Mental Health Screening Research Articles

Multi-Informant Universal Mental Health Screening for Preschool-Aged Children by Parents and Educators: A PRISMA Systematic Review.

Children develop rapidly in the preschool period, making accurate appraisals of mental health (MH) difficult. The preschool years are a key period for early identification of MH concerns and could benefit from multi-informant, universal MH screening (UMHS). This systematic review aimed to identify multi-informant UMHS measures for preschool-aged children, and to examine their clinical utility, effectiveness, and acceptability. Studies reporting the predictive and incremental validity, effectiveness or acceptability of parent and educator-report UMHS measures for children aged 3-5years were identified through CINAHL, Embase, ERIC, Medline, PsycINFO, Scopus and Web of Science. Studies were excluded if screening was not the primary focus, not universal, single informant, or primarily focussed on Autism Spectrum Disorder. A total of 11 studies using 10 measures was identified. Ten studies screened for broad MH difficulties. Three educator-report and one parent- and educator-report measures had acceptable predictive validity. One study reporting incremental validity found that adding educator-report to parent ratings significantly improved the identification of MH concerns. No studies reported on effectiveness. Three studies that explored acceptability reported strong support for either UMHS in general or specific measures. There are promising results that UMHS can accurately identify child MH concerns in the preschool period using parent and educator reports. However, with few of the examined measures reaching the benchmark standards for predictive validity and only one study examining incremental validity, further research is needed to establish clinical utility. UMHS with preschool populations appears to be acceptable; future studies should further examine multi-informant screening in preschool populations. This systematic review was registered with the International Prospective Register of Systematic Reviews (PROSPERO; https://www.crd.york.ac.uk/prospero ; registration number: CRD 42022383426).

Prevalence of depressive symptoms in adolescents living with HIV in Johannesburg, South Africa

Background: Adolescents living with HIV (ALWHIV) are more vulnerable to developing depressive symptoms. Despite this knowledge, the screening for depression is not routinely integrated into HIV treatment programmes.Aim: The study aimed to determine the prevalence of depressive symptoms among ALWHIV.Setting: The study was carried out in the primary healthcare clinics and an antiretroviral clinic situated in a district hospital, West Rand District, Johannesburg.Methods: This was a cross-sectional study of 125 ALWHIV. The modified Patient Health Questionnaire for Adolescents (PHQ-A) was used to screen for depressive symptoms with a score of ≥ 5 deemed significant. A distress protocol was used for immediate psychological intervention.Results: The prevalence of depressive symptoms was 44.8% and the majority of ALWHIV reported mild-moderate symptoms (36.8%). Overall, 25.6% of adolescents had suicidal behaviours. Those with psychosocial difficulties and those who reported a previous suicide attempt were 3.6 (adjusted odds ratio [aOR] 3.59, 95% confidence interval [CI]:1.17–11.03) and 6.9 (aOR 6.93, 95% CI:1.39–34.55) times likely to develop depressive symptoms, respectively.Conclusion: A high prevalence of depressive symptoms was found in ALWHIV. Psychosocial difficulties and previous suicide attempts were predictive factors for depressive symptoms. This highlights the unmet need for the integration of mental health screening and overall mental health services into adolescent HIV programmes.Contribution: This study emphasises an urgent need for routine mental health screening and prompt psychosocial support in ALWHIV.

Evaluation of New Mental Health Diagnoses After Pediatric Traumatic Injuries at a Level 1 Pediatric Trauma Center.

