Universal Mental Health Screening Research Articles

The Implementation of Universal Mental Health Screening in an Early College High School Program

Meeting the needs of gifted students is particularly challenging for school counselors. This practitioner action research study examined the effectiveness of implementing complete universal mental health screening with early college high school students. Using a complete mental health approach, we classified students into need-based groups. The groups were then aligned with the school’s multitiered system of supports (MTSS) and results identified 64 students (20.1%) as needing services beyond Tier 1. The correlational analysis demonstrated a strong negative correlation between social/emotional well-being and internalizing psychopathology ( r = −.579, p < .05). These findings further support the gifted population’s need for tailored identification and can be used to support the expansion of targeted school counseling services, because this group often is overlooked due to their high functioning in certain areas.

Universal Mental Health Screening in Teens at BullDoc Health Clinic – A Quality Improvement Project

Universal Mental Health Screening in Teens at BullDoc Health Clinic – A Quality Improvement Project

Scoping review of barriers to mental health service utilization among medical students and residents

Background: Undergraduate medical students and resident doctors face high rates of anxiety, depression, and psychological distress. Despite these issues, their mental health service utilization is very low; this can be attributed to various structural and attitudinal factors. The current research aims to highlight such barriers to accessing mental health care and bridge the existing research gap. Methods: A literature search on barriers to mental health treatment for medical students was conducted involving PubMed, Web of Science and Scopus databases, along with bibliographic search, from inception till 30th April 2023 to identify relevant English records with full-text available. Studies not involving medical students or not assessing treatment barriers, and non-original papers were excluded. Results: Our comprehensive literature search yielded 12 articles. We identified six key themes concerning barriers to accessing mental health services: stigmatization, attitudinal barriers, confidentiality concerns, time constraints, lack of knowledge, and access to services. Discussion: Stigmatization was found to be a prominent barrier, while attitudinal barriers included beliefs that mental health problems are a sign of weakness and should be managed independently. Medical students and residents also worried about breaches in confidentiality affecting their interpersonal relationships and career prospects. Time constraints due to demanding academic and clinical responsibilities also posed challenges in seeking mental health care. These critical barriers to mental health service utilization among medical students and residents can be addressed through mental health awareness campaigns in college campuses, universal mental health screening in medical schools, providing internet-based services and collaborative programs with local mental health professionals to widen the treatment options.

Potential mental health-related harms associated with the universal screening of anxiety and depressive symptoms in Australian secondary schools

BackgroundAnxiety and depressive disorders typically emerge in adolescence and can be chronic and disabling if not identified and treated early. School-based universal mental health screening may identify young people in need of mental health support and facilitate access to treatment. However, few studies have assessed the potential harms of this approach. This paper examines some of the potential mental health-related harms associated with the universal screening of anxiety and depression administered in Australian secondary schools.MethodsA total of 1802 adolescent students from 22 secondary schools in New South Wales, Australia, were cluster randomised (at the school level) to receive either an intensive screening procedure (intervention) or a light touch screening procedure (control). Participants in the intensive screening condition received supervised self-report web-based screening questionnaires for anxiety, depression and suicidality with the follow-up care matched to their symptom severity. Participants in the light touch condition received unsupervised web-based screening for anxiety and depression only, followed by generalised advice on help-seeking. No other care was provided in this condition. Study outcomes included the increased risk of anxiety, depression, psychological distress, decreased risk of help-seeking, increased risk of mental health stigma, determined from measures assessed at baseline, 6 weeks post-baseline, and 12 weeks post-baseline. Differences between groups were analysed using mixed effect models.ResultsParticipants in the intensive screening group were not adversely affected when compared to the light touch screening condition across a range of potential harms. Rather, participants in the intensive screening group were found to have a decreased risk of inhibited help-seeking behaviour compared to the light touch screening condition.ConclusionsThe intensive screening procedure did not appear to adversely impact adolescents’ mental health relative to the light touch procedure. Future studies should examine other school-based approaches that may be more effective and efficient than universal screening for reducing mental health burden among students.Trial registration Australian and New Zealand Clinical Trials Registry (ACTRN12618001539224) https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=375821.

The Brief Evaluation of Adolescents and Children Online (BEACON): Psychometric development of a mental health screening measure for school students.

