Mental Health Screening Instrument Research Articles

Having any mental health condition before the COVID-19 pandemic as a risk factor of COVID-19 contagion during the first year of pandemic: A Spanish adult cohort.

Numerous studies suggest that subjects suffering from a mental health condition before the COVID-19 pandemic were at higher risk of contagion, but mostly are cross-sectional or retrospective. The BIOVAL-D-COVID-19 is a longitudinal cohort study design with 922 subjects who full filled two evaluations from an online survey of Spanish residents before and during the pandemic. Mental health conditions assessed were: Major Depressive Episode (MDE), Generalised Anxiety Disorder (GAD), Suicidal Thoughts and Behaviours (STB) and subthreshold of panic and bipolar disorder (BD). Mental health screening instruments used were: the Spanish version of the Composite International Diagnostic Interview (CIDI) version 3.0 for the evaluation of MDE, the GAD-7 scale to evaluate GAD; STB was evaluated with four items from the CIDI questionnaire. Panic Disorder and BD were screened from a modified and self-reported version of the CIDI. A bivariate plus five logistic regression models were developed for each mental health condition adjusted by socio-demographic variables; employment status; general and physical health; comorbidity; and including all previous variables and the other mental health conditions. We found in bivariate model that MDE; GAD and STB were statistically significant risk factors of contagion of COVID-19. The logistic regression models developed reveal that having a previous GAD (aOR 3.30 1.31-8.31) or STB (aOR 2.16 CI 95% 1.01-4.62) was statistically significant associated with COVID-19 contagion, independently of all variables included. MDE was not a risk factor of contagion when it was adjusted by comorbidity (aOR 0.99 CI 95% 0.47-2.09). It is recommended to detect those subjects with previous GAD or STB as vulnerable groups of infection to reduce contagion rates.

Cost-effectiveness of screenings for mental health in pregnancy: A systematic review

Mental disorders posses significant obstacles both during and after pregnancy for many women. Birth weight, premature birth, perinatal and infant deaths, postpartum psychopathology, emotional difficulties, inappropriate behavior in children and adolescents, and adverse effects on other people are just a few of the negative impacts that mental disorders are linked to during pregnancy in that family. Women with mental disorders may experience issues after giving birth, affecting their health throughout pregnancy. Infections, including depression, frequently go undiagnosed and receive subpar treatment despite routine interactions with medical providers during pregnancy. Hormonal changes impact Mother's body movements; for example, she moves more slowly and gets exhausted more rapidly. Pregnant ladies who are in this scenario tend to become indolent. A systematic assessment of research findings on the effectiveness of economic evaluation of mental health screening instruments during pregnancy is frequently used to encourage early detection of mental health in pregnant women as maternal reactions become more sensitive, irritable, and irritable. These investigations mostly used the EPDS and PHQ-9. For the systematic review portion of this investigation, the PRISM ScR 2020 Flowchart was employed, and the A search of the literature was done using the databases Pubmed and Whiley. This article was assessed using the CHEC-Extended checklist. Two reports satisfied the inclusion criteria after an investigation of 890 chosen papers. The systematic review identified three themes: cost, effectiveness, and threshold. Given the variety of treatments used to treat mental health issues in pregnant women, it is clear that using two approaches rather than just one will result in greater cost-effectiveness

Psychometric properties and normative data of the Latvian and Russian language versions of the strengths and difficulties questionnaire (SDQ) in the Latvian general adolescent population

Objectives Mental health screening instruments are essential in population health research and clinical practice. The strengths and difficulties questionnaire (SDQ) self-report version has been widely used across the globe to screen for mental health problems in adolescent populations. This study aimed to explore the psychometric properties of the Latvian and Russian language versions of the SDQ in a representative sample of a general population of Latvian adolescents and establish the population-based normative scores. Materials and methods This analysis was based on data from the international Health Behaviour in School-aged Children study year 2017/2018 Latvian database. The sample comprised 2683 Latvian and 1321 Russian-speaking 11-, 13-, and 15-year-old adolescents. Results Significant language-based variance was observed in the mean scores of the externalising subscales of the SDQ, with Latvian-speaking adolescents reporting higher levels of conduct problems and hyperactivity. The reliability was satisfactory (ordinal alpha >0.7) only for the prosocial behaviour, emotional, internalising problems, and total difficulties subscales, while conduct, hyperactivity, peer, and externalising problems scales demonstrated lower internal consistency (ordinal alpha 0.5–0.7). Confirmatory factor analysis (CFA) did not support the hypothesised narrow-band five-factor or broad-band three-factor structure of the SDQ. The normative banding scores were calculated for both language variants. Conclusions This study suggests that the self-report SDQ must be used cautiously in Latvian adolescents because some SDQ subscales lack reliability. When used in population research, the internalising subscales seem more reliable than the externalising ones. More research is needed regarding the reliability of the SDQ in clinical adolescent populations.