Traumatic injury is associated with significant mental health morbidity. To evaluate the need for implementation of active-post injury mental health screening at a Level 1 Pediatric Trauma center, we aimed to characterize all new mental health diagnoses after injury and evaluated for patient or injury factors that may aid in targeting of future screening. A single-center retrospective analysis of trauma patients aged 6-18years presenting in 2022 was performed. Our primary outcome was a new DSM-5 mental health diagnosis documented after traumatic injury. Patients with and without a new mental health diagnosis were compared by age, sex, race, ethnicity, injury type/mechanism, injury severity score (ISS), intensive care unit (ICU) admission, and length of stay (LOS). 492 patients were included. Their median (IQR) age was 13.5 (10.4, 15.4) years. The median (IQR) follow-up interval was 157 (9, 429) days. There were 24 (4.9%) children with a new mental health diagnosis: 12 (50%) with trauma-related stress disorders, with the remaining having diagnoses such as depressive or anxiety disorders. Patients with a new mental health diagnosis had longer LOS (3.0 [1.8, 7.5] vs 2.0 [1.0, 3.3] days, P = 0.02) and were more likely to have sustained penetrating injury (P = 0.01). There were no differences in demographics, rates of preexisting mental health diagnosis or area deprivation index (P > 0.05). There were fewer new mental health diagnoses in our cohort than expected, likely underestimating the acute need. Comprehensive post-injury screening is imperative to sufficiently identify and intervene upon mental health morbidity after pediatric trauma.

Mental health curricula in predoctoral dental school programs: A content analysis.

Given the prevalence of mental health concerns, dentists have an opportunity to provide mental health screenings to enhance overall patient care. The purpose of this study is to summarize and discuss the characteristics of mental health curricula related to patient care in accredited dental schools. We identified accredited predoctoral dental programs incorporating mental health training related to patient care into their curriculum. We summarized course characteristics and thematically analyzed course descriptions using headings from the National Library of Medicine. From our review of curricula from 80 dental programs, 27 included a mental health component, and these were found in both didactic and clinical courses. Behavioral science and building clinical competence were the most common themes. While mental health is an important component in overall patient care, a minority of accredited dental programs' curricula address it. Further, the manner and extent of inclusion varies. Including mental health training into dental curricula will better prepare dentists for their patients' comprehensive health needs.

Biomechanical factors influencing mental health in college students and the role of physical activity in cognitive resilience

The Mental Health (MH) of college students is increasingly becoming a public health concern, with rising rates of depression, anxiety, and stress. This study aims to explore the relationship between Biomechanical Factors (BF), Physical Activity (PA), and MH outcomes in college students, addressing gaps in current research that frequently overlook the biomechanical features of physical well-being. A cross-sectional observational design was employed, involving 200 college students aged 18–24. SP underwent comprehensive assessments, including postural analysis, movement pattern evaluation, and MH screening. Physical activity levels and cognitive resilience were also measured to evaluate their roles in mediating and moderating the relationships between BF and MH. Key findings revealed that poor biomechanical alignment, such as forward head posture and movement asymmetry, were significantly associated with higher levels of depression, anxiety, and stress. Correlation analysis showed that forward head posture correlated positively with depression (r = 0.52, p < 0.01) and anxiety (r = 0.47, p < 0.01). Movement asymmetry was also associated with MH disturbances (depression: r = 0.45, p < 0.01). PA mediated the relationship between BF and MH, with significant indirect effects via PA for forward head posture (0.18, p < 0.05). Cognitive resilience emerged as a significant moderator, buffering the negative impact of biomechanical inefficiencies on MH outcomes. Within-subject comparisons indicated improvements in BF and MH scores over a one-month follow-up, with decreases in forward head posture (−2.2 ± 1.5 degrees, p < 0.05) and depression scores (−1.5 ± 1.2, p < 0.01).

Psychological experience of patients with postpartum depression: A qualitative meta-synthesis.

To determine the psychological experiences of patients with postpartum depression by systematically reviewing, retrieving, and synthesizing data from qualitative studies. Nine databases were systematically searched for relevant publications, from database establishment to September 20, 2024. All qualitative studies in English and Chinese that explored the real-life experiences, feelings, etc., of individuals affected by postpartum depression after childbirth were included. The qualitative meta-synthesis was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations. Two independent reviewers selected these studies and evaluated the quality of each study, conducting a meta-analysis to integrate the results. A total of 28 studies revealed 12 sub-themes and 3 descriptive themes: negative physical and psychological experiences and coping strategies, role transition discomfort and impact, lack of relevant support. The prominence of negative physical and psychological experiences, the discomfort of role transformation, and the lack of relevant support in patients with postpartum depression. In future studies, more attention should be paid to maternal mental health, and full mental health screening during pregnancy and childbirth should be implemented. Psychological counseling services should also be provided to pregnant women. [REGISTRATION: PROSPERO ID: CRD42024504506].

