An Ultra-Brief Proxy Measure for Early Mental and Substance Use Disorders and Suicide Risk Case Detection at the Community and Household Level: An Efficient and Feasible Clinical and Population-level Service Needs Screening Tool

Melissa A Stockton; Ernesha Webb Mazinyo; Lungelwa Mlanjeni; Kwanda Nogemane; Nondumiso Ngcelwane; Annika C Sweetland; Cale Basaraba; Charl Bezuidenhout; Griffin Sansbury; Kathryn L Lovero; Maria Lídia Gouveia; Palmira Fortunato Dos Santos; Paulino Feliciano; Wilza Fumo; Antonio Suleman; Maria A Oquendo; Christoffel Grobler; Melanie M Wall; Phumza Nobatyi; Andrew Medina-Marino; Milton L Wainberg

doi:10.18103/mra.v11i10.4381

An Ultra-Brief Proxy Measure for Early Mental and Substance Use Disorders and Suicide Risk Case Detection at the Community and Household Level: An Efficient and Feasible Clinical and Population-level Service Needs Screening Tool

Med Res Arch. 2023 Oct;11(10):10.18103/mra.v11i10.4381. doi: 10.18103/mra.v11i10.4381. Epub 2024 Jan 11.

Authors

Melissa A Stockton¹, Ernesha Webb Mazinyo^{2

3}, Lungelwa Mlanjeni⁴, Kwanda Nogemane⁵, Nondumiso Ngcelwane⁵, Annika C Sweetland^{6

7}, Cale Basaraba^{8

9}, Charl Bezuidenhout¹⁰, Griffin Sansbury¹¹, Kathryn L Lovero¹², Maria Lídia Gouveia¹³, Palmira Fortunato Dos Santos¹³, Paulino Feliciano¹³, Wilza Fumo¹³, Antonio Suleman¹³, Maria A Oquendo¹⁴, Christoffel Grobler¹⁵, Melanie M Wall^{6

9}, Phumza Nobatyi⁵, Andrew Medina-Marino^{4

14}, Milton L Wainberg^{6

7}

Affiliations

¹ Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC.
² University of California Global Health Institute, University of California, San Francisco, USA.
³ Research Unit, Foundation for Professional Development, Buffalo City Metro, Eastern Cape Province, South Africa.
⁴ The Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa.
⁵ Eastern Cape Provincial Department of Health, Buffalo City Metro Health District, South Africa.
⁶ Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, USA.
⁷ New York State Psychiatric Institute, New York, USA.
⁸ Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, New York, USA.
⁹ Department of Biostatistics, Columbia University Mailman School of Public Health, New York, New York, USA.
¹⁰ Department of Global Health, Boston University School of Public Health, Boston, MA, USA.
¹¹ University of North Carolina-Project, Malawi, Lilongwe, Malawi.
¹² Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, USA.
¹³ Ministry of Health of Mozambique, Mental Health Department, Maputo, Mozambique.
¹⁴ Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
¹⁵ School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.

Abstract

Valid mental and substance use disorders and suicide risk screening tools are needed for community case finding of individuals who may not otherwise seek care. We evaluated the Proxy Mental Wellness Tool-3 (mwTool-3-proxy) a three-item screener that asks about the mental health of another adult, against a diagnostic gold standard in Mozambique and South Africa. The mwTool-3-proxy adapts the three items of the Mental Wellness Tool-3, developed in Mozambique using Mini International Neuropsychiatric Interview diagnoses as the criterion standard, regression modeling and expert consultation to determine the best three items for identifying any mental disorder. The Mental Wellness Tool-3 has been validated in South Africa, Spain and the United States, and is being validated in three countries in the Asia-Pacific and Israel. Pairs of adults in South Africa and Mozambique at primary and tertiary healthcare facilities were separately screened with the mwTool-3-proxy and diagnosed using the Mini International Neuropsychiatric Interview. We calculated the sensitivities and specificities for predicting any mental and/or substance use disorder and suicide risk among the proxy individual. We performed additional analyses restricted to respondents who were relatives of one another and who lived in the same household. The prevalence of any Mini International Neuropsychiatric Interview-diagnosed disorder among the 229 pairs in both countries was 35.6% (38.5% in Mozambique; 32.9% in South Africa). The pooled sensitivity of the mwTool-3-proxy for identifying any disorder among the proxy individual was 73.01 (95%CI: 65.5-79.65) - 70.24 (95%CI: 59.27-79.73) in Mozambique and 80.00 (95%CI 69.17-88.35) in South Africa. The mwTool-3-proxy is a culturally-relevant, ultra-brief valid measure that can improve mental and substance use disorders and suicide risk case detection with strong sensitivity at the community and household level and offer a means to efficiently and feasibly collect clinical and population-level service needs data.

Keywords: Community Care; Mental Health; Proxy Screening; South Africa; Validation.

Abstract

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