Screening instruments in child and adolescent psychiatry: general and methodological considerations

Michel, Chantal; Schultze‐Lutter, Frauke; Schimmelmann, Benno Karl Edgar

doi:10.1007/s00787-014-0608-x

Cited by 17 publications

(27 citation statements)

References 19 publications

(31 reference statements)

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“…Furthermore, the success of preventive approaches also depends on a sufficiently high rate of target persons who are reached by it. Thus, to reach also CHR persons who do not actively seek help for their mental problems, more research in the general population is needed to develop ethically justified means such as well-validated and reliable screeners [68] on the basis of those already proposed [49,66,85].…”

Section: Discussionmentioning

confidence: 99%

EPA guidance on the early detection of clinical high risk states of psychoses

et al. 2015

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The aim of this guidance paper of the European Psychiatric Association is to provide evidence-based recommendations on the early detection of a clinical high risk (CHR) for psychosis in patients with mental problems. To this aim, we conducted a meta-analysis of studies reporting on conversion rates to psychosis in non-overlapping samples meeting any at least any one of the main CHR criteria: ultra-high risk (UHR) and/or basic symptoms criteria. Further, effects of potential moderators (different UHR criteria definitions, single UHR criteria and age) on conversion rates were examined. Conversion rates in the identified 42 samples with altogether more than 4000 CHR patients who had mainly been identified by UHR criteria and/or the basic symptom criterion 'cognitive disturbances' (COGDIS) showed considerable heterogeneity. While UHR criteria and COGDIS were related to similar conversion rates until 2-year follow-up, conversion rates of COGDIS were significantly higher thereafter. Differences in onset and frequency requirements of symptomatic UHR criteria or in their different consideration of functional decline, substance use and co-morbidity did not seem to impact on conversion rates. The 'genetic risk and functional decline' UHR criterion was rarely met and only showed an insignificant pooled sample effect. However, age significantly affected UHR conversion rates with lower rates in children and adolescents. Although more research into potential sources of heterogeneity in conversion rates is needed to facilitate improvement of CHR criteria, six evidence-based recommendations for an early detection of psychosis were developed as a basis for the EPA guidance on early intervention in CHR states.

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Section: Discussionmentioning

confidence: 99%

EPA guidance on the early detection of clinical high risk states of psychoses

et al. 2015

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“…Prognostic testing is commonly used in preventive medicine . While a screening test should identify all individuals who may develop the disease , a prognostic test is used to predict the development or not of the future disease when a patient shows some heralding signs or symptoms. Examples of predictive testing in somatic medicine include fasting glucose and oral glucose tolerance test and glycated haemoglobin to detect subjects at high risk for diabetes (pre‐diabetes or intermediate hyperglycaemia) .…”

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confidence: 99%

“…Predictive values are not fixed indicators of a test performance, but are affected by the prevalence of the condition . Within help‐seeking CHR+ samples, the ability of the above psychometric instruments to identify true positives is accumulating to 29% at 2‐year follow‐up – a finding comparable to other preventive approaches in medicine .…”

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confidence: 99%

At risk or not at risk? A meta‐analysis of the prognostic accuracy of psychometric interviews for psychosis prediction

et al. 2015

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An accurate detection of individuals at clinical high risk (CHR) for psychosis is a prerequisite for effective preventive interventions. Several psychometric interviews are available, but their prognostic accuracy is unknown. We conducted a prognostic accuracy meta-analysis of psychometric interviews used to examine referrals to high risk services. The index test was an established CHR psychometric instrument used to identify subjects with and without CHR (CHR1 and CHR2). The reference index was psychosis onset over time in both CHR1 and CHR2 subjects. Data were analyzed with MIDAS (STATA13). Area under the curve (AUC), summary receiver operating characteristic curves, quality assessment, likelihood ratios, Fagan's nomogram and probability modified plots were computed. Eleven independent studies were included, with a total of 2,519 help-seeking, predominately adult subjects (CHR1: N51,359; CHR2: N51,160) referred to high risk services. The mean follow-up duration was 38 months. The AUC was excellent (0.90; 95% CI: 0.87-0.93), and comparable to other tests in preventive medicine, suggesting clinical utility in subjects referred to high risk services. Meta-regression analyses revealed an effect for exposure to antipsychotics and no effects for type of instrument, age, gender, follow-up time, sample size, quality assessment, proportion of CHR1 subjects in the total sample. Fagan's nomogram indicated a low positive predictive value (5.74%) in the general non-help-seeking population. Albeit the clear need to further improve prediction of psychosis, these findings support the use of psychometric prognostic interviews for CHR as clinical tools for an indicated prevention in subjects seeking help at high risk services worldwide.

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“…The experts warned that instruments that yield false negatives could lead to lack of adequate treatment, while those that yield false positives could lead to unjustified medicalization and cruel stigmatization of those erroneously found to be at risk [66,[68][69][70]. Other challenges mentioned by our panel were language difficulties, the misleading capture of transitory rather than with Arabic numerals corresponding to the challenges within each theme, by rank.…”

Section: Design and Validation Of Screening Toolsmentioning

confidence: 96%

The ethical, social, and cultural dimensions of screening for mental health in children and adolescents of the developing world

et al. 2020

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Despite their burden and high prevalence, mental health disorders of children and adolescents remain neglected in many parts of the world. In developing countries, where half of the population is younger than 18 years old, one of every five children and adolescents is estimated to suffer from a mental health disorder. It is then essential to detect these conditions through screening in a timely and accurate manner. But such screening is fraught with considerable ethical, social, and cultural challenges. This study systematically identifies, for the first time, these challenges, along with potential solutions to address them. We report on the results of an international multi-and inter-disciplinary three-round Delphi survey completed by 135 mental health experts from 37 countries. We asked these experts to identify and rank the main ethical, social, and cultural challenges of screening for child and adolescent mental health problems in developing nations, and to propose solutions for each challenge. Thirty-nine significant challenges emerged around eight themes, along with 32 potential solutions organized into seven themes. There was a high degree of consensus among the experts, but a few interesting disagreements arose between members of the panel from high-income countries and those from low-and middle-income nations. The panelists overwhelmingly supported mental health screening for children and adolescents. They recommended ensuring local acceptance and support for screening prior to program initiation, along with careful and comprehensive protection of human rights; integrating screening procedures into primary care; designing and implementing culturally appropriate screening tools, programs, and follow-up; securing longterm funding; expanding capacity building; and task-shifting screening to local non-specialists. These recommendations can serve as a guide for policy and decision-making, resource allocation, and international cooperation. They also offer a novel approach to

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Screening instruments in child and adolescent psychiatry: general and methodological considerations

Cited by 17 publications

References 19 publications

EPA guidance on the early detection of clinical high risk states of psychoses

EPA guidance on the early detection of clinical high risk states of psychoses

At risk or not at risk? A meta‐analysis of the prognostic accuracy of psychometric interviews for psychosis prediction

The ethical, social, and cultural dimensions of screening for mental health in children and adolescents of the developing world

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