Anxiety Screening in Polytrauma Patients by Use of Single-Item Reporting With the Neurobehavioral Symptom Inventory: How Brief Is Too Brief?

2021 ◽  
pp. 003329412110317
Author(s):  
Glen A. Palmer ◽  
Daniel G. Palmer
Keyword(s):  
Mental Health ◽  
Roc Curve ◽  
Single Item ◽  
Symptom Inventory ◽  
Mental Health Referral ◽  
Minimum Score ◽  
Polytrauma Patients ◽  
Cutoff Scores ◽  
Anxiety Screening ◽  
Post Hoc

Purpose/Objective: This study examined the clinical utility of a single item for anxiety from the Neurobehavioral Symptom Inventory (NSI) in determining the need for mental health referral for veterans with traumatic brain injury (TBI). Research Method/Design: Three hundred eighty veterans referred for TBI evaluation were administered the NSI and a common anxiety screening measure (Beck Anxiety Inventory; BAI). Receiver Operating Characteristic (ROC) curve analyses were conducted to determine ideal BAI total cutoff scores for a single item of the NSI pertaining to anxiety (i.e., “anxious or tense”). Results Using multiclass ROC curve analyses, NSI scores of 3 and 4 for the sample were comparable to scores of 11 and 22 on the BAI, respectively. Post hoc ROC curve analyses were then conducted on the sample after removal of potentially invalid NSI protocols (i.e., Validity-10 scores greater than 22), and NSI scores 3 and 4 corresponded with scores of 11 and 20, respectively. Conclusion/Implications A minimum score of 3 (severe) on the NSI item was deemed sufficient to indicate the need for further mental health referral without warranting additional screening for anxiety. Further analyses also revealed that removal of positive Validity-10 protocols did not significantly change ROC curve findings, suggesting that the particular NSI item for anxiety can still be used for clinical purposes despite an otherwise invalid protocol. Implications for treatment and recommendations pertaining to when additional screening might be required are discussed.

B-62 Using Single-Item Reporting on the Neurobehavioral Symptom Inventory to Determine Minimum Thresholds of Clinical Anxiety in a Polytrauma Veteran Sample.

2019 ◽  
Vol 34 (6) ◽  
pp. 1008-1008
Author(s):  
G Palmer ◽  
G Falcone ◽  
A Arch ◽  
S Olson
Keyword(s):  
Roc Analysis ◽  
Self Report ◽  
Receiver Operating Curve ◽  
Department Of Veterans Affairs ◽  
Physical And Mental Health ◽  
Item Score ◽  
Single Item ◽  
Positive Screen ◽  
Symptom Inventory ◽  
Anxiety Screening

Abstract Objective The Neurobehavioral Symptom Inventory (NSI) is a self-report measure used to evaluate physical and mental health symptoms secondary to traumatic brain injury (TBI) in the Department of Veterans Affairs health care system. There has been little research examining the relationship between anxiety reported on the NSI and other anxiety screening measures. The purpose of the study was to compare single-item response on item 19 (i.e., feeling anxious or tense) of the NSI to symptoms as reported on the Beck Anxiety Inventory (BAI). Method Retrospective data collected from veteran patients (N = 321) of a polytrauma outpatient clinic were used in the analyses. Veterans whose cutoff scores exceeded an embedded validity scale (i.e., NSI Validity-10) or had missing data were excluded. Receiver Operating Curve (ROC) analysis was conducted to determine which item score (i.e., score of 0-4) on the NSI best classified the presence of anxiety as measured by a BAI cut-off score greater than 7 (i.e., mild anxiety). Results There were 82 subjects who tested positive for anxiety based on a score of 3 on item 19 of the NSI. The ROC analysis was significant (AUC = .692, p < .001; 95% CI = .633 - .750). A score greater than 7 on the BAI yielded a sensitivity rate of .976 and a specificity rate of .711. Conclusions These results indicate that item 19 of the NSI is suggestive of a positive screen for mild anxiety in polytrauma samples with scores of 3 or greater indicating that further assessment of anxiety is recommended.

scholarly journals Disparities in Mental Health Referral and Diagnosis in the New York City Jail Mental Health Service

2015 ◽  
Vol 105 (9) ◽  
pp. 1911-1916 ◽  
Author(s):  
Fatos Kaba ◽  
Angela Solimo ◽  
Jasmine Graves ◽  
Sarah Glowa-Kollisch ◽  
Allison Vise ◽  
...  
Keyword(s):  
Mental Health ◽  
New York ◽  
New York City ◽  
Mental Health Service ◽  
Health Service ◽  
York City ◽  
Mental Health Referral

Requirement of Mental‐Health Referral Letters for Staged and Revision Genital Gender‐Affirming Surgeries: An Unsanctioned Barrier to Care

Andrology ◽  
2021 ◽  
Author(s):  
Nance Yuan ◽  
Theodore Chung ◽  
Edward C. Ray ◽  
Caitlin Sioni ◽  
Alma Jimenez‐Eichelberger ◽  
...  
Keyword(s):  
Mental Health ◽  
Mental Health Referral ◽  
Barrier To Care ◽  
Referral Letters

scholarly journals ReCAP: Would Women With Breast Cancer Prefer to Receive an Antidepressant for Anxiety or Depression From Their Oncologist?

