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

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.

Mental Health Literacy and Confidence in a Sample of Student Athletic Therapists

Intercollegiate student-athletes appear to be a high-risk population with respect to mental health. Student athletic therapists are one of the groups with whom these athletes may be comfortable disclosing concerns. The current study investigated the relationship between mental health literacy and mental health referral efficacy in a sample of intercollegiate student therapists. One hundred and eleven student athletic therapists (81 female, 29 male, 1 nondiscloure) competed a revised version of the multicomponent mental health literacy measure and a four-item measure of mental health referral efficacy. T tests revealed statistically significant differences in mental health literacy by gender and personal history, and a multiple linear regression revealed a significant model predicting referral efficacy from mental health literacy. There are several implications of these results, particularly when working with a high-risk population of student-athletes.

Development and Implementation of the National Mental Health Referral Network for Elite Athletes: A Case Study of the Australian Institute of Sport

Awareness-raising and antistigma campaigns have sought to increase the acceptance of mental ill health across the general community and subpopulations of elite athletes. Nonetheless, gaps remain for models of clinical service provision. As cultural change prompts elite athletes toward more open and positive perceptions of help seeking, the number of athletes seeking evidence-based mental health intervention has been predicted to increase. In this context, the Australian Institute of Sport (AIS) established the national Mental Health Referral Network. The network comprises registered mental health professionals (psychologists) and is led by the AIS Athlete Wellbeing and Engagement branch. This case study describes the development and implementation of this network, including the service-provider procurement process and strategic consultation provided by Orygen. Details are provided for international bodies seeking to undertake similar initiatives. Reflections on program implementation highlight opportunities for expansion and data capture, informing future education-based initiatives.

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

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]