Validation of screening tools for common mental health disorders in the methadone maintenance population in Hanoi, Vietnam

Abstract

Background Common mental health disorders (CMDs), including depression, anxiety and post-traumatic stress disorder (PTSD) may worsen both HIV and drug use outcomes, yet feasible tools to accurately identify CMDs have received limited study in this population. We aimed to validate the Patient Health Questionnaire (PHQ-9), Generalized Anxiety Disorder screen (GAD-7) and Primary Care PTSD screen for DSM-5 (PC-PTSD-5) in a methadone maintenance therapy (MMT) patient population in Hanoi, Vietnam. Methods We conducted a cross-sectional survey. The PHQ-9, GAD-7, and PC-PTSD-5 were administered to MMT patients. A blinded interviewer administered the Mini-International Neuropsychiatric Interview (MINI) as the reference gold standard. Total scores of each tool were compared with the MINI diagnoses using a receiver operating characteristic curves, and we identified the optimal respective cut-off scores using the Youden’s Index. Results We enrolled 400 MMT patients. Approximately 99.3% were male (n = 397) and 21.8% (n = 87) were HIV positive. The prevalence of major depressive disorder, generalized anxiety disorder and PTSD, respectively, was 10.5, 4 and 2%. Optimal cut-off scores for the PHQ-9, GAD-7 and PC-PTSD were ≥ 5, ≥3, and ≥ 4 with a sensitivity/specificity of 95.2%/91.9, 93.8%/87.5, and 62.5%/95.2%. Conclusions The prevalence of CMDs in the MMT population was lower than expected. A lower cut-off score may be considered when screening for CMDs in this population. Further research should investigate the validity of somatic symptom-based screening tools among other drug-using or MMT populations.

Psychometric Properties of Vietnamese Versions of the Clinician-Rated and Self-Reported Quick Inventory of Depressive Symptomatology and the Patient Health Questionnaire

“…This finding is consistent with the finding of a study of Vietnamese cancer patients that reported 87% sensitivity and 58% specificity. 24 In contrast, other studies have suggested higher cut-off 23 a score of 7 in medical students (82% sensitivity and 71% specificity), 25 and a score of 8 in patients with epilepsy (87% sensitivity and 82% specificity). 22 Some international studies have suggested higher cut-off scores when screening for MDD in primary care, including a score of 6 (91% sensitivity and 72% specificity), 31 a score of 10 (88% sensitivity and 88% specificity), 19 and a score of 11 (83% sensitivity and 83% specificity).…”

“…19 In PHCs, the PHQ-9 is easy to administer with outstanding discriminatory performance and accurate psychometric properties. 20 The Vietnamese PHQ-9 has been validated in sexual minority women, 21 patients with epilepsy, 22 patients undergoing methadone therapy, 23 patients with cancer, 24 and medical students. 25 It has good internal consistency, with a Cronbach's alpha of 0.81 for medical students and 0.86 for sexual minority women.…”

Prevalence, assessment and correlates of mental health problems in neglected tropical diseases: a systematic review

“…The insight that population characteristics can affect responses to study measures has motivated validation studies of screening measures in different populations. 34 , 35 Thus, while the relatively high prevalence of depressive symptoms, anxiety and stress in persons with NTDs could reflect the mental health burden in this population, it could also be due to the artifact of the screening tools. The SRQ, developed by the World Health Organization (WHO), screens for the presence of mental disorders in patients contacting primary healthcare providers.…”

Association of mental health conditions and functional gastrointestinal disorders among Vietnamese new-entry medical students

“…The questionnaire comprised the following five parts: (1) demographic characteristics including age, gender, height, weight, history of H. pylori infection and eradication (yes/no); (2) lifestyle habits covering breakfast habits, time for studying, extracurricular activities (yes/no), smoking (yes/no), alcohol intake (yes/no), living alone (yes/no); (3) sleeping habits including sleep timing, sleep duration, self-assessment of sleep quality (good/poor); (4) gastrointestinal symptoms including regurgitation, heartburn, epigastric pain, epigastric burning, postprandial fullness, early satiation, recurrent abdominal pain related to defecation or change in frequency or form of stool, the frequency and duration of these symptoms; and (5) mental health status evaluated by Generalised Anxiety Disorder Assessment (GAD-7) and Patient Health Questionnaire-9 (PHQ-9) scales, respectively. In this questionnaire, we used the Vietnamese versions of GAD-7 and PHQ-9, which have been validated in the Vietnamese population in previous studies [8,9].…”