Systematic Review: Mental Health Screening Tools for Collegiate Athletes

The mental health of college athletes has become a priority for the National Collegiate Athletic Association (NCAA) and for athletic departments across numerous Colleges and Universities. Sport social work has limited research exploring empirical evidence on the use and effectiveness of specific mental health assessments for the population of college athletes. College athletes experience a plethora of stressors and mental health concerns that will require the use of mental health assessments to determine the appropriate level of care. A systematic review was conducted utilizing the Cochrane Handbook of Systematic Reviews for Interventions. An initial search of sport social work literature yielded 1,199 articles. After the application of inclusion and exclusion criteria, five articles remained that met the full criteria for inclusion. Results indicate there are mental health assessment tools that have empirical data supporting their use with college athletes. Although appropriate mental health screening tools were identified, future research is necessary to expand the breadth of empirical data that supports additional mental health assessment tools for specific use with the population of college athletes. These tools should include a positive psychology component to reduce the stigma surrounding mental health care in the college athlete population and increase their likeliness to engage in mental health services.

Postnatal care after gestational diabetes – a systematic review of clinical practice guidelines

BackgroundGestational diabetes mellitus (GDM) is the most common metabolic disorder in pregnancy and later is associated with an increased risk of type 2 diabetes and other metabolic disorders. Consistent and evidence based postnatal care is key to improving maternal long-term health. We therefore aimed to review and compare recommendations of national and international clinical practice guidelines (CPG) for postnatal care after GDM and identify any evidence gaps in recommendations needing further research.MethodsWe searched five databases and forty professional organization websites for CPGs providing recommendations for postnatal care after GDM. CPGs which had full versions in English, endorsed, prepared, or authorized by a professional body, and published between 2013 and 2023 were eligible for inclusion. Two reviewers independently screened the articles, extracted the recommendations, and appraised the included CPGs using the Appraisal of Guidelines, Research, and Evaluation (AGREE) II tool.ResultsTwenty-six CPGs from 22 countries were included. Twelve CPGs (46%) were appraised as low quality with the lowest scoring domains being rigor of development and editorial independence. We found little high certainty evidence for most recommendations and few recommendations were made for maternal mental health and postpartum metabolic screening. Evidence gaps pertained to postpartum glucose screening, including frequency, tests, and ways to improve uptake, evaluation of effective uptake of lifestyle interventions, and ongoing long-term follow up care.ConclusionsMost of the postnatal care recommendations in GDM guidelines are not based on high certainty evidence. Further efforts are needed to improve the global evidence base for postnatal care after GDM to improve long-term maternal health.Protocol RegistrationThis review was registered in PROSEPRO (CRD42023454900).

Mental Health Experiences of Muslim American Women During the Perinatal Period

ObjectiveTo describe the mental health experiences of Muslim American women in the perinatal period. DesignQualitative descriptive. SettingTelephone interviews. ParticipantsEighteen Muslim American women who gave birth in the last 12 months. MethodsWe used a semistructured guide to conduct individual interviews and thematic network analysis to identify key themes across the interviews. ResultsParticipants had a mean age of 32.5 years, 83% were White, and 17% were Asian. Educational attainment ranged from high school diploma to doctorate degree (83% completed a bachelor’s degree or higher), and 83% reported U.S. citizenship. We identified four organizing themes: Need for Tailored Mental Health Support; Challenging Screening Experiences; Mental Health Experiences That Affect Maternal–Infant Bonding; and Faith, Culture, and Mental Health. ConclusionFindings underscore the need for culturally responsive mental health screening and enhanced support tailored to Muslim American women during the perinatal period. Health care providers should use culturally sensitive care approaches to build trust and enhance mental health outcomes.

Symptoms of depression, but not PTSD, influence cognitive performance in healthy Army National Guard Soldiers.