This paper describes the development and psychometric evaluation of a brief self-report measure (BEACON) to inform universal mental health screening in schools. Items assess symptoms and impairment associated with anxiety and attention/hyperactivity problems (grades 4-11) as well as depression and eating difficulties (grades 6-11), with optional items for suicidality and self-harm (grades 7-11). Initial item examination based on Item Response Theory (IRT) and classical test theory involved 3844 students in grades 4 through 11 (Study 1) and identified 18 items for grades 4-5 and 31 items for grades 6-11 that fulfilled pre-set criteria. Study 2 extended testing with 10,479 students in grades 4-11 and added an additional four items assessing impairment associated with eating difficulties for older students (grades 6-11) creating a total of 35 items for grades 6-11. All items, for both grade-level versions, met the pre-set criteria for IRT and classical test theory analysis supporting their strength in the measurement of the dimensions of concern. The measure showed good reliability (subscale alphas .87 to .95). Validity was also demonstrated against standard symptom measures, school grades, school absenteeism, and help-seeking. The BEACON appears to be a psychometrically sound measure to use in the first stage of school-based screening for mental health problems.

Promotion of mental health and prevention of mental disorders in a rich welfare state: A Norwegian perspective

The population's mental health - their ability to handle emotions, think rationally, control their behavior, and maintain good relations with others - is a county's most important resource. Failing ability to do so, causes a country's most burdensome illnesses, mental distress and mental disorder, and hinders optimal utilization of other resources. In Norway, prevalence of mental illness is similar to that of other rich countries. Cost of mental illness corresponds to four times the cost of running the armed forces. In working age, loss of health from mental illness is greater than from all somatic non-communicable illness together, and loss of healthy life years is comparable to that of all cancers together. More treatment cannot curb this. Prevention is the only way out. Based on known risk and protecting factors, thirteen strategic principles for an effective prevention plan are presented together with the new Norwegian escalation plan for mental health 2023–2033. Four evidence-based priorities are recommended: universal mental health screening in pregnancy and early motherhood, mandatory guidance of all new day-care center teachers, mental health as a separate subject in school, and employment for all. Finally, with reference to human rights, seven mental health rights are suggested to assure that all organizations become mental health promoting.

The effectiveness of school based interventions to prevent psychotic experiences over a year period

Abstract Prevention is a key step to improving public mental health. Psychotic experiences, transient hallucinations/delusions which occur outside of a psychotic disorder, are relatively prevalent in the general population, particularly in childhood (∼15%) and adolescence (7-8%). They are associated with high psychopathology, increased risk of mental disorders, and suicidal behaviours. Therefore, psychotic experiences are well-placed to be used as a “marker” for prevention interventions. Current knowledge on prevention of psychotic experiences is extremely limited, with one previous study. With such limited information, but such potential benefits, we opted to conduct a secondary data analysis to test three school based interventions for their potential efficacy at preventing psychotic experiences. This study used the Saving and Empowering Lives in Europe study, Irish site (n = 1096). The interventions were a teacher training intervention, an educational tool, and a universal mental health screener and selective referral system (ProfScreen). A minimal intervention arm was used as a control. Schools were randomly assigned to one of the arms, and the students were followed over a year period. ProfScreen showed a 12-month reduction in point prevalence in psychotic experiences. This intervention was also associated with prevention of incident psychotic experiences, and a reduction in depression and anxiety scores in those with psychotic experiences. Ours is the first study to look at school based interventions for psychotic experiences, offering promising evidence for universal screening and selective referral strategies. Notably, the intervention showed improvements for all students in that sample, not just those who attended the clinical referral. This suggests that universal screening may itself support better mental health, and may be an important integrative component to improving mental health at a population level. Key messages • Psychotic experiences are a valid marker of vulnerable youth, and prevention of psychotic experiences in schools is possible using a universal screening and selective referral intervention. • Regardless of if the child was referred/attended services, overall mental health rates improved in this arm, suggesting a universal mental health screening tool in schools itself may be valuable.

Referral Patterns and Sociodemographic Predictors of Adult and Pediatric Behavioral Health Referrals in a Federally Qualified Health Center.