COVID-Somnia: A Multicentric Study on Sleep Disturbances During the COVID-19 Pandemic With Spatial Mapping of Hotspots.

Objective The purpose of this study was to document sleep quality and assess its sociodemographic, behavioral (i.e., tobacco use, alcohol use, and screen time), and mental-health-related indicators (i.e., anxiety and depression) in adults aged 30-59 years across three states of India, and to geo-locate state and district-level findings of sleep quality during the ongoing coronavirus disease 2019 (COVID-19) pandemic. Methods From October 2020 to April 2021, residents (aged 30-59 years) of Kerala, Madhya Pradesh, and Delhi completed a web-based survey that included sociodemographic and behavioral factors, clinical history of COVID-19, and mental health screening instruments for anxiety and depression, namely the Generalized Anxiety Disorder 2-item (GAD-2) and Patient Health Questionnaire-2 (PHQ-2). The Pittsburgh Sleep Quality Index (PSQI) was used to evaluate the quality of sleep. Average PSQI scores were geo-mapped. Results Of the 694 participants who responded, 647 completed the PSQI. The mean (SD) global PSQI score was 5.99 (3.2), with approximately 54% of participants reporting poor sleep quality (PSQI Score>5). Eight hotspot districts with severe sleep disturbances (mean score PSQI>6.5) were identified. Multivariable logistic regression analysis showed that compared to Madhya Pradesh, participants from Kerala and Delhi had 62% and 33% lower chances of having poor sleep quality, respectively. Those who screened positive for anxiety had higher odds of having poor sleep quality (adjusted odds ratio {aOR}=2.4, P=0.006*). Conclusion Overall, sleep quality was poor during the early stages of the COVID-19 pandemic (October 2020-April 2021), especially among those who reported high levels of anxiety. Among the three included states, there were differences in sleep quality.

Editorial introductions.

Editorial introductions.

Evaluating the Efficacy of Ethical Guidelines for Online Screening of Mental Health in South Africa

Despite the rapid growth in digital mental health options, a systematic review conducted on the ethics of developing online mental health screening instruments highlighted that there were no formal guidelines in this area. This lack of formal guidelines and the results of the systematic review led to the development of formal guidelines for online mental health screening tools in South Africa. This study aimed to explore the efficacy of these draft guidelines using a qualitative design with two samples of individuals recognised as experts in the field of mental health. Sample one consisted of a purposive sample of 15 experts who commented on the appropriateness of the draft guidelines. The second sample consisted of 9 experts who completed the Appraisal of Guidelines for Research and Evaluation (AGREE) instrument to assess the guidelines. Both samples were in agreement on the relevance of the core content areas in the guidelines, namely purpose and scope, modes of testing, psychometric properties, informed consent, ensuring minimal risk to participants, feedback as well as data security. There was also agreement on the appropriateness of the methods used to develop the guidelines. The use of the guidelines was supported with the suggestion that issues of risk and suicidality be explored further.

