCID). We measured and compared performance using receiver operating characteristic (ROC) curve analysis and explored client characteristics associated with screen performance using ROC regression. Last, we used logistic regression to test whether SSQs can be usefully combined with other measures. The prevalence of past-month disorder was 71%. The performance of the SSQ (AUC = 0.77, 95% CI [0.72, 0.83]) was similar to, and not significantly different from, those of the K6 (AUC = 0.78) and the GAIN (AUC = 0.79). The K6 and the GAIN performed better than the SSQ among people with a psychotic disorder. The addition of the SSQ slightly improved the performance of the other measures. SSQs can offer screening performance comparable to that of longer instruments. Reasons for caution include the small number of possible thresholds, lower accuracy than other measures in identifying psychotic disorder, and possible differential functioning in different populations. Performance of all three screens was also moderate; when prevalence is high and resources are available, offering full assessments may be preferable to screening. Nevertheless, SSQs offer an intriguing area for further evaluation.

The GAIN Short Screener (GSS) as a Predictor of Future Arrest or Incarceration among Youth Presenting to Substance Use Disorder (SUD) Treatment

The National Institutes of Health (NIH) data harmonization project on existing measures (www.phenx.org) has recommended the Global Appraisal of Individual Needs (GAIN)—Short Screener (GSS) as one of the most reliable, valid, efficient, and inexpensive general behavioral health screeners to quickly identify people with internalizing and externalizing mental health disorders, substance use disorders, and crime/violence problems. The present study examined how well the four GSS screeners and their sum predict future arrest or incarceration among individuals entering treatment for a substance use disorder. Using a cross-validation design, a diverse sample of 6,815 youth with substance use disorders was split into a development sample and a validation sample. Overall, results found the GSS’s crime and violence screener (CVScr) and the substance disorder screener (SDScr) to be the two best predictors of arrest/incarceration within the 12 months following treatment intake. Additionally, we found that these screeners could be used to categorize individuals into three groups (low risk, moderate risk, high risk) and this simplified classification had good predictive validity (Area Under the Curve = 0.601). In sum, the GSS’s predictive validity was similar to other instruments that have been developed to predict risk for recidivism; however, the GSS takes only a fraction of the time to collect (ie, approximately 2–3 minutes for just these two screeners).

Smoking and Behavioral Health of Women

Using data from a study of reliability and validity of a screening tool for co-occurring substance abuse and mental health problems, our objective was to compare behavioral health issues of female smokers and nonsmokers and explore correlates of smoking. Using a convenience sample (n=1021), we recruited participants to complete an online survey conducted in substance abuse treatment, primary care, mental health services, senior, and public settings. The survey included demographic questions, smoking status, the co-occurring disorders screening tool, the Global Appraisal of Individual Needs-Short Screener (GAIN-SS) and the Postraumatic Stress Disorder Checklist (PCL)-Civilian. One third of participants self-identified as smokers, and African American, American Indian, and bisexual women reported the highest rates of smoking. Seventy-two percent of women reported at least one mental health problem in the past year; 29% had a past year substance abuse problem, and 26% reported a past year co-occurring disorder of both. Smokers had significantly higher rates of posttraumatic stress disorder (PTSD), past year depression and anxiety, suicidality, past year substance abuse, and co-occurring disorders. Smokers also had significantly higher rates of lifetime intimate partner violence (IPV) and childhood abuse. Smoking in women was associated with significantly higher rates of mental health and substance abuse problems. Substance abuse, being in a treatment setting, IPV, African American and mixed ethnicity, Medicaid insurance status, reduced income, and no home ownership were identified as predictors of smoking. Screening and evaluation of smoking status, mental health, substance use disorders, and the presence and impact of violence are essential for women's health.

Validity and Reliability of the COJAC Screening Tool for Co-occurring Disorders

This study explored the reliability and validity of a nine-item screening tool (Co-Occurring Joint Action Council [COJAC] Screening Tool [CST]) for co-occurring disorders (COD). Using a convenience sample (n=1,951), an online survey was conducted in multiple settings and included demographic questions, the CST, the Global Appraisal of Individual Needs-Short Screener (GAIN-SS), and the Posttraumatic Stress Disorder Checklist-Civilian version. The CST substance abuse (SA) scale performed well with a Cronbach's alpha of .84 and a correlation of .71 with GAIN-SS SA (past year). The CST mental health and trauma items did not perform well as scales with Cronbach's alphas of .64 and .56, respectively. The CST-SA is a short, reliable, and valid measure of SA. Further study is needed to determine the best evaluation tool for the mental health portion of the COD screening instrument.

Development and Validation of the GAIN Short Screener (GSS) for Internalizing, Externalizing and Substance Use Disorders and Crime/Violence Problems Among Adolescents and Adults

The Global Appraisal of Individual Needs (GAIN)1 is a 1-2 hour standardized biopsychosocial that integrates clinical and research assessment for people presenting to substance abuse treatment. The GAIN - Short Screener (GSS) is 3-5 minute screener to quickly identify those who would have a disorder based on the full 60-120 minute GAIN and triage the problem and kind of intervention they are likely to need along four dimensions (internalizing disorders, externalizing disorders, substance disorders, and crime/violence). Data were collected from 6,177 adolescents and 1,805 adults as part of 77 studies in three dozen locations around the United States that used the GAIN. For both adolescents and adults the 20-item total disorder screener (TDScr) and its four 5-item sub-screeners (internalizing disorders, externalizing disorders, substance disorders, and crime/violence) has good internal consistency (alpha of .96 on total screener), is highly correlated (r = .84 to .94) with the 123-item longer scales in the full GAIN. The GSS also does well in terms of its receiver operator characteristics (90% or more under the curve in all analyses) and has clinical decision-making cut points with excellent sensitivity (90% or more) for identifying people with a disorder and excellent specificity (92% or more) for correctly ruling out people who did not have a disorder. The GSS has good potential as an efficient screener for identifying people with co-occurring disorders across multiple systems and routing them to the right services and more detailed assessments.