Brief Screening Tool for Stepped-Care Management of Mental and Substance Use Disorders

Lovero, Kathryn L.; Basaraba, Cale; Khan, Saida; Suleman, Antonio; Mabunda, Dirceu; Feliciano, Paulino; Santos, Palmira dos; Fumo, Wilza; Mandlate, Flavio; Greene, M. Claire; Salem, Andre Fiks; Mootz, Jennifer J.; Mocumbi, Ana Olga; Duarte, Cristiane S.; Gouveia, Lídia; Oquendo, María A.; Wall, Melanie M.; Wainberg, Milton L.

doi:10.1176/appi.ps.202000504

Cited by 17 publications

(28 citation statements)

References 27 publications

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“…The Mozambique Ministry of Health has included child and adolescent mental health as a priority in its Strategy and Action Plan for Mental Health 2016-2026 [21] and is working to implement task-shifted adolescent mental health services. However, like in other LMIC [22], there has been almost no research on adolescent mental health locally and, though two studies have demostrated the validity of brief mental health assessment tools adapted for Mozambican adults [23,24], to our knowledge, none have been evaluated in Mozambican adolescents.…”

Section: Introductionmentioning

confidence: 92%

Validation of brief screening instruments for internalizing and externalizing disorders in Mozambican adolescents

et al. 2022

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Background Mental disorders are the leading cause of disability for youth worldwide. However, there is a dearth of validated, brief instruments to assess mental health in low- and middle-income countries (LMIC). We aimed to facilitate identification of mental disorders in LMIC contexts by adapting and validating measures of internalizing and externalizing disorders for adolescents in Mozambique, an LMIC in southeastern Africa. Methods We selected instruments with good support for validity in high-income and other LMIC settings: the Patient Health Questionnaire Adolescent (PHQ-A), Generalized Anxiety Disorders 7 (GAD-7), and Strengths and Difficulties Questionnaire (SDQ). Instruments were adapted by local and international mental health specialists followed by cognitive interviews (n = 48) with Mozambican adolescents. We administered the instruments along with the Miniature International Neuropsychiatric Interview for Children and Adolescents (MINI-KID)to 485 adolescents aged 12–19 years attending two secondary schools in Maputo City, Mozambique. One week later, we re-administered instruments to a randomly selected sample of 49 adolescents. Results Participants were 66.2% (n = 321) female and the average age was 15.9 (S.D = 1.7).Internal consistency (alpha = 0.80, PHQ-A; 0.84, GAD-7; 0.80, SDQ) and test–retest reliabilty (ICC = 0.74, PHQ-A; 0.70, GAD-7; 0.77, SDQ) were acceptabe for the PHQ-A, GAD-7, and the full SDQ. The SDQ internalizing subscale showed poor test–retest reliability (ICC = 0.63) and the SDQ externalizing subscale showed poor internal consistency (alpha = 0.65). All instruments demonstrated good sensitivity and specificity (> 0.70). Youden’s index identified optimal cutoff scores of 8 for the PHQ-A, 5 for the GAD-7, 10 for the SDQ internalizing and 9 for the SDQ externalizing subscales, though a range of scores provided acceptable sensitivity and specificity. Conclusions Our data supports reliability and validity of the PHQ-A, GAD-7, and SDQ instruments for rapidly assessing mental health problems in Mozambican adolescents. Use of these tools in other contexts with limited specialists may asist with expanding mental health assessment. Specific instrument and cutoff selection should be based on screening goals, treatment resources, and program objectives.

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Section: Introductionmentioning

confidence: 92%

Validation of brief screening instruments for internalizing and externalizing disorders in Mozambican adolescents

et al. 2022

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“…Our study shows the importance of identifying and treating most mental disorders among PWH as they also negatively impact ART adherence, quality of life, and the 95-95-95 targets. Researchers should consider using valid ART adherence measures and interventions and rigorous, and validated comprehensive mental health assessments (58) with accompanying evidence-based treatments (83) to be implemented through task-shifting approaches integrated within HIV care in Mozambique and throughout the region.…”

Section: Discussionmentioning

confidence: 99%

“…Participants were recruited from 2 primary healthcare facilities (health centers) and 1 tertiary facility in Maputo (general hospital) between May 16 and Jun 8, 2018, and from 3 primary healthcare facilities in Nampula between Nov 28 to Dec 13, 2018. These participants were selected from 1469 adults who had been recruited into a cross-sectional validation study conducted to develop a screening tool for multiple mental disorders (58). Patients and those accompanying them were considered eligible for the study, if they were 18 years of age or older, did not display or reported any cognitive impairment, and provided written consent to participate in the study.…”

