The Global Mental Health Assessment Tool-validation in Hindi: A validity and feasibility study.

BACKGROUND: A computer-assisted interview, the Global Mental Health Assessment Tool-validation (GMHAT/PC) has been developed to assist general practitioners and other health professionals to make a quick, convenient, yet reasonably comprehensive standardized mental health assessment. GMHAT/PC has been translated into various languages including Hindi. This is the first study conducted in India, using the Hindi version GMHAT/PC of the series of studies assessing its validity in different cultures. AIM: The study aims to assess the feasibility of using a computer assisted diagnostic interview by health professionals and to examine the level of agreement between the Hindi version GMHAT/PC diagnosis and psychiatrists' ICD-10 based clinical diagnosis. DESIGN: Cross-sectional validation study. SETTING: Psychiatric clinic of a General Hospital and an out patient (Neurology) clinic in the Teaching General Hospital in Jaipur, India. MATERIALS AND METHODS: All consecutive patients attending the psychiatric out patient clinic were interviewed using GMHAT/PC and psychiatrists made a diagnosis applying ICD-10 criteria for a period of six weeks. A small sample of subjects was interviewed in a similar way in a Neurology clinic for four weeks. RESULTS: The mean duration of interview was under 17 minutes. Most patients were pleased that they were asked about every aspect of their mental health. The agreement between psychologists' GMHAT/PC interview diagnoses and psychiatrists' clinical diagnoses was excellent (Kappa 0.96, sensitivity 1.00, and specificity 0.94). CONCLUSION: GMHAT/PC Hindi version detected mental disorders accurately and it was feasible to use GMHAT/PC in Indian settings.

Mental health diagnosis by nurses using the Global Mental Health Assessment Tool: a validity and feasibility study.

BACKGROUND: The Global Mental Health Assessment Tool-Primary Care Version (GMHAT/PC) has been developed to assist health professionals to make a quick and comprehensive standardised mental health assessment. It has proved to be a reliable and valid tool in a previous study involving GPs. Its use by other health professionals may help in detecting and managing mental disorders in primary care and general health settings. AIM: To assess the feasibility of using a computer-assisted diagnostic interview by nurses and to examine the level of agreement between the GMHAT/PC diagnosis and psychiatrists' clinical diagnosis. DESIGN OF STUDY: Cross-sectional validation study. SETTING: Primary care, general healthcare (cardiac rehabilitation clinic), and community mental healthcare settings. METHOD: A total of 215 patients between the ages of 16 and 75 years were assessed by nurses and psychiatrists in various settings: primary care centre (n = 54), cardiac rehabilitation centre (n = 98), and community mental health clinic (n = 63). The time taken for the interview, and feedback from patients and interviewers were indicators of feasibility, and the kappa coefficient (kappa), sensitivity, and specificity of the GMHAT/PC diagnosis were measures of validity. RESULTS: Mean duration of interview was under 15 minutes. The agreement between nurses' GMHAT/PC interview-based diagnosis and psychiatrists' International Classification of Diseases (ICD)-10 criteria-based clinical diagnosis was 80% (kappa = 0.76, sensitivity = 0.84, specificity = 0.92). CONCLUSION: The GMHAT/PC can assist nurses to make accurate mental health assessment and diagnosis in various healthcare settings and it is acceptable to patients.

Depression in older people in rural China.

BACKGROUND: In Western countries depression is the most common psychiatric condition in older persons and related to low socioeconomic status and low social supports. Along with social deprivation, the rural communities in China retain many Chinese traditions that involve high levels of social supports. Studying such a population might offer insights into the cause and prevention of depression that may be applicable in developing and developed countries. METHODS: Using a cross-sectional, household-based, community survey in rural China, we aimed to determine the prevalence of and risk factors for depression among older people who had a low income (mean annual per capita income of about 280 US dollars) and high social support in 16 villages in Anhui Province. Participants included 754 men and 846 women aged 60 years or older. Depression was diagnosed using the Geriatric Mental State and the Automated Geriatric Examination for Computer Assisted Taxonomy. Risk factors, collected from the standard questionnaire and physical measurements, were examined in a stepwise multiple logistic regression model. RESULTS: The prevalence of depression (world age standardized) was 6.0% (95% confidence interval [CI], 4.8%-7.3%). Of all persons, 1374 older persons (85.9%) living with family members. Depression was significantly and independently associated with female gender, low family income, lack of social support, relationship problems, poor health status, and adverse life events in the past 2 years. The risk of depression increased in those eating meat less than once a week (multiple-adjusted odds ratio, 2.20; 95% CI, 1.20-4.03), not watching television (odds ratio, 1.76; 95% confidence interval, 1.03-3.00), and having undetected hypertension (odds ratio, 1.78; 95% CI, 1.05-3.01). CONCLUSIONS: Older people in rural China have a lower risk of depression than those in Western countries. Low socioeconomic status showed a "dose-response" relationship with depression, and social supports were much more common, which were protective for depression. Further exploration of Chinese culture and tradition may yield universal insights into preventive factors for depression in older people.