Validating Lyfas as a reliable mental health screening and monitoring instrument: a step towards mobile health application during COVID-19 Pandemic

COVID-19 has disturbed mental health to a great extent. Lockdowns, re-infections in fully vaccinated people, frequent mutations of the virus, working from home, shutting of school colleges, contradictory information flying in the air, and so on are some serious predisposing factors in deteriorating the mental health. The Indian Govt. has granted the telemedicine model of healthcare in the country. Mobile health (mHealth) adds to it effectively and Lyfas is such a smartphone-based instrument that works using the principle of arterial photoplethysmography and photochromatography. It captures short (120 sec) heart rate variability (HRV) and the allied optical biomarkers that surrogate for the cardiovascular autonomic modulation, which is influenced by mental health issues. The study aims to validate Lyfas optical biomarkers (SD1/SD2, LF/HF, pNN50, and HRVscores) and a set of physical parameters e.g., age, HR, BP – systolic and diastolic, and serum cortisol in addressing the mental health state. A total of RTPCR positive 1130 adults (Male 541, Female 589) within the age group of 27-68 yrs. participated in the study. Till the participants became RTPCR negative (average time of 14 days), the Depression-Anxiety-Stress Screening-21 (DASS-21) and Covid Screening Scale (CSS)-based monitoring is done once daily to note the distress levels, and Lyfas tests are taken thrice daily simultaneously. The average of all scores constructs the experimental data. Internal consistency (Cronbach’s α), normality test (Shapiro Wilkis test), and Spearman’s correlations (ρ) and their respective statistical significance (p<0.05, CI: 95%) are computed. The study concludes that Lyfas biomarkers show strong correlations with that of the DASS-21 and CSS scores. Physical parameters are also corroborative to the result.

Editorial introductions

Editorial introductions

Impact of the COVID-19 pandemic on mental health, access to care, and health disparities in the perinatal period

BackgroundThe COVID-19 pandemic has affected mental health and created barriers to healthcare. In this study, we sought to elucidate the pandemic's effects on mental health and access to care for perinatal individuals. MethodsThis cross-sectional study of individuals in Massachusetts who were pregnant or up to three months postpartum with a history of depressive symptoms examined associations between demographics and psychiatric symptoms (via validated mental health screening instruments) and the COVID-19 pandemic's effects on mental health and access to care. Chi-square associations and multivariate regression models were used. ResultsOf 163 participants, 80.8% perceived increased symptoms of depression and 88.8% of anxiety due to the pandemic. Positive screens for depression, anxiety, and/or PTSD at time of interview, higher education, and income were associated with increased symptoms of depression and anxiety due to the pandemic. Positive screens for depression, anxiety, and/or PTSD were also associated with perceived changes in access to mental healthcare. Compared to non-Hispanic White participants, participants of color (Black, Asian, Multiracial, and/or Hispanic/Latinx) were more likely to report that the pandemic changed their mental healthcare access (aOR:3.25, 95%CI:1.23, 8.59). LimitationsLimitations included study generalizability, given that participants have a history of depressive symptoms, and cross-sectional design. ConclusionsThe pandemic has increased symptoms of perinatal depression and anxiety and impacted perceived access to care. Self-reported increases in depression and anxiety and changes to healthcare access varied by education, race/ethnicity, income, and positive screens. Understanding these differences is important to address perinatal mental health and provide equitable care.

Structural validity and reliability of the Danish self-report Strengths and Difficulties Questionnaire among male and female students in vocational education and training

Objective: The Strengths and Difficulties Questionnaire (SDQ) is a widely used mental health screening instrument among children and adolescents and increasingly used by welfare professionals in Denmark. However, the psychometric properties of the SDQ-self report (SDQ-S) among vocational education and training (VET) students are unknown. We assess the structural validity, internal consistency reliability, and test-retest reliability of the Danish SDQ-S among these students. Method: The SDQ-S was tested twice in a sample of VET students (sample N = 486; mean age = 17 years) with 10 to 14 days in-between. Using separate analyses for men (n = 371) and women (n = 115), structural validity was assessed using confirmatory factor analysis; internal consistency was assessed using composite reliability (CR); and test-retest reliability using Pearson’s correlation. Results: Overall, the results provide inconsistent support for the five-factor first-order model, especially among males. CR was acceptable for all five scales except for Peer problems (among females and males) and Conduct (among males only). Test-retest reliability was satisfactory for all scales among females but for only two of the five scales (Conduct, Hyperactivity) among men. Conclusion: Overall, the SDQ-S is a more valid and reliable instrument among females. Results suggest caution in using the SDQ-S among VET students, in particular males.