Federally Qualified Health Centers (FQHCs) provide comprehensive care to medically underserved populations whose access to behavioral health services may be limited. The goal of the current study was to examine referral patterns to specialty mental health and subsequent treatment initiation in an FQHC. In a 13-month period from March 2017 to March 2018, 1201 patients received a specialty mental healthcare referral. Of these patients, 37% reported scheduling an appointment with this referral, 44% refused the referral, 4% reported improvement in symptoms and not needing a referral, and 5% were not able to be reached due to a contact number being out of service. Common referral reasons among adults were depression, anxiety, and stress, and the most prevalent pediatric referral reasons were behavioral problems, depression, attention deficit hyperactivity disorder (ADHD), and anxiety. These data suggest that of the patients who received a specialty mental health referral, only one-third scheduled an appointment. The study also suggested that anxiety problems may be underrecognized in both adult and pediatric patients. Although significant attention has been put on increasing access to behavioral health services, there is still an unmet need. Universal mental health screening and increased coordination with specialty mental health providers in the community may better address this need.

Mental health disorders and survival among older patients with diffuse large B-cell lymphoma in the USA: a population-based study

Mental health disorders can potentially decrease quality of life and survival in patients with cancer. Little is known about the survival implications of mental health disorders in patients with diffuse large B-cell lymphoma (DLBCL). We aimed to evaluate the effect of pre-existing depression, anxiety, or both on survival in a US cohort of older patients with DLBCL. Using the Surveillance, Epidemiology, and End Results-Medicare (SEER-Medicare) database, we identified patients aged 67 years or older, diagnosed with DLBCL in the USA between Jan 1, 2001, and Dec 31, 2013. We used billing claims to identify patients with pre-existing depression, anxiety, or both before their DLBCL diagnosis. We compared 5-year overall survival and lymphoma-specific survival between these patients and those without pre-existing depression, anxiety, or both using Cox proportional analyses, adjusting for sociodemographic and clinical characteristics, including DLBCL stage, extranodal disease, and B symptoms. Among 13 244 patients with DLBCL, 2094 (15·8%) had depression, anxiety, or both disorders; 6988 (52·8%) were female, and 12 468 (94·1%) were White. The median follow-up for the cohort was 2·0 years (IQR 0·4-6·9 years). 5-year overall survival was 27·0% (95% CI 25·1-28·9) for patients with these mental health disorders versus 37·4% (36·5-38·3) for those with no mental health disorder (hazard ratio [HR] 1·37, 95% CI 1·29-1·44). Although survival differences between mental health disorders were modest, those with depression alone had the worst survival compared with no mental health disorder (HR 1·37, 95% CI 1·28-1·47), followed by those with depression and anxiety (1·23, 1·08-1·41), and then anxiety alone (1·17, 1·06-1·29). Individuals with these pre-existing mental health disorders also had lower 5-year lymphoma-specific survival, with depression conferring the greatest effect (1·37, 1·26-1·49) followed by those with depression and anxiety (1·25, 1·07-1·47) and then anxiety alone (1·16, 1·03-1·31). Pre-existing depression, anxiety, or both disorders present within 24 months before DLBCL diagnosis, worsens prognosis for patients with DLBCL. Our data underscore the need for universal and systematic mental health screening for this population, as mental health disorders are manageable, and improvements in this prevalent comorbidity might affect lymphoma-specific survival and overall survival. American Society of Hematology, National Cancer Institute, Alan J Hirschfield Award.

Could improving mental health disorders help increase cancer survival?

The Article by Thomas Kuczmarski and colleagues 1 Kuczmarski TM Tramontano AC Mozessohn L et al. Mental health disorders and survival among older patients with diffuse large B-cell lymphoma in the USA: a population-based study. Lancet Haematol. 2023; (published online June 1.)https://doi.org/10.1016/S2352-3026(23)00094-7 Google Scholar in The Lancet Haematology is the first in several decades to carefully consider the association between common pre-existing mental health disorders and survival outcomes in patients with diffuse large B-cell lymphoma. Previous studies have explored the possibility of a relationship using smaller cohorts of patients with Hodgkin lymphoma, acute myeloid leukaemia, or less common blood cancers, but by comparison this new study of patients with diffuse large B-cell lymphoma is substantially larger. Using data from the US Surveillance, Epidemiology and End Results Program (SEER) linked to Medicare claims data for those aged 67 years or older, the researchers assembled a cohort of 13 244 patients. The authors focused on anxiety and depression—the two most common mental health diagnoses—finding that one in six patients had been diagnosed with either disorder in the 2 years before their B-cell lymphoma diagnosis. Moreover, the presence of either or both disorders was associated with a subsequent decreased overall survival and 5-year lymphoma-specific survival. The authors consider delayed cancer treatments and barriers to adherence as likely explanations for these disparities, and recommend clinicians undertake comprehensive psychosocial assessments at diagnosis to identify patients at risk and develop psychological interventions to improve their subsequent survival. Mental health disorders and survival among older patients with diffuse large B-cell lymphoma in the USA: a population-based studyPre-existing depression, anxiety, or both disorders present within 24 months before DLBCL diagnosis, worsens prognosis for patients with DLBCL. Our data underscore the need for universal and systematic mental health screening for this population, as mental health disorders are manageable, and improvements in this prevalent comorbidity might affect lymphoma-specific survival and overall survival. Full-Text PDF

