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Dr Vikram Palanisamy
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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
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