Factor Structure of the Self-Report Strength and Difficulties Questionnaire in a Diverse U.S. Sample

The Strengths and Difficulties Questionnaire (SDQ) is a widely used mental health screening instrument developed in the United Kingdom that measures five proposed factors. U.S. research, however, historically supports a slightly different three-factor solution. The present study reports results using both principal factor analysis (PFA) and confirmatory factor analysis (CFA) on data from multiple waves of an ongoing mental health project in middle school aged children. PFA analyses suggested three, five and six-factor solutions with substantial cross-loadings from items. CFAs showed alternative five and six-factor solutions fit well when items guided by the initial PFA were allowed to cross-load. Neither the original five-factor nor popular three-factor models fit well without allowing cross-loading items. These data suggest that popular SDQ three and five-factor model may have variable fit in certain U.S. populations.

Using mental health screening instruments for understanding depression and personality profiles among Chinese transgender individuals

ABSTRACT This study assessed the depression status of transgender individuals and their personality profiles for seeing the psychological functioning. We further compared their status with cisgender individuals and explored the role of personality profiles in explaining the variance of depression level among transgender and cisgender individuals. Seventy-one transgender individuals and seventy-three cisgender individuals were investigated in Shanghai Mental Health Centre. The general depression level and personality profiles of transgender individuals remained normative range, but percentages of transgender individuals who reported moderate or major symptoms and poor personality profiles were significantly higher than those of cisgender counterparts. Subscale scores of paranoia and psychopathic deviate significantly contributed to the variance of depression level among transgender people in multiple regression model. This study sheds light on the psychological needs of transgender people, which provided healthcare providers with the implications of developing psychological intervention programmes and mental health services.

Establishing reliability and validity for mental health screening instruments in resource-constrained settings: Systematic review of the PHQ-9 and key recommendations

Mental illness is one of the largest contributors to the global disease burden. The importance of valid and reliable mental health measures is crucial in order to accurately measure said burden, to capture symptom improvement, and to ensure that symptoms are appropriately identified and quantified. This is of particular importance in low and middle-income countries (LMICs), where the burden of mental illness is relatively high, and there is heterogeneity in linguistic, racial, and ethnic groups. Using the PHQ-9 as an illustrative example, this systematic review aims to provide an overview of existing work and highlight common validation and reporting practices. A systematic review of published literature validating the use of the PHQ-9 in LMICs as indexed in the PubMed and PsychInfo databases was conducted. The review included n = 49 articles (reduced from n = 2,349). This manuscript summarizes these results in terms of the frequency of reporting on important procedures and in regards to the types of reliability and validity measured. Then, building off of the existing literature, we provide key recommendations for measure validation in LMICs, which can be generalized for any type of measure used in a setting in which it was not initially developed.

Editorial introductions

Editorial introductions

THE RELATIONSHIP BETWEEN MENTAL HEALTH HISTORY AND SYMPTOMS, SEX, AND RECOVERY TIME IN A CONCUSSED PEDIATRIC POPULATION

Background:The Generalized Anxiety Disorder scale (GAD-7) and Patient Health Questionnaire (PHQ-9) are mental health screening instruments that assess symptoms of depression and anxiety. Studies of patients with concussion suggest that history of mental illness is associated with prolonged recovery; however, little research has examined the value of these tools in a concussed pediatric population (Iverson et al., 2017).Hypothesis/Purpose:The purpose of this study was to explore the relation between anxiety and depression symptoms, mental illness history, sex, and time to recover in a concussed pediatric population. We hypothesized that mental health symptoms and history, and female sex would predict longer recoveries in the pediatric population.Methods:IRB-approved retrospective chart review was used for data collection. Demographics, self-reported mental health history, GAD-7, and PHQ-9 scores were acquired for 250 adolescents ages 12-18 (45.2% female) who presented to an outpatient concussion clinic for their initial visit. Days to recover was imputed for all patients who had been discharged by clinic physicians based on international return to play standards.Results:Mann-Whitney U tests were used for analysis of this nonnormally distributed data. Males were found to recover more quickly than females (female median = 15 days, IQR 7-27; male median = 12 days, IQR 6-23; p=.013). No significant differences were observed in days to clearance based on reported history of mental health disorder (p=.066). Individuals who scored above cutoff (see Kroenke et al., 2001; Spitzer et al., 2006) on the GAD-7 (below cutoff median = 12.00 days; above cutoff median = 21.00 days) and PHQ-9 (below cutoff median = 23.5 days; above cutoff median = 57.00 days) required longer recovery times (p <.001).Conclusion:We found longer recovery times in females versus males, and in those whose scores fell above cutoff for the PHQ-9 and GAD-7 at their initial clinic visit. Although a trend existed, there were no significant differences in recovery time for those who reported a mental health history compared to those who did not. Results suggest that the GAD-7 and PHQ-9 may be useful screening measures in a concussion clinic and may provide additional insight into potential recovery times for pediatric patients.