African Immigrant Mothers' Views of Perinatal Mental Health and Acceptability of Perinatal Mental Health Screening: Quantitative Cross-sectional Survey Study.

Mental health disorders are the most common perinatal conditions. They affect mothers, babies, partners, and support networks. However, <15% of pregnant and postpartum women seek timely help for their mental health care. Low perinatal mental health knowledge and universal screening unacceptability are cited as important deterrents to obtaining timely mental health care. The purpose of this quantitative cross-sectional study was 2-fold: (1) to determine African immigrant mothers' views of perinatal mental health and to identify predictors of those views and (2) to identify African immigrant mothers' views regarding perinatal mental health screening and to determine factors associated with those views. A cross-sectional survey was conducted using a convenience sample of African immigrant women from the province of Alberta, Canada. Respondents were eligible to participate if they were aged ≥18 years, had a live birth, and the infant was aged ≤2 years. Questions were drawn from the Edinburgh Postnatal Depression Scale, the Generalized Anxiety Disorder-7 scale, and additional questions were developed using the Alberta Maternal Mental Health 2012 survey as a guide and tested to reflect the immigrant context. Descriptive and multivariable regression analyses were conducted. Among the 120 respondents, 46.5% (53/114) were aged 31-35 years, 76.1% (89/117) were employed or on maternity leave, 92.5% (111/120) were married, and 55.6% (65/117) had younger infants aged 0 to 12 months. Significantly more respondents had higher levels of knowledge of postnatal (109/115, 94.8%) than prenatal (57/110, 51.2%) mental health (P<.001). Only 25.4% (28/110) of the respondents accurately identified that prenatal anxiety or depression could negatively impact child development. Personal knowledge of postpartum anxiety and depression was a significant predictor of prenatal and postnatal mental health knowledge. Most respondents strongly agreed or agreed that all women should be screened in the prenatal (82/109, 75.2%) and postnatal (91/110, 82.7%) periods. Respondents reported that their partner would be their first choice when seeking help and support. The acceptability of postnatal screening was a significant predictor of prenatal mental health knowledge (P<.001), whereas the acceptability of prenatal screening was a significant predictor of postnatal mental health knowledge (P=.03). Prenatal mental health knowledge was a significant predictor of both prenatal (P<.001) and postnatal (P=.001) screening acceptability. Although African mothers' knowledge of postnatal mental health is high, their prenatal mental health knowledge and its influence on child development are limited. Perinatal mental health interventions for African immigrant mothers in Alberta should target these knowledge gaps. The high acceptability of universal perinatal mental health screening among African mothers provides a promising strategy for perinatal mental health literacy initiatives to achieve optimal perinatal mental health.

A Phenomenological Investigation of Universal Mental Health Screening: Making Meaning for School Counseling

In the United States, K–12 schools have been going through a double pandemic: the COVID-19 pandemic and ongoing systemic racial injustices. Multitiered systems of support (MTSS), including universal mental health screening (UMHS), are highly recommended to assist students through these pandemics. While research on MTSS for school counselors is ample, school counseling UMHS literature is much more limited. As such, in the present study, we conducted a phenomenological investigation of participants’ experiences with UMHS, recruiting multidisciplinary, school-based UMHS team members, particularly school counselors. In describing the essence of participants’ experiences with UMHS, we identified 2 themes. The first theme is UMHS shifting the school culture, with subthemes (a) prioritizing prevention, (b) increasing collaboration, (c) using data, (d) gaining a holistic perspective, and (e) advocating for school counseling. The second theme is working through roadblocks, with subthemes (a) liability, (b) screener concerns, (c) resistance, (d) lack of time, and (e) staff wellness.

