scholarly journals MP33: A systematic review of the psychometric properties and diagnostic performance of instruments to identify mental health and substance use problems among children in the emergency department

CJEM ◽  
2017 ◽  
Vol 19 (S1) ◽  
pp. S76
Author(s):  
S.W. Kirkland ◽  
A. Soleimani ◽  
R. Gokiert ◽  
A.S. Newton

Introduction: The objective of this systematic review was to investigate the psychometric properties and diagnostic performance of instruments used in the emergency department to identify pediatric mental health and substance use problems. Methods: A search of seven electronic databases and the grey literature was conducted. Studies assessing any instrument to identify and or diagnose mental illness, emotional or behavioural problems, or substance use disorders in pediatric patients with presentations for mental health or substance use issues were considered eligible for inclusion. Two independent reviewers judged the relevance and study quality of the studies. A descriptive analysis of the outcomes was reported. Results: From 4832 references, 14 studies were included. Eighteen instruments were evaluated for identifying suicide risk, alcohol use disorders, mood disorders, and ED decision-making. The HEADS-ED has good inter-rater reliability (r=0.785) for identifying general mental health problems and modest evidence for ruling out patients requiring hospital admission (positive likelihood ratio, LR+=6.30). The internal consistency varied for tools to screen for suicide risk (α=0.46-0.97); no tools have both high sensitivity and high specificity. The Ask Suicide-Screening Questionnaire (ASQ) is highly sensitive (98%) and provides strong evidence to rule out risk (negative likelihood ratio, LR−=0.04). Among tools to screen for alcohol use disorders, a two-item tool based on DSM-IV criteria was found to be the most accurate in identifying patients with a disorder (area under the curve: 0.89), and has modest evidence to rule in and rule out risk (LR+=8.80, LR−=0.13). Conclusion: Reliable, valid, and accurate instruments are available for use with pediatric mental health ED visits. Based on available evidence, emergency care clinicians are recommended to use the HEADS-ED to rule in ED admission, ASQ to rule out suicide risk, and DSM-IV two-item tool to rule in/rule out alcohol use disorders.

Author(s):  
Philip Cowen ◽  
Paul Harrison ◽  
Tom Burns

The phrases substance use disorder (DSM-IV) or disorders due to psychoactive drug use (ICD-10) are used to refer to conditions arising from the misuse of alcohol, psychoactive drugs, or other chemicals such as volatile substances. In this chapter, problems related to alcohol will be discussed first under the general heading of alcohol use disorders. Problems related to drugs and other chemicals will then be discussed under the general heading of other substance use disorders.


2016 ◽  
Vol Volume 10 ◽  
pp. 1489-1500 ◽  
Author(s):  
Stacey McCallum ◽  
Jane Andrews ◽  
Matthew Gaughwin ◽  
Deborah Turnbull ◽  
Antonina Mikocka-Walus

2021 ◽  
Vol 26 (2) ◽  
pp. 490-504
Author(s):  
Peter Fuggle ◽  
Laura Talbot ◽  
James Wheeler ◽  
Jessica Rees ◽  
Emily Ventre ◽  
...  

Adaptive Mentalization Based Integrative Therapy (AMBIT) is a systemic, mentalization based intervention designed for young people with multiple problems including mental health problems. The purpose of this paper is to examine the impact of this approach both on clinical and functional outcomes for young people seen by a specialist young people’s substance use service between 2015 and 2018. About 499 cases were seen by the service during this period. Substance use outcomes were obtained for 383 cases using the Treatment Outcome Profile (TOP). Cannabis and alcohol use were the key substance use problems for 81% and 63% respectively. Functional outcomes using the AMBIT Integrative Measure (AIM) were obtained for 100 cases covering domains of daily living, socio-economic context, peer relationships and mental health. At treatment end, cannabis use reduced significantly ( t = 10.78; df = 311; p = .00; Cohen’s d ES.61 as did alcohol use ( t = 6.938; df = 242; p = .000; ES 0.44). Functional improvements were shown in five out of seven domains with highly significant total functional improvements on key problems selected by the client ( t = 14.01; df = 99; p = .000; ES1.34). Measuring functional as well as clinical outcomes appears to reflect more accurately the overall benefit of the service to clients.


2016 ◽  
Vol 28 (3) ◽  
pp. 721-741 ◽  
Author(s):  
Tiffany M. Jones ◽  
Karl G. Hill ◽  
Marina Epstein ◽  
Jungeun Olivia Lee ◽  
J. David Hawkins ◽  
...  

AbstractThis study examines the interplay between individual and social–developmental factors in the development of positive functioning, substance use problems, and mental health problems. This interplay is nested within positive and negative developmental cascades that span childhood, adolescence, the transition to adulthood, and adulthood. Data are drawn from the Seattle Social Development Project, a gender-balanced, ethnically diverse community sample of 808 participants interviewed 12 times from ages 10 to 33. Path modeling showed short- and long-term cascading effects of positive social environments, family history of depression, and substance-using social environments throughout development. Positive family social environments set a template for future partner social environment interaction and had positive influences on proximal individual functioning, both in the next developmental period and long term. Family history of depression adversely affected mental health functioning throughout adulthood. Family substance use began a cascade of substance-specific social environments across development, which was the pathway through which increasing severity of substance use problems flowed. The model also indicated that adolescent, but not adult, individual functioning influenced selection into positive social environments, and significant cross-domain effects were found in which substance-using social environments affected subsequent mental health.


Author(s):  
S. Janet Kuramoto-Crawford ◽  
Holly C. Wilcox

Intentional injuries affect millions of lives worldwide. The authors provide an overview of the epidemiological and preventive evidence on the relationship between substance use disorders (SUD) and intentional injuries. Emphasis is placed on suicide and intimate partner violence, as each area has received substantial research attention in relation to SUD. There is robust epidemiological evidence on the relationship between SUD, notably with alcohol use disorders, and most intentional injuries. Research has focused on the identification of factors that distinguish individuals with alcohol use disorders who are at particularly high risk for intentional injuries. Characterization of those with other drug use disorders who are at risk for engaging in intentional injuries and the role of SUD in intentional injuries has been less extensively investigated. The authors conclude with a discussion of public health approaches to the prevention of intentional injuries among individuals with SUD.


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