Validation of Global Mental Health Scale - Prize Presentation

Validation and feasibility of Global Mental Health Assessment Tool – Primary care version (GMHAT/PC) in the older adults. Presenter: Vikram Palanisamy

Background
Under-detection of mental illness in older people is widespread- The NSF for older people (DH, 2001)
Emphasis is on primary care to identify and assess common mental illness (NSF 1999), (Everybody’s business, DH, 2005)
GPs are poor at detecting or treating depression (Cooper 2003)

Background- Probable Reasons
Limited Training
What questions to ask?
How to make diagnosis from the symptoms elicited?
Limited time

Need for an interview tool..,

Global Mental Health Assessment Tool/Primary Care version (GMHAT/PC)
Developer- Dr Vimal K Sharma
Prof John RM Copeland
Steering group- Dr Murali Krishna, Dr Peter Lepping, Dr Patricia Mottram, Dr Mahesh Odiyoor, Prof Kenneth Wilson, Dr Rashmi Parhee, Dr Steven Lane, Dr Ben Quinn (G.P), Dr Vikram Palanisamy

GMHAT-PC
Computerised Tool
Covers wide range of disorders
Needs minimal training

Published Literature
Sharma and Copeland, Ment Health Fam Med. 2009
Krishna M, Lepping P, Sharma VK, et al. Clinical Practice and Epidemiology in Mental Health 2009.
Vimal K Sharma, Peter Lepping, Murali Krishna et al., Br J Gen Pract 2008.
Vimal K Sharma, Peter Lepping, Anthony GP Cummins et al., World Psychiatry. 2004

Aims and objectives
To assess the validity and feasibility of the GMHAT/PC in the population over the age of 60.
Validity: Sensitivity, Specificity and Kappa coefficient
Feasibility: Duration and acceptance by patients and interviewers

Methodology
Three settings in the UK: a Psychiatric Day Hospital for older people, mental health outpatient clinics and Cardiac Rehab setting
Consecutive patients were included in the study

Methodology
Independent Clinical Assessment by Consultant Psychiatrist-ICD diagnosis
A general nurse practitioner or a Specialist Registrar (VP,SK) administered the GMHAT/PC to generate the diagnosis
Interviewers and Psychiatrists were blind to each others’ diagnosis
Demographics, Diagnosis, time taken and satisfaction

Results- Demographics Site Number Male Mean Age Diagnosis Day Hospital (London) 30 10 79 ± 7
(83%)
Out Patient (Wirral) 67 29 75 ± 9
(71%)
DGH (Wrexham) 72 54 68 ± 6
(18%)
Total 169 93 73 ± 9
(50.8)

Results- continued
Mean time 14 min ( 4-32 minutes)

Levels of Agreement between the Consultant’s diagnosis and GMHAT/PC diagnosis Kappa (95% CI) Sensitivity (95% CI) Specificity (95% CI) Mental Illness 0.72 (0.62, 0.83) 0.77 (0.68, 0.85) 0.96 (0.89, 0.98) Organic 0.67 (0.53, 0.82) 0.60 (0.43, 0.77) 0.95 (0.96, 1.00) Depression 0.84(0.72, 0.93) 0.84 (0.72, 0.97) 0.97 (0.85, 1.00)

Results- Feasibility
Average time taken- 14 mins
Feedback - positive

Discussion
Validity - Kappa value, sensitivity and specificity comparable/ better than other similar tools
Feasibility - Easy to administer, Takes a short time, acceptable to patients and interviewers

Discussion

Strengths and Limitations
Good sample size
Different health care settings
Assessment -Blind
Gold standard- Consultant Psychiatrists’ Diagnosis
Power of agreement for Anxiety/Psychosis

Implications for future
Care pathways- Low and middle income countries
GMHAT- Full Version

GMHAT/PC translated in different languages
Chinese
Hindi
Tamil
Dutch
Deutsch
Spanish

Arabic

Studies completed or in progress
India
Singapore Australia
Germany
Holland Belgium
Abudhabi
Ghana

Acknowledgement
Karen Keating, Jackie Cliff, Loraine Lockwood from the cardiac rehabilitation service of the Wrexham Maelor Hospital.
Karen Gill, St Catherine’s Hospital Wirral for administrative support.
Dr Ferran, Consultant Old Age Psychiatry, Cheshire and Wirral Partnership NHS Foundation Trust
Dr. Tobiansky, Consultant Old Age Psychiatry at Edgware Hospital, London

References
Department of Health, 2001. National Service Framework for Older People.
Department of Health, 2005. Everybody’s business – Integrated mental health service for older adults: a service development guide.
Cooper JE ,2003. Detection and management of psychiatric disorders in primary care. British Journal of Psychiatry 2003.
Sharma VK, Lepping P, Krishna M et al. 2008. Mental health diagnosis by nurses using the Global Mental Health Assessment Tool: a validity and feasibility study. Br J Gen Pract, 58 (551): 411-416,
Sharma VK, Lepping P, Cummins A et al. 2004. The Global Mental Health Assessment Tool- Primary Care Version (GMHAT/PC). Development, reliability and validity. World Psychiatry 3(2): 115-119 .
Sharma VK., Copeland JRM, Dewey ME et al. 1998. Five year outcome of the depressed elderly living in the community (GMS-AGECAT), Psychological Medicine 28: 1329-1337

My Role
Involved in designing the methodology
Lead the project in Wirral site
Designed the patient information leaflets, consent forms
Interviewed patients in Wirral, collected the data
Coordinated data collection from all the sites, standardised them
Did the descriptive analysis
Prepared this presentation
Wrote the draft paper

Validation of Global Mental Health Scale - Prize Presentation

by JP Rajendran on Aug 28, 2010

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Validation of Global Mental Health Scale - Prize Presentation — Presentation Transcript