Recommendations for measurement of well-being

Introduction: Measurements of child well-being in the military context through cross-national surveys must allow assessment of both (1) indicators for vulnerability and resilience in such children, and (2) factors leading to program success across the different NATO members. Methods: This review identifies psychometric properties (including validity, cross-cultural validation, sensitivity [SE], and specificity [SP] of each measure for various cutoffs for referral for psychiatric evaluation) as well as feasibility (cost-efficiency, time needed for filling in the questionnaire, language availability, and costs for its use). The measures included are four generic health-related quality-of-life measures (PedsQL 4.0, KIDSCREEN-52, DCGM-37, and KINDL-R) and four screening measures for mental health: the Achenbach System of Empirically Based Assessment (ASEBA), the Child Health Questionnaire (CHQ), the Pediatric Symptom Checklist (PSC), and the Strengths and Difficulties Questionnaire (SDQ). Results: High SE and SP values (0.70) for the screening instruments occurred in only 30%–55% of the studies reviewed. Cross-cultural validation and content validity are best covered by the KIDSCREEN-52, which is the dominant HRQOL instrument in Europe. The HRQOL instrument mostly used in the United States is the PedsQL. Discussion: Although there is no gold standard, the combination of a mental health screening instrument (the SDQ) with a HRQOL instrument (the KIDSCREEN-52), is recommended due to their complementary advantages on the evaluation criteria. Future comparability of items banks, such as those in the KIDSCREEN-52 and the PedsQL, is aimed for by the United States based PROMIS project.

Quality of life of patients on treatment for latent tuberculosis infection: a mixed-method study in Stockholm, Sweden

BackgroundUnlike active tuberculosis, latent tuberculosis infection (LTBI) is asymptomatic and often considered not to affect the health-related quality of life (HRQoL) of patients. However, being diagnosed with and treated for LTBI can be associated with adverse clinical evens such side effects of treatment as well as psychosocial challenges. Therefore, the aims of this study were to qualitatively explore patients’ experiences during diagnosis and treatment of LTBI in Stockholm measure their HRQoL, and contrast and merge the results to better understand how the HRQoL of these patients is affected.MethodsLTBI patients who were treated in Stockholm during September 2017 and June 2018and who fulfilled the inclusion criteria were invited to fill a survey that included a HRQoL instrument, EQ-5D-3 L, and a mental health screening instrument, RHS-15. After filling the survey, a subset of these patients was asked to participate in an interview with open-ended questions that focused on their experiences during the diagnosis and treatment.ResultsIn total 108 participants filled that survey and interviews were conducted with 20 patients. Patients scored relatively high on EQ-5D: the scores of utility and VAS scale are similar to those reported by the general population of Stockholm. Very few patients reported problems on the physical health domains of EQ-5D which was supported by the quantitative data that showed no effect on physical health and usual activity. Thirty-eight percent screened positive for RHS-15 and 27.8% reported problems with anxiety/depression domain of EQ-5D which could be related to many stressing factors mentioned in the interviews such as: fear and distress related to lack of clarity about LTBI diagnosis, perceived risk of infecting others and uncertainties about the future.ConclusionThe quantified HRQoL of LTBI patients in Stockholm is similar to the general population and there is thus no HRQoL decrements that is detectable with EQ-5D. However, the study reinforces the importance of tackling anxiety and fear and ensuring good health information for persons diagnosed with and treated for LTBI.