A community-based study of depression in older people in Hefei, China--the GMS-AGECAT prevalence, case validation and socio-economic correlates.

OBJECTIVE: Previously published studies of prevalence of depression in older people in China showed much variation in the results, while the pooled prevalence is low. In this study we used a standardised method, the Geriatric Mental State (GMS) to investigate the prevalence of depression in older people in China, validate the GMS-AGECAT depression cases and examine the relationship between depression and socio-economic deprivation. METHODS: 1736 subjects aged > or =65 were recruited from Hefei city, China. They were interviewed at home by a survey team from Anhui Medical Universtiy using the GMS and other interviews. Their mental disorders were diagnosed by the Automated Geriatric Examination for Computer Assisted Taxonomy (AGECAT). Chinese psychiatrists re-examined depression cases and their controls. RESULTS: 39 depressed cases were diagnosed by the GMS-AGECAT. Age-standardised prevalence was 2.2% (95% CI 1.5-2.9), which was about five-times lower than that of older people in Liverpool, UK. Agreement on depression diagnoses between the GMS-AGECAT and local Chinese psychiatrists was 83.6%, with a Kappa of 0.67 (p<0.001). Depression was significantly related to socio-economic deprivation. CONCLUSIONS: This community-based study suggested a low prevalence of depression in older people in urban China. Approved training in the use of the GMS-AGECAT in mainland China should make it possible to carry out a large scale epidemiological study on depression in the Chinese elderly population to investigate its geographic variation and risk factors. The dose-response relation between socio-economic deprivation and depression indicates that strategies for tackling inequality in depression in elderly are urgently needed in China.

The Global Mental Health Assessment Tool--Primary Care Version (GMHAT/PC). Development, reliability and validity.

The Global Mental Health Assessment Tool--Primary Care Version (GMHAT/PC) is a computerised clinical assessment tool developed to assess and identify a wide range of mental health problems in primary care. It generates a computer diagnosis, a symptom rating, a self-harm risk assessment, and a referral letter. Patients from primary care and community psychiatric outpatient clinics and a small sample of inpatients were interviewed for a period of two months using the GMHAT/PC. A proportion of patients were simultaneously rated by a psychiatrist and a general practitioner for inter-rater reliability. All patients also completed the Hospital Anxiety and Depression Scale (HAD). To conduct the interview was easy in all settings and took 10-15 minutes for patients who had psychiatric symptoms. Inter-rater agreement on mental state symptom groups ranged from 0.49 to 1 (kappa). The computer diagnosis correlated highly with the clinical diagnosis and there was a good level of agreement between HAD ratings and GMHAT/PC ratings. These data suggest that the GMHAT/PC is an easy to administer computerised tool which can be used in primary care for the standardised assessment of mental health problems.

National context of healthcare, economy and religion, and the association between disability and depressive symptoms in older Europeans: results from the EURODEP concerted action.

Associations between disability and depression have been shown to be consistent across cultures among middle-aged adults. In later life the association between disability and depression is much more substantial and may be amenable to influences by health care facilities as well as economic and sociocultural factors. Fourteen community-based studies on depression in later life in 11 western European countries contribute to a total study sample of 22,570 respondents aged 65 years or older. Measures are harmonised for depressive symptoms (EURO-D scale) and disability. Using multilevel modelling to control for the stratified data structure we examined whether the association between disability and depressive symptoms is modified by national health care and mental health care availability, national economic circumstances, demographic characteristics and religious tradition. The association between depressive symptoms and disability is attenuated by health care expenditure and availability of mental health care and also by gross domestic product; it was more pronounced in countries with high levels of orthodox religious beliefs. Higher levels of depressive symptoms are found in countries with a larger gross domestic product (per capita) and higher health care expenses but are interpreted with care because of measurement differences between the centres. The findings from this contextual perspective indicate that general and mental health care should be geared to one another wherever possible.