2016 ◽  
Vol 12 (2) ◽  
pp. 172-174 ◽  
Author(s):  
Daniel C. McFarland ◽  
Megan Johnson Shen ◽  
Kirk Harris ◽  
John Mandeli ◽  
Amy Tiersten ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Mental Health ◽  
Health Professional ◽  
Mental Health Professional ◽  
Antidepressant Medication ◽  
Self Report ◽  
Mental Health Provider ◽  
Anxiety And Depression ◽  
Pharmacologic Treatment ◽  
Mental Health Referral

QUESTIONS ASKED: Preferences of patients with breast cancer for provider-specific pharmacologic management of anxiety and depression are unknown. Use of patient-guided treatment preferences for the treatment of depression and anxiety are known to improve adherence and treatment outcomes in primary care settings, but these preferences are not known in women with breast cancer. This may be especially true shortly after the patient receives a diagnosis of cancer and is most psychologically symptomatic, yet committed to following through with her oncologic care. Do breast cancer patients have preferences regarding having their anxiety and depression assessed and treated by their oncologists versus being cared for by a psychiatrist or mental health provider? SUMMARY ANSWER: The majority of patients accepted antidepressant prescribing by their oncologist; only a minority preferred treatment by a mental health professional. These findings are consistent with previous data from medically ill patients that demonstrated a preference for medical providers to address and treat their depression or anxiety. Twenty percent of participants would not want any treatment. Patients who met depression criteria were less likely to prefer a mental health referral. Patients who were already taking an antidepressant or demonstrated higher levels of chronic stress were more likely to prefer a mental health referral. METHODS: Patients with breast cancer (stages 0-IV) were asked two questions: (1) “Would you be willing to have your oncologist treat your depression or anxiety with an antidepressant medication if you were to become depressed or anxious at any point during your treatment?” and (2) “Would you prefer to be treated by a psychiatrist or mental health professional for problems with either anxiety or depression?” In addition, the Distress Thermometer and Problem List, Hospital Anxiety and Depression Scale, Risky Families Questionnaire, and demographic information were assessed. BIAS, CONFOUNDING FACTORS, DRAWBACKS: This was a survey of only women who were asked to self-report hypothetical preferences. Although minimal differences were noted for the 16.8% of participants who were already taking an antidepressant medication, it is not clear how they might have interpreted the questions in a more realistic setting. REAL-LIFE IMPLICATIONS: These findings suggest a benefit for promoting education of oncologists to assess psychological symptoms and manage anxiety and depression as a routine part of an outpatient visit. It highlights a fertile opportunity for oncologists to integrate mental health treatment for their patients by beginning pharmacologic treatment, discussing their anxiety or depressive symptoms, and initiating or comanaging pharmacologic treatment of anxiety or depression. Early recognition and management of distress, anxiety, and depression would limit the delay in obtaining appropriate treatment, especially during the first year after a cancer diagnosis when patients are most symptomatic and have many difficult treatment decisions to make. The oncologist’s use of antidepressant medications to treat anxiety and depression may benefit patients most by following guidelines. A collaborative care model offers one potential solution that could establish ownership, expand resources, disseminate knowledge, and provide a system of integration for mental health and oncology providers. [Table: see text]

Checklist Identification of Elementary Schoolboys for Clinical Referral or Evaluation of Eligibility for Special Education

1993 ◽  
Vol 18 (3) ◽  
pp. 218-227 ◽  
Author(s):  
Richard E. Mattison ◽  
James C. Lynch ◽  
Helen Kales ◽  
Alan D. Gamble
Keyword(s):  
Mental Health ◽  
Logistic Regression ◽  
General Population ◽  
Population Group ◽  
Regression Analyses ◽  
Practical Procedure ◽  
Emotional Dysfunction ◽  
Mental Health Referral ◽  
General Population Group ◽  
Clinical Referral

Achenbach and Edelbrock teacher and parent checklists were used to develop a practical procedure to assist educators in determining if a boy with behavioral/emotional dysfunction in elementary school requires mental health referral or SED evaluation. SED, psychiatric outpatient, and general population Caucasian boys ages 6 to 11 years were compared. Appropriately, scores for the SED and the outpatient groups were pathological and significantly greater than scores for the general population group on both checklists, while SED scores were significantly higher than outpatient scores on the teacher checklist. Logistic regression analyses showed the Total Problem scales of both checklists to be the most efficient and economical scales for classification. Finally, probability tables were constructed to distinguish SED and outpatient boys from general population boys, and SED boys from outpatient boys.

scholarly journals Controlling risks in the safe city: The rise of pre-emptive practices in law enforcement, public surveillance and mental health and addiction care (1970–2020)