Research suggests that comorbid depression and PTSD may contribute to cognitive impairment. However, few studies have explored this dynamic in military personnel who report only subclinical symptoms of PTSD and depression. Army National Guard Soldiers (ARNG; N = 1415) completed the Automated Neuropsychological Assessment Metrics (ANAM), the PTSD Checklist (PCL), and the Center for Epidemiological Studies Depression Scale (CES-D). The effects of PTSD and depression symptoms on ANAM performance were examined using multiple linear regression analyses. Exploratory factor analysis and regression models examined the relationship between symptom clusters and ANAM performance. Six factors were identified: avoidance/flashbacks, cognitive/social difficulty, depressed mood, positive mood, sleep difficulty, and hypervigilance. Elevated symptoms of depression (measured using factor scores) were associated with poorer attention (β range -0.19-0.18, p range < 0.01-0.04, f2 effect size range 0.02-0.94). Depression symptoms were associated with diminished attentional performance in a large sample of ARNG Soldiers who reported no clinical diagnosis. This study was limited in that unmeasured factors other than depression, PTSD, or demographics may explain much of the variance in cognitive performance. These findings highlight the importance of careful mental health screening and strategies to heighten awareness of the potential detrimental effects of depression and PTSD on health and performance.

FREQUENCY OF GENERALIZED ANXIETY DISORDER IN HOSPITALIZED COVID-19 PATIENT

The COVID-19 pandemic has had a profound impact on mental health, with anxiety disorders being particularly prevalent among hospitalized patients. Identifying and addressing mental health issues like generalized anxiety disorder (GAD) is crucial for improving patient outcomes and providing holistic care. Objective: To determine the frequency of generalized anxiety disorder (GAD) among hospitalized COVID-19 patients at MTI-Hayatabad Medical Complex, Peshawar, and to explore its association with gender and socioeconomic status. Methods: A cross-sectional study was conducted in the Department of Psychiatry at MTI-Hayatabad Medical Complex, Peshawar, over six months, from October 16, 2021, to April 16, 2022. A total of 179 hospitalized COVID-19 patients, aged 25 years and above, were included. Patients presenting with symptoms of anxiety were assessed using the Generalized Anxiety Disorder-7 (GAD-7) scale. Unstable patients, who had a history of other mental disorders or were receiving treatment for depression and anxiety were excluded. Data were analyzed using statistical methods to explore associations between GAD and demographic factors such as gender and socioeconomic status. Results: The study included 179 COVID-19 patients, with a mean age of 43.50 ± 10.18 years. Generalized anxiety disorder was identified in 62 patients, representing 34.6% of the total population. GAD prevalence was significantly higher among female patients (p &lt; 0.001) and those from lower socioeconomic backgrounds (p = 0.002). Conclusion: This study highlights a high prevalence of generalized anxiety disorder among hospitalized COVID-19 patients, particularly among females and those of lower socioeconomic status. The findings underscore the need for routine mental health screening and targeted interventions to address anxiety in this vulnerable population.

Depression Among Resettled Karen Refugees in the United States: An Exploratory Pilot Study

Due to prolonged ethnic and religious persecution, the Karen have endured numerous traumatic experiences including systematic violence and mistreatment, resulting in long-term psychological sequelae. This study examines the prevalence of depression among Karen refugees from Burma ( N = 37) using a culturally grounded mental health screening tool within a primary health care community clinic in the southern United States. A total of 48.60% met the clinical cutoff for depression. The researchers identified three themes: (a) manifestations of depression, (b) depression linked to post-migration stressors, and (c) importance of support and education about depression. Family service organizations and resettlement agencies can assist Karen refugees by connecting them with social and tangible support, as well as providing education about depression. Future research should include Karen refugees from various parts of the United States to improve generalizability.

Predictors of perinatal cannabis use in colorado and the association with depression during pregnancy.

To evaluate the prevalence and predictors of cannabis use and reasons for use during and/or after pregnancy among Colorado birthing individuals. To determine the independent association of self-reported depression during pregnancy and cannabis used. Data from Health eMoms, a statewide perinatal longitudinal electronic surveillance system were analyzed. Perinatal cannabis use was defined as any use during and/or after pregnancy. Bivariate associations of birthing individual and infant characteristics with use were estimated using chi-square tests. Multivariable logistic regression was used to assess the independent relationship between depression and reported cannabis use versus no reported cannabis use. A weighted sample of 117,812 birthing individuals was analyzed from survey responses between 2018-2021. Among the 15,585 (13.3%) who reported perinatal cannabis use, 35.5% reported use during pregnancy and 87.3% reported post-partum use. Individuals with depression during pregnancy had 2.2 times higher adjusted odds (95% CI: 1.5. 3.3) of any perinatal cannabis use compared to those without depression. Among those who had any perinatal cannabis use, reported use for medical reasons was 92% during pregnancy, while 43% cited this as the reason for use 12-14months post-partum. Self-reported cannabis use during the perinatal period in a state with legalized recreational use was over 1 in 10. Use varied significantly by demographics and social factors with inconsistent perinatal guidance provided by healthcare professionals. Depression during pregnancy was significantly associated with use, illustrating the need for comprehensive mental health screening and therapeutic evidence-based interventions to support these individuals.