Preliminary psychometric validation of a brief screening tool for athlete mental health among male elite athletes: the Athlete Psychological Strain Questionnaire

There is growing interest in the area of elite athlete mental health, however brief, valid and reliable screening instruments designed to identify early indictors of athlete-specific distress and potential mental health symptoms are lacking. This study sought to develop a brief screening instrument for athlete populations – the Athlete Psychological Strain Questionnaire (APSQ) – and examine convergent, divergent and construct validity. A two-stage psychometric validation study was undertaken. Self-report data was collected from 1,007 currently competing Australian elite male athletes (M = 23.67, SD = 4.16). The sample was randomly partitioned into calibration (n = 497) and validation (n = 510) samples. Exploratory and confirmatory factor analysis, and tests of differential item functioning were conducted. Exploratory factor analysis, with parallel analysis, conducted on the calibration sample supported a three-factor solution, with subscales assessing Self-Regulation, Performance and External Coping accounting for 50.44% of total scale variance. Confirmatory factor analysis supported this three-factor model, yielding excellent model fit indices (CFI = 0.976, TLI = 0.966, RMSEA = 0.055, SRMR = 0.032), with the Bayesian Information Criterion supporting the superordinate structure. Differential item functioning analysis indicated item-equivalence relative to athletes’ level of education and ethnicity. As predicted, a multivariate effect indicated higher APSQ scores for currently injured athletes (p = .040) with a univariate effect on the Performance subscale. The APSQ may help identify early symptoms of athlete psychological strain facilitating timely management. Replication and validation studies in broader samples, including female athletes and comparison with other athlete-specific, coping and stress measures are needed.

Age-specific norms and validation of the German SDQ parent version based on a nationally representative sample (KiGGS).

The Strengths and Difficulties Questionnaire (SDQ) is the most widely used mental health screening instrument for children and adolescents. It is a short questionnaire including 25 items that can be answered by parents, teachers or children. There are two studies which report norms for the German SDQ parent version. They do not include children younger than 6years. Moreover, whether the German SDQ parent version is measurement invariant across age has not yet been investigated. The absence of measurement invariance across age would support the use of age-specific norms that are not yet available for the German SDQ parent version. We used data of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS), a nationally representative survey including 14,835 children aged 3-17years, to assess measurement invariance of the German SDQ parent version across the full age range. Multi-group confirmatory factor analysis revealed that the hyperactivity and emotional symptoms subscales are not comparable between children of different ages. This supports the use of age-specific norms for these two subscales and for the total SDQ. We used methods of centile estimation to smoothly model the centiles of the SDQ totalscore and the subscale scores in dependence on age. These age-specific centiles reflect the developmental course of SDQ problems in children (including preschoolers) and adolescents living in Germany. They can be used to identify children and adolescents with abnormal behaviour, while accounting for the developmental course of emotional and behaviour problems.

Occult Suicidality and Psychiatric Disease Among Emergency Department Patients with Low-acuity Chief Complaints.

IntroductionPatients presenting to emergency departments (ED) are often screened for suicidality, even when their chief complaint does not involve mental health concerns. Patient receptiveness to ED-based mental health screening and intervention is unknown, particularly among patients with low-acuity chief complaints, who often prioritize rapid evaluation and discharge.MethodsThis cross-sectional study included adults with low-acuity chief complaints presenting to an urban, academic ED in the Northeastern United States during daytime and evening hours, from 2015 to 2016. Participants completed validated mental health screening instruments, including the Suicide Behaviors Questionnaire-Revised and the Patient Health Questionnaire-4. Participants were also asked to rate the importance of addressing mental health concerns during their ED visit.ResultsWe approached 1,688 patients, and 816 (48.4%) consented to participate in the study. Of these, 27% screened positive for anxiety and 25% screened positive for depression. Even among patients with no prior depression history, 17% were at high risk of depression. Eleven percent of participants were at high risk for suicidal behavior, including 5% of those with no reported history of depression or bipolar disorder. Thirty-five percent of patients at risk for suicide and 53% of those at high risk of depression thought it was important or very important to address these issues during the ED visit.ConclusionSymptoms of mental health disorders were common among this group of ED patients presenting with low-acuity chief complaints. Patients often desired to address these mental health concerns as part of their ED visit.