Universal Mental Health Screening: Steps for School Counselors Through Multidisciplinary Teaming

School counselors collaborate with multidisciplinary teams to implement universal mental health screening (UMHS) in schools and this work is especially pertinent in light of the U.S. K–12 mental health crisis. Because the school counseling UMHS literature is still emerging, expanding this literature is necessary, particularly to meet students’ mental health concerns. The present study examined the qualitative experiences of school counselors and other multidisciplinary UMHS team members implementing screening. We coded data through a phenomenological lens and used deductive coding from the National Center for School Mental Health’s (2018) eight steps to UMHS. We discuss not only the results but applications and implications, geared toward school counselors at the building and district level to assist with their practice.

Mental Health Screening in Pediatric Primary Care: Factors Associated With Screening Completion and Elevated Scores.

This study aimed to examine predictors of complete and elevated youth mental health screens. Parents of 4- to 11-year-old children completed the Strengths and Difficulties Questionnaire (SDQ) during a routine, universal mental health screening initiative in primary care. Bivariate logistic regressions were run to examine associations between independent (visit age, sex, race/ethnicity, language, insurance, and guardian) and dependent variables (screening completion and elevated SDQ score). Parents of younger and Spanish-speaking (vs English-speaking) children were less likely to have a complete SDQ screen. Among those with complete SDQ screens, older children, male children, those with public or no insurance, and those who had a mother (vs father) complete the screener were more likely to have an elevated score. Understanding patterns of screening completion rates and predictors of elevated screens provides valuable information to improve resource mapping and planning. Findings can inform mental health screening implementation and optimization within primary care.

Universal Mental Health Screening Practices in Midwestern Schools: AWindow of Opportunity for School Psychologist Leadership and Role Expansion?

The conducting of universal mental health screening is one widely endorsed practice suitable for use within P-12 school settings to more proactively identify children and young people experiencing or displaying characteristics of a mental health disorder. Absent routine screening, many school-age youth with mental health concerns, especially those of an internalizing nature, may go unidentified and left without timely treatment, support, and services. The current study, which employed survey methodology with principal respondents from four Midwestern states, primarily sought to contribute to and update the literature on the universal mental health screening practice habits of P-12 schools. Most principal respondents reported that their school does not currently conduct universal mental health screening and cited barriers (e.g., money, time, lack of support system in place) to screening commonly documented in prior studies. Many principals reported at least a moderate degree of interest in their school beginning to conduct universal screening in their buildings; however, a similar majority reported little to no knowledge about this important practice. Fortunately, principal respondents were generally interested in and receptive to support from their school psychologist in exploring and eventually implementing the conducting of universal mental health screening in their building. Implications for practice and future research, along with the potential for school psychologist leadership and role expansion, are discussed.

Antenatal depression screening and psychosocial assessment in an Australian private hospital: An evaluation.

Universal mental health screening and psychosocial assessment during pregnancy have been recommended as best practice, but uptake of universal programs in the private hospital system has been slow. The aim of this study was to evaluate the Pre-admission Midwife Appointment Program (PMAP), an antenatal mental health screening program at the Mater Hospital, Sydney. In this mixed-methods design study, PMAP interview data were collected for a consecutive series of 485 women who attended the PMAP during a 10-month period. Women also completed two postnatal telephone interviews (10 weeks and 9months postpartum). The interviews involved depression screening and questions about the program. Of the 485 participants, 4.1% screened positive for depression on the Edinburgh Postnatal Depression Scale. In total, 19% were identified as currently suffering from, or at risk of developing, perinatal mental health issues; referrals to support services were provided for the 13% who were not already linked in with appropriate supports. All women displayed a decrease in depressive symptom severity from pregnancy to 10 weeks and 9months postpartum. The PMAP was viewed positively by consumers, with >93% viewing the program as helpful and >98% saying that they would recommend the program to others. Additional program benefits identified included opportunities to gain practical information and prepare for motherhood and to think/reflect on their emotional well-being. Given the observed rates of psychosocial risk among this sample, related referral opportunities and positive consumer feedback, we recommend other Australian private hospitals consider implementing PMAP or similar programs.

Perceived social support on postpartum mental health: An instrumental variable analysis.

The postpartum period is a challenging transition period with almost one in ten mothers experiencing depression after childbirth. Perceived social support is associated with mental health. Yet empirical evidence regarding the causal effects of social support on postpartum mental health remains scarce. In this paper, we used a nationally representative panel data of women to examine causality between perceived social support and postpartum mental health. We used fixed-effect method and included dependent variable lags to account for past mental health condition before birth (i.e., the pre-pregnancy and prenatal periods). The study also used an instrumental variable approach to address endogeneity. We find a declining trend in postpartum mental health between 2002 to 2018. Our study also showed that past mental health (i.e., before childbirth) is positively correlated with postpartum mental health. A universal routine mental health screening for expectant and new mothers should remain a key priority to ensure mental wellbeing for the mothers and their infants.

The Impact of Universal Mental Health Screening on Pediatric Emergency Department Flow.

Assess the impact of universal mental health screening with MyHEARTSMAP on emergency department (ED) flow, an important aspect of feasibility. We hypothesized that the difference in departmental level ED length of stay (LOS) for screening and matched nonscreening days is less than 30 minutes. We conducted a 2-center, retrospective cohort study between December 2017 and June 2019. At each center, random mental health screening days were assigned over the course of 15 consecutive months. We matched each 24-hour screening day to a unique nonscreening day based on: location (Center 1 or Center 2); day type (weekday: Monday-Thursday or weekend: Friday-Sunday); date (±28 days); and 24-hour volume (±15 patients). We collected retrospective patient flow data, including LOS, across all ED visits to determine the difference in departmental level median LOS between matched screening and nonscreening days. There was not a statistically significant difference in departmental LOS between screening and nonscreening days. Overall, the difference in departmental LOS was -4.0 minutes (95% confidence interval, -9.8, 1.8) for screening days compared to nonscreening days, with a difference of -2.0 minutes (-9.0, 4.9) at Center 1 and -6.0 minutes (-15.4, 3.4) at Center 2. Our findings show that universal mental health screening with MyHEARTSMAP can be implemented without a significant impact of ED LOS.

Examining the predictive utility of the self-report Strengths and Difficulties Questionnaire with middle school students

This study aimed to investigate the added value of universal mental health screening in school settings. A total of 1735 students were screened using the youth self-report version of Strengths and Difficulties Questionnaire (SDQ-SR). Non-parametric models were fit to data from the SDQ-SR Internalizing and Externalizing subscales to predict total ODRs by the end of the school year. Final models confirmed the positive predictive relationship between SDQ-SR externalizing scores and ODRs and consistently found internalizing scores to be a negative predictor of ODRs. Specifically, for every 1-point increase in the Externalizing score, ODRs increase by .09 standard deviations; for every 1-point increase in Internalizing scores, ODRs decrease by 0.02 standard deviations. Findings suggested that students with internalizing concerns were likely under-identified when examining patterns in ODRs alone. The implementation of school-based universal mental health screening in addition to examining patterns in academic and behavioral outcomes may assist school personnel in identifying students with emerging social-emotional difficulties.

Advancing Mental Health Screening in Schools: Innovative, Field-Tested Practices and Observed Trends During a 15-Month Learning Collaborative.

Schools are well positioned to facilitate early identification and intervention for youth with emerging mental health needs through universal mental health screening. Early identification of mental health concerns via screening can improve long-term student development and success, but schools face logistical challenges and lack of pragmatic guidance to develop local screening policies and practices. This study summarizes mental health screening practices tested by six school districts participating in a 15-month learning collaborative. Qualitative analysis of 42 Plan-Do-Study-Act cycles revealed that districts tested quality improvement changes across seven screening practice areas, with all teams conducting at least one test to: 1) build a foundation; and 2) identify resources, logistics and administration processes. Quantitative data indicated that the average percentage of total students screened increased from 0% to 22% (range = 270 - 4,850 students screened at follow-up). Together, these results demonstrate how school districts not currently engaged in mental health screening can apply small, specific tests of change to develop a locally-tailored, practical and scalable process to screen for student mental health concerns. Lessons learned are provided to inform future directions for school-based teams.