Mental health literacy of prospective brides in marriage preparedness: Scoping review

Mental well-being is inherent to one's overall health and societal harmony, empowering individuals to achieve their full potential and establish meaningful connections with others. Mental health literacy will thus possibly improve the preparation of prospective brides towards marriage, so that it will be lead to a healthy and happy marriage. Mental health literacy will thus possibly improve the preparation of prospective brides towards marriage, so that it will lead to a healthy and happy marriage. The researcher reported a scoping review of peer-reviewed articles to identify the importance of mental health literacy for brides and grooms about to be married about to be married. It was adopted only five of the six steps of Arskey and O’Malley’s framework to facilitate scoping of 998 articles published between 2013-2024 from databases (MEDLINE/Pubmed, Proquest, Science Direct with 12 articles reviewed. Our findings show that Our findings show that mental health of prospective brides of prospective brides can be improved by increasing their their mental health literacy. Improving mental health literacy requires premarital mental health screening policies, awareness campaigns, training courses, and educational workshops and can be through digital-based mass media/social media.

Developing an implementation blueprint: Lessons learned from integrating electronic patient-reported outcomes in HIV clinics in Alabama.

People living with HIV are disproportionately affected by depression, anxiety, and substance use which impede engagement with HIV treatment services and can increase risks of HIV-related morbidity and mortality. Capturing timely, accurate patient data at point of care is recommended to inform clinical decision-making and retain patients on the HIV care continuum. Currently, there is limited use of validated screening tools for substance use and mental health at the point of care in HIV clinics, even though people with HIV (PWH) have a high prevalence of these comorbidities. Even fewer clinics screen in a manner that encourages disclosure of stigmatized substance use, depression, and anxiety. Electronic patient-reported outcomes (ePROs) are an evidence-based modality to overcome such limitations by eliciting responses directly from patients via tablet, smartphone, or computer. To date, there is limited consensus on how to implement ePROs into non-academic settings and enhance uptake. Our team sought to address this gap by examining the implementation of ePROs, previously implemented in an academic clinic, to enhance screening and treatment of mental health (MH) and substance use at five Ryan White HIV/AIDS Program-funded clinics in Alabama. The ePROs were delivered through a multi-component intervention titled HIV + Service delivery and Telemedicine through Effective Patient Reported Outcomes (+STEP), which also provides targeted training to frontline clinicians, and resources for MH and substance use treatment for PWH without access to care. The objective of this study is to provide an implementation blueprint that can be tested and utilized in other HIV clinics to integrate ePROs and increase evidence-based screening for depression, anxiety, and substance use among PWH, as well as outline lessons learned from implementation to date. The findings from this study provide practical steps and advice based on our experience in implementing electronic patient-reported outcomes in HIV clinics in the US Deep South.

Effectiveness of multifaceted interventions including motivational interviewing and home-based rehabilitation program for improving mental and physical health in stroke patients: A randomized controlled trial