Urban Studies ◽  
2020 ◽  
pp. 004209802095266
Author(s):  
Wim de Jong ◽  
Litska Strikwerda
Keyword(s):  
Mental Health ◽  
Law Enforcement ◽  
Risk Society ◽  
Urban Crisis ◽  
Inner Cities ◽  
Public Surveillance ◽  
Public Nuisance ◽  
Urban Level ◽  
Post Hoc ◽  
Addiction Care

This article describes pre-emptive practices in law enforcement, public surveillance and mental health and addiction care in the Dutch city Amersfoort and the Netherlands in general between 1970 and 2020. These developments are driven by top-down as well as bottom-up interactions on an urban level. The development of this ‘preventive gaze’, though intensified by 9/11, has deeper origins in the urban crisis: the struggle against communal crime and the heroin epidemic in circumstances of austerity encouraged a shift from post-hoc repression to prevention of public nuisance. This shift is analysed in light of the concepts of the risk society, the culture of control and the Disneyisation of inner cities, and its legal and moral implications are assessed. Aiming at unknown future risks, the ‘precautionary culture’ itself risks encroaching on the freedoms of citizens, ultimately making cities less safe.

scholarly journals ‘Having a Quiet Word’: Yarning with Aboriginal Women in the Pilbara Region of Western Australia about Mental Health and Mental Health Screening during the Perinatal Period

2019 ◽  
Vol 16 (21) ◽  
pp. 4253 ◽  
Author(s):  
Emma Carlin ◽  
David Atkinson ◽  
Julia V Marley
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Western Australia ◽  
Perinatal Depression ◽  
Perinatal Period ◽  
Screening Tools ◽  
Depression And Anxiety ◽  
Aboriginal Women ◽  
Anxiety Screening ◽  
Mood Scale

Despite high rates of perinatal depression and anxiety, little is known about how Aboriginal women in Australia experience these disorders and the acceptability of current clinical screening tools. In a 2014 study, the Kimberley Mum’s Mood Scale (KMMS) was validated as an acceptable perinatal depression and anxiety screening tool for Aboriginal women in the Kimberley region of Western Australia. In the current study, we explored if it was appropriate to trial and validate the KMMS with Aboriginal women in the Pilbara. Yarning as a methodology was used to guide interviews with 15 Aboriginal women in the Pilbara who had received maternal and child health care within the last three years. Data were analysed thematically, the results revealing that this cohort of participants shared similar experiences of stress and hardship during the perinatal period. Participants valued the KMMS for its narrative-based approach to screening that explored the individual’s risk and protective factors. While support for the KMMS was apparent, particular qualities of the administering health care professional were viewed as critical to the tool being well received and culturally safe. Building on these findings, we will work with our partner health services in the Pilbara to validate the KMMS with Pilbara Aboriginal women.

The development and validation of a marginalization index for inpatient psychiatry

2020 ◽  
pp. 002076402095078
Author(s):  
Sebastian Rios ◽  
Samantha B Meyer ◽  
John Hirdes ◽  
Susan Elliott ◽  
Christopher M Perlman
Keyword(s):  
Mental Health ◽  
Cluster Analysis ◽  
Roc Curve ◽  
Convergent Validity ◽  
Curve Analysis ◽  
Assessment System ◽  
Assessment Instrument ◽  
Roc Curve Analysis ◽  
Inpatient Psychiatry ◽  
And Cluster Analysis

Background: Marginalization is a multidimensional social construct that influences the mental health status of individuals and their use of psychiatric services. However, its conceptualization and measurement are challenging due to inconsistencies in definitions, and the lack of standard data sources to measure this construct. Aims: To create an index for screening marginalization based on an existing comprehensive assessment system used in inpatient psychiatry. Method: Items anticipated to be indicative of marginalization were identified from the Resident Assessment Instrument-Mental Health (RAI-MH) that is used in all inpatient mental health beds in Ontario, Canada. Principal Component Analysis (PCA) and cluster analysis of these items was performed on a sample of 81,232 patients admitted into psychiatric care in Ontario between 1 January 2011 and 31 December 2016 to identify dimensions being measured. Various weights and scoring methods were tested to assess convergent validity on multiple outcomes of marginalization. Receiver Operating Characteristic (ROC) curve analysis was utilized to determine optimal cut-offs for the index by modeling the likelihood of different marginalization outcomes, including homelessness. Results: Fifteen items were identified for the development of the Marginalization Index (MI). PCA and cluster analysis identified that the items measured five dimensions. ROC curve analysis among homeless individuals identified an Area Under the Curve of 0.76 and an optimal cut-off of five on the MI. Frequency analysis of the index by different characteristics identified homeless individuals, frequent mental health service users, persons with a history of violence and police intervention, and persons with addictions issues, as groups with the highest scores, confirming the convergent validity of the index. Conclusion: The MI is a valid measure of marginalization and is strong predictor of risk of homelessness among psychiatric inpatients. MI provides a resource that can be used for social and health policy, decision-support and evaluation.

The problem of mental health referral

1971 ◽  
Vol 22 (5) ◽  
pp. 41-45
Author(s):  
W. E. Wygant
Keyword(s):  
Mental Health ◽  
Mental Health Referral
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