Canadian High School Mental Health Survey Assessment of a Mental Health Screen
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Slide 1 :
Canadian High School Mental Health Survey Assessment of a Mental Health Screen Nasreen Roberts Department of Psychiatry Queens University Supervisors: Dr Heather Stuart Dr Miu Lam
Slide 2 :
Adolescent Psychiatric Statistics Suicide is the 2nd leading cause of death in adolescents (14.8/100,000) Suicide attempts very much higher Population prevalence of common psychiatric disorders ranges from 2 to 22 % Only 1 in 5 of those needing psychiatric services are being treated
Slide 3 :
Study Rationale Request by School board for expedited assessment service for its high school students Service planning needed to be based on the extent of the need, specially with limited resources Estimate the number of students who would need such a service and have an efficient means of identifying them.
Slide 4 :
Study Objectives To estimate the size of the population potentially in need of psychiatric assessment based on the twelve-month period prevalence of child and adolescent psychiatric disorders A secondary goal was to evaluate the validity (sensitivity, specificity, positive predictive value and negative predictive value), accuracy and yield of the DPS-8 screen against the gold standard NIMH-Diagnostic Interview Schedule
Slide 5 :
Study Participants Came from 1 local high school chosen by the school board All 662 students enrolled in 2003-2004 were invited to participate after signed parental consent 33.5% participated in the first stage screen 69 % of those screened completed the second stage of diagnostic interview
Slide 6 :
Study Design Two phase cross sectional survey of grade 9-12 students Phase1 computerized DPS-8 Screen Phase 2 Those who were positive asked to complete NIMH-DISC All remaining students requested to complete the NIMH-DISC Students assigned a diagnosis by the NIMH-DISC were offered clinical consult
Slide 7 :
Flowchart of Screening N=222 Completed DPS-8 n+ =54DPS+ n-=168 DPS- m*+ = 7 No DISC m*- = 62 No DISC m- = 106 DISC m-- = 87 DISC - m-+ = 19 DISC + m*+ = 30 DISC + m*+ = 17 DISC - m+ = 47 DISC
Slide 8 :
Data Management Diagnostic software for both the screen and the gold standard NIMH-DISC was loaded onto the school computers Students were assigned unique identification numbers and reports were password protected Each day all files were transferred to study computer and deleted from school computers Files were not accessible to school staff
Slide 9 :
Data Analysis We assessed the representativeness of the screened sample to study and district schools using chi-square statistics of significance Frequency tables of socio-clinical characteristics by gender using chi-square to identify differences Period prevalence of symptoms using frequency tables stratified by gender for DPS-8 Screen Period prevalence of the disorders was estimated by two-phase sampling design stratified by gender and by grade with 95% confidence intervals
Slide 10 :
Data Analysis (cont’d) 5. Due to the two-phase sampling design, the sensitivity and specificity of the DPS-8 screen were estimated using Bayes’ Rule 6. Negative Predictive Value, Positive Predictive Values Accuracy and Yield were also calculated 7. Due to the small sample size power is a concern in this study
Slide 11 :
Results Representativeness The sample was neither representative of the study school nor the district schools, in both cases chi-square values were >.05 Females were overrepresented in the sample Socio-clinical characteristics No gender difference for socio-clinical characteristics 1in 4 had a previous contact and 1 in 4 screened positive
Slide 12 :
Results Clinical Characteristics Most frequent symptoms was depressed mood lack of energy and poor concentration(½ to ¾) 1in 10 students had thought of suicide or made a suicide attempt High prevalence of symptoms but a smaller proportion met impairment threshold on the screen Prevalence Prevalence adjusted to grade and sex distribution of the study school showed 29% of the sample met criteria for any disorder--highest for Anxiety disorders
Slide 13 :
Validity Sensitivity: 53.4% Specificity: 87.6% PPV 63.8% NPV 82.1% Varying the cut-off point of the screen did not improve the validity or predictive power beyond the balanced achieved by the preset cut-off score
Slide 14 :
Discussion There is a high prevalence of symptoms which do not reach the impairment threshold yet…this could represent a prodromal stage of a disorder The prevalence of any disorder is higher than those quoted in literature maybe due to selection bias or volunteer bias The sensitivity is lower than accepted however the specificity being higher is desirable in ruling out referrals for further assessment
Slide 15 :
Limitations Sample size; Only 1 of possible 3 schools requested, was chosen by the Board. Only 23% participated in the full study. (To minimize sampling bias we adjusted prevalence estimates to grade the gender distribution of study school and the district schools) Selection Bias; smallest school with largest number of special educational classes Volunteer Bias Not generalizable
Slide 16 :
Implications If we based service planning on the findings from this study we would need to increase the clinical services fourfold to serve between 2134 to 2287 high school students in the district (present referral rate is 600) The screen correctly identifies almost 77% of the students 53.1% who have a disorder and 86% who do not The time required to complete DPS screen and diagnostic interview preclude general screening at this time DPS screen would be useful for school guidance officers to use for their ‘at risk’ students prior to making referral for further assessment
Slide 17 :
Acknowledgments Jeanne Mance Foundation of the Hotel Dieu Hospital Kingston Department of Psychiatry Ms Chen ding, Drs. Heather Stuart, Miu Lam and Kevin Parker, Dr. Julio Arboleda-Flórez Students of LCVI
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