BackgroundIn Vietnam, early screening and intervention for post-stroke mental health are limited, with rising demand for home-based rehabilitation due to the scarcity of inpatient programs. ObjectivesWe aimed to evaluate the effectiveness of multifaceted interventions, including Motivational Interviewing and home-based rehabilitation, in improving the mental and physical health of stroke patients. DesignA randomized controlled trial at the Vietnam National Geriatric Hospital assessed a multi-intervention approach for stroke survivors from 2021 to 2022. Ninety-two participants (aged over 45 with a stroke diagnosis) were randomly assigned to an intervention group (Motivational Interviewing and home-based rehabilitation) or a control group (standard care), with 46 participants in each group. Outcomes for mental health (Patient Health Questionnaire-9, Fatigue Severity Scale, Mini-Mental State Examination) and physical health (Barthel Index) were measured at baseline and after 1, 3, and 6 months. Statistical analyses used t-tests, Cohen's d, and repeated measures ANOVA. ResultsOver 6 months, 37 participants completed the intervention program. Baseline characteristics were similar except for age, lesion locations, and National Institutes of Health Stroke Scale scores. The intervention group showed significant improvements in mental health and physical function. Patient Health Questionnaire-9 scores decreased from 9.1 to 1.8, and Fatigue Severity Scale scores dropped from 28.5 to 17.8, while Barthel Index scores improved from 58.8 to 68.8 (p < 0.001). ConclusionsWe found that participants who underwent Motivational Interviewing therapy and home-based rehabilitation were more likely than those receiving standard care to experience substantial improvements in both mental and physical health metrics. RegistrationThe research protocol was registered on ClinicalTrials.gov on August 1, 2021 (Identifier: NCT04941482, link: https://clinicaltrials.gov/study/NCT04941482).

Symptoms of Anxiety and Depression (SAD) in patients undergoing transcatheter aortic valve implantation. A multicentre Australian experience: The SAD-TAVI Study

Abstract Background Symptoms of anxiety and/or depression (SAD) commonly co-exist in severe aortic stenosis, associated with increased morbidity and mortality following transcatheter aortic valve implantation (TAVI). Despite this, mental health remains under-researched in the TAVI literature. Purpose To characterise the prevalence of SAD in those undergoing TAVI and identify patient phenotypes at highest risk of these symptoms. We also aimed to examine how SAD evolve following TAVI and establish factors predictive of improvement and regression in mental health. Methods Retrospective review of prospectively collected data from patients undergoing TAVI between 2018 and 2023 included in an Australian TAVI registry. Results Of 1279 patients, median age was 82 (IQR 77, 87), 41% were female and median STS score was 3.9 (2.3, 5.9). 353 (28%) patients reported moderate or worse SAD at baseline. Of this group, 260 (74%) had complete resolution in symptoms within 30-days. Body Mass Index&amp;lt;25 (adjusted odds ratio [aOR] 3.4, p&amp;lt;0.001), vascular site complications (aOR 3.4, p=0.029) and non-home discharge (aOR 2.4, p=0.036) independently predicted failed improvement in SAD. Onset of new SAD was uncommon, present in only 72 (8%) patients. Non-home discharge (19% vs 8%, p=0.006) and a composite endpoint of stroke, acute myocardial infarction, and heart-failure readmission (11% vs 4%, p=0.012) were more prevalent in this cohort. Conclusion Symptoms of anxiety and depression are common but under recognised in severe aortic stenosis. TAVI is highly effective at improving these symptoms. Regular screening for mental health should be adopted as a standard of care in TAVI.Evolution of SAD Following TAVI

Examining the relationship between religious volunteering and mental health screeners among firefighters

ABSTRACT Firefighters experience a high level of traumatic incidents in their work. This high level of exposure puts them at risk for trauma-related symptoms. These trauma symptoms include PTSD, suicide risk, alcohol misuse, and depression, and anxiety. Furthermore, repeated exposure has been found to lead to desensitization, flashbacks, irritability, and PTSD. Exposure to natural disasters may also impact ecospirituality. A survey was designed to include the Life Events Checklist, PHQ-9, GAD-7, PCL-5, and the SBQ-R. This survey was administered to firefighters from Northwest Florida in the fall of 2020 and spring of 2021. Participants were found to have higher levels of PTSD, anxiety, depression, and suicidal risk than the general population. Participants were further asked about their volunteering for religious organization activity. A significant relationship was found between volunteering for religious organization and mental health screeners. Religious volunteering predicted lower levels of PTSD symptoms, depression, and anxiety. The effect size was small.

Prior exposure to racial discrimination and patterns of acute parasympathetic nervous system responses to a race-related stress task among Black adults.

Black adults' prior exposure to racial discrimination may be associated with their acute parasympathetic reactivity to and recovery from a new race-related stressor. Existing analytical approaches to investigating this link obscure nuances in the timing, magnitude, and patterns of these acute parasympathetic nervous system (PNS) responses. In a re-analysis of a prior study, we utilize an hidden Markov model (HMM) approach to examine how prior experiences of racial discrimination are associated with intraindividual patterns of (1) physiological states of PNS activity and (2) patterns of and variability in transitions between these physiological states. Participants (N = 118) were Black young adults (range 18-29 years; Mage = 19.67, SDage = 2.04) who completed an online survey to index prior racial discrimination exposure, followed by an in-person lab visit during which their PNS activity in response to a race-related stress task was measured via electrocardiogram and converted into respiratory sinus arrhythmia. HMMs indicated evidence for two states: baseline and a second state representing a significant reduction in respiratory sinus arrhythmia. Most participants (93.22%) demonstrated a blunted response to the task, indicating that they did not transition from baseline during the procedure. Prior racial discrimination was not associated with HMM states or state transition parameters. Blunted physiological responses may be an important area of future investigation that could inform early life course mental and physical health screenings.

61 The HEADS-ED under 6: Validation of a mental health and developmental screening and triage tool

Abstract Background The HEADS-ED screening and triage tool was developed for children 6 years to young adults as a communimetric mental health (MH) and addictions screener to help clinicians identify and communicate areas of need and recommended clinical care. Few clinician-administered tools identify both MH and developmental needs in young children under 6. From a review of milestone tools and in consultation with paediatricians, psychiatrists, and family physicians, the HEADS-ED Under 6 is a MH and developmental screening and triage tool that was developed to screen and flag functional impairment and action required in several areas, including: Home &amp; caregivers, Eating &amp; sleeping, Activities &amp; peers, Development /speech/language/motor, Safety, Emotions &amp; behaviours and Discharge &amp; current resources (see http://heads-ed.com for more background and access to both tools available in English and French). Objectives Our objectives were to examine: 1) feasibility of implementing the new HEADS-ED Under 6 screening and triage tool in community and hospital settings, 2) clinical utility of the tool to assist with clinical decision making, and 3) validity of the tool against a comprehensive assessment. Design/Methods We conducted two implementation and validation studies to examine uptake of the tool and how the tool assists in clinical referral decisions to more specialized and intensive services at 2 sites. For our initial validation study, we piloted and validated the tool at a community MH agency in Ontario for children under the age of 6 from November 2019- March 2021 (N=566). For our cross-validation study, we examined how the tool was implemented within a regional coordinated access service housed in a paediatric hospital in Ontario from June 2021- August 2023 (N=589). Results For our initial validation study, the HEADS-ED Under 6 was widely used by intake workers (95%, N = 536/566) to communicate children’s MH and developmental needs (Figure 1) and assisted in recommending services of varying intensity. The tool showed good concordance with the InterRAI Early Years assessment in similar domains requiring no action (61.1% to 81.6%), requiring action but not immediate (49.2% to 88.0%) and requiring immediate action (66.7% to 100%) for children under 4 years old (p's &amp;lt;.001). Three clinical domains (Eating &amp; sleeping, Development/speech/language/motor, and Emotions &amp; behaviours) also independently predicted an urgent care recommendation (p's &amp;lt; .001). For our cross-validation study, the tool was used for all 589 intake appointments, and 96.4% (N = 568/589) had a level of need documented. HEADS-ED Under 6 clinical domains (.24-.38) and total scores (.52) were significantly correlated with level of need (p&amp;lt;.001). Higher HEADS-ED Under 6 total scores helped intake workers decide on more intense services based on level of need (p&amp;lt;.001; Figure 2). ROC analyses (AUC = .807, SE = 68.5% sensitivity, 79.5% specificity) confirmed a total score of 6 or above helped triage to more targeted and intense services. Conclusion The HEADS-ED Under 6 is a brief, straight-forward, and valid screening and triage tool that can be used by intake workers, physicians, and paediatricians to guide their interview in several areas of MH and development, communicate the severity of the child’s MH and developmental needs, and assist with determining level of need for services. When a HEADS-ED Under 6 total score reaches ≥6, clinicians should advocate for more intensive services when making MH service referrals.