Primary care is accessible and ideally placed for case finding of patients with lifestyle and mental health risk factors and subsequent intervention. The short selfadministered Case-finding and Help Assessment Tool (CHAT) was developed for lifestyle and mental health assessment of adult patients in primary health care. This tool checks for tobacco use, alcohol and other drug misuse, problem gambling, depression, anxiety and stress, abuse, anger problems, inactivity, and eating disorders. It is well accepted by patients, GPs and nurses. AimTo assess criterion-based validity of CHAT against a composite gold standard. Design of studyConducted according to the Standards for Reporting of Diagnostic Accuracy statement for diagnostic tests. SettingPrimary care practices in Auckland, New Zealand. MethodOne thousand consecutive adult patients completed CHAT and a composite gold standard. Sensitivities, specificities, positive and negative predictive values, and likelihood ratios were calculated. ResultsResponse rates for each item ranged from 79.6 to 99.8%. CHAT was sensitive and specific for almost all issues screened, except exercise and eating disorders. Sensitivity ranged from 96% (95% confidence interval [CI] = 87 to 99%) for major depression to 26% (95% CI = 22 to 30%) for exercise. Specificity ranged from 97% (95% CI = 96 to 98%) for problem gambling and problem drug use to 40% (95% CI = 36 to 45%) for exercise. All had high likelihood ratios (3-30), except exercise and eating disorders. ConclusionCHAT is a valid and acceptable case-finding tool for most common lifestyle and mental health conditions.
Background: Problem gambling often goes undetected by family physicians but may be associated with stress-related medical problems as well as mental disorders and substance abuse. Family physicians are often first in line to identify these problems and to provide a proper referral. The aim of this study was to compare a group of primary care patients who identified concerns with their gambling behavior with the total population of screened patients in relation to co-morbidity of other lifestyle risk factors or mental health issues.
In treatment of problem gambling in New Zealand, brief telephone interventions are associated with changes in days gambling and dollars lost similar to more intensive interventions, suggesting that more treatment is not necessarily better than less. Some client subgroups, in particular those with greater problem severity and greater distress, achieve better outcomes when they receive more intensive treatment.
There is a growing interest in the comorbidity of "substance use disorder" and "problem gambling." although there has been little study specifically on people with "alcohol dependence" who are being treated in general alcohol- and drug-user outpatient settings. This study aimed to determine the nature and extent of gambling in a sample of 124 mild-moderate alcohol-dependent outpatients. Of these, 79.8% had gambled in the previous 6 months and 29.8% on at least a weekly basis. Although a wide range of gambling modes was used, by far the commonest was Lotto, a national weekly lottery, at 60.5%. Some 19.4% were found to manifest current "problem gambling" [i.e., scored at least 1 on the South Oaks Gambling Screen (SOGS) instrument], and a further 4.0% were found to manifest pathological gambling confirmed by Diagnostic and Statistical Manual of Mental Disorders Version IV (DSMIV) diagnosis. "Problem gamblers" were significantly more likely to be involved in all modes of gambling compared with non problem gamblers. However, the most differentiating modes, in order, were gambling machines, dogs, casino, and horses. Treatment implications of these findings are discussed. A two-arm model of intervention for problem gambling within the alcohol- and drug-user treatment setting is proposed.
Prison populations have been identified as having elevated levels of problem gambling prevalence, and screening for problem gambling may provide an opportunity to identify and address a behaviour that may otherwise lead to re-offending. A problem gambling screen for this purpose would need to be brief, simple to score, and be able to be administered, with limited training, by prison assessors. The Eight Screen was developed as a brief tool for Family Doctors to use in a patient population, but has also been used effectively in more generalised populations. In this study 100 inmates received into a medium security prison were screened using the Eight screen and the South Oaks Gambling Screen (SOGS), with those scoring three or more on either screen then being assessed by a specialist clinician using DSM-IV Pathological Gambling Disorder criteria. Twenty-nine inmates were screen positives who also correlated highly with assessed gambling pathology.The Eight Screen appears to be a suitable gambling screen for prison use and has since been adopted as an assessment instrument by the New Zealand Department of Corrections.
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