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- 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)

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