Brief Mental Health Disorder Screening Questionnaires and Use with Public Safety Personnel: A Review
Abstract
:1. Introduction
Objectives
2. Materials and Methods
2.1. Search Strategy
2.2. Data Analysis
3. Results
3.1. Multiple Symptom Screening Questionnaires
3.1.1. The 90 to 120 Day Post-Deployment Psychological Short Screen
3.1.2. Anxiety and Depression Detector (ADD)
3.1.3. Alcohol, Smoking, and Substance Involvement Screening Test-Version 2 (ASSIST-2)
3.1.4. Composite International Diagnostic-Screener (CID-S)
3.1.5. Composite International Diagnostic Interview Screening Scale (CIDI-SC)
3.1.6. Five-Item Mental Health Inventory (MHI-5)
3.1.7. Kessler Psychological Distress K6 Screening Scale (K6)
3.1.8. Mental Health Component Scale (MCS-12)
3.1.9. Mini-International Neuropsychiatric Interview (M.I.N.I.) Screen
3.1.10. My Mood Monitor (M-3) Checklist
3.1.11. Patient Health Questionnaire-4 (PHQ-4)
3.1.12. Posttraumatic Adjustment Scale (PAS)
3.1.13. Web Screening Questionnaire (WSQ)
3.2. Single-Disorder Symptom Questionnaires
3.2.1. Alcohol Use Disorders Identification Test-Consumption (AUDIT-C)
3.2.2. Brief Panic Disorder Severity Scale-Self Report (Brief PDSS-SR)
3.2.3. Brief PTSD Screen (Brief PSS)
3.2.4. Panic Disorder Screener (PADIS)
3.2.5. The Patient Health Questionnaire-2 (PHQ-2)
3.2.6. Primary Care Posttraumatic Stress Disorder Screen (PC-PTSD-5)
3.2.7. Short-Form Posttraumatic Checklist-5 (Short-Form PCL-5)
3.2.8. Short Forms of PTSD Checklist (PCL-C-SF)
3.2.9. Short Posttraumatic Stress Disorder Rating Interview (SPRINT)
4. Discussion
4.1. Limitations
