validation of global mental health scale - prize presentation
DESCRIPTION
Dr Vikram PalanisamyTRANSCRIPT
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Validation and feasibility of Global Mental Health Assessment Tool – Primary care version
(GMHAT/PC) in the older adults.
Presenter: Vikram Palanisamy
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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)
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Background- Probable Reasons
Limited Training
• What questions to ask?
• How to make diagnosis from the symptoms elicited?
Limited time
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Need for an interview tool..,
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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
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GMHAT-PC
• Computerised Tool
• Covers wide range of disorders
• Needs minimal training
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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
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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
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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
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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
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Results- DemographicsSite Number Male Mean Age Diagnosis
Day Hospital
(London)
30
10
79 ± 7 25 (83%)
Out Patient
(Wirral)
67 29 75 ± 9 48 (71%)
DGH
(Wrexham)
72 54 68 ± 6 13 (18%)
Total
169 93 73 ± 9 86 (50.8)
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Results- continued
• Mean time 14 min ( 4-32 minutes)
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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)
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Results- Feasibility
• Average time taken- 14 mins
• Feedback - positive
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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
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Discussion
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Strengths and Limitations
• Good sample size
• Different health care settings
• Assessment -Blind
• Gold standard- Consultant Psychiatrists’
Diagnosis
• Power of agreement for Anxiety/Psychosis
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Implications for future
• Care pathways- Low and middle income countries
• GMHAT- Full Version
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GMHAT/PC translated in different languages
Chinese
Hindi
Tamil
Dutch
Deutsch
Spanish
Arabic
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Studies completed or in progress
India
Singapore Australia
Germany
Holland Belgium
Abudhabi
Ghana
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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
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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
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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