Sensitivity priority
Importantly, the latest study validated the effectiveness of the screening tool in a new set of patients. This is essential to ensure the screening is generalizable, the researchers said.
The new study included adult patients from three hospitals in California, Ohio, and Washington, D.C., with diverse educational, economic, and ethnic backgrounds. Patients were screened within days of admission and were available in English, Chinese, and Spanish. Approximately 450 patients completed the study, including patients from five self-identified ethnic groups: Asian American/Pacific Islander, American Indian or Alaska Native, Black, Hispanic, and White. .
At the 2-month follow-up, patients’ mental health status was assessed using standard measures of depression, anxiety, and PTSD.
Overall, the screen accurately predicted 79% of patients who had a mental health diagnosis two months later. This is a measure known as sensitivity. The study accurately predicted 72% of patients had no mental health diagnosis at two months (a measure known as specificity).
This screen has good prediction for all ethnic groups, with slightly higher sensitivity for multiracial, Asian American/Pacific Islander, black and Hispanic patients, and a higher sensitivity for white and Hispanic patients. The specificity was slightly higher for There were no differences between injured and acutely ill patients.
The researchers prioritized sensitivity over specificity when choosing a cutoff score to distinguish low-risk from high-risk patients. This means that they prioritized capturing all high-risk patients, even if some low-risk patients were included.
“Some people refer people who don’t need help or resources, but we want to make sure we don’t miss anyone who might develop symptoms,” Spain said.
The next, and more difficult, step is for those at high risk to evaluate the resources that can help lower their risk.
“There are very few hospitals in the United States that can provide specialized preventive mental health care,” Carlson said. “Unfortunately, most referrals to mental health care do not receive care.”
Instead, researchers are developing self-help programs that patients can use at home and provide professional care if needed. Family coaching programs to better support patients may also be helpful.
Although the new test was designed for hospitals, it could also be applied to survivors of other types of trauma, such as natural disasters or mass shootings.
“Based on what I’ve seen, I think it would work in other situations as well,” Spain said.
Researchers from the Veterans Affairs Palo Alto Health System, Suma Health, and Howard University School of Medicine contributed to the study.
This study was funded by the National Institute on Minority Health and Health Disparities (grant R01MD012273).