Section: Methodsmentioning

confidence: 99%

Mental disorders and adherence to antiretroviral treatment in health facilities in Mozambique

Mandlate

Green

Pereira

et al. 2022

Preprint

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Introduction: Less adherence to antiretroviral treatment (ART) has been found among people suffering from HIV (PWH) with comorbid mental disorders like depression and alcohol use in Mozambique, a Sub-Saharan African country. However, less is explored with regards to other mental disorders. Methods: This study assessed the association of multiple mental disorders and adherence to ART based on the data from primary/tertiary health care facilities in Maputo and Nampula, Mozambique. We administered a sociodemographic questionnaire, Mini International Neuropsychiatric Interview (MINI) Plus 4.0.0 adapted for use in Mozambique to assess mental conditions, and a 3-item self-report to measure ART adherence. Results: Out of 1469 participants, 409 were HIV positive (self-report), with an average age of 36.7 years (SD=9.8), and 30.4% were male. The most common mental disorders were major depressive disorder (27.34%) followed by psychosis (22.03%), suicidal ideation/behavior (15.44%), and alcohol-use disorder (8.35%). Higher levels of non-adherence to ART [(Mean Difference=1.19, 95% CI: 1.04, 1.37)] and the likelihood of missing at least one dose in the last 30 days (OR=3.06, 95% CI: 2.00, 4.67) were found in participants with any mental disorder compared to those without a mental disorder. The highest levels of non-adherence were observed among those with drug use disorders and panic disorder. Conclusions: In Mozambique, PWH with any co-occurring mental conditions had a lower probability of ART adherence. Integrating comprehensive mental health assessment and treatment and ART adherence interventions tailored to PWH with co-occurring mental disorders is necessary to attain optimal ART adherence and reach the UNAIDS ART target. Keywords:Mental disorders, ART adherence, HIV/AIDS treatment, Mozambique

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“…One such advance which covers a gap in current screening instruments is the “Electronic Mental Wellness Tool” (E-mwTool) [ 29 ], which was developed and validated in a low-income country, Mozambique (Africa [ 2 , 30 ]). Thus, it has not been tested in developed countries or languages different from Portuguese.…”

Section: Introductionmentioning

confidence: 99%

The Electronic Mental Wellness Tool as a Self-Administered Brief Screening Instrument for Mental Disorders in the General Spanish Population during the Post-COVID-19 Era

Martínez-Nicolás

Basaraba

Gómez

et al. 2023

IJERPH

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(1) Background: In the “post-COVID-19 era”, there is a need to focus on properly assessing and addressing the extent of its well-established mental health collateral damage. The “Electronic Mental Wellness Tool” (E-mwTool) is a 13-item validated stepped-care or stratified management instrument that aims at the high-sensitivity captures of individuals with mental health disorders to determine the need for mental health care. This study validated the E-mwTool in a Spanish-speaking population. (2) Methods: It is a cross-sectional validation study using the Mini International Neuropsychiatric Interview as a criterion standard in a sample of 433 participants. (3) Results: About 72% of the sample had a psychiatric disorder, and 67% had a common mental disorder. Severe mental disorders, alcohol use disorders, substance use disorders, and suicide risk had a much lower prevalence rate (6.7%, 6.2%, 3.2%, and 6.2%, respectively). The first three items performed excellently in identifying any mental health disorder with 0.97 sensitivity. Ten additional items classified participants with common mental disorders, severe mental disorders, substance use disorders, and suicide risk. (4) Conclusions: The E-mwTool had high sensitivity in identifying common mental disorders, alcohol and substance use disorders, and suicidal risk. However, the tool’s sensitivity in detecting low-prevalence disorders in the sample was low. This Spanish version may be useful to detect patients at risk of mental health burden at the front line of primary and secondary care in facilitating help-seeking and referral by their physicians.

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Brief Screening Tool for Stepped-Care Management of Mental and Substance Use Disorders

Cited by 17 publications

References 27 publications

Validation of brief screening instruments for internalizing and externalizing disorders in Mozambican adolescents

Validation of brief screening instruments for internalizing and externalizing disorders in Mozambican adolescents

Mental disorders and adherence to antiretroviral treatment in health facilities in Mozambique

The Electronic Mental Wellness Tool as a Self-Administered Brief Screening Instrument for Mental Disorders in the General Spanish Population during the Post-COVID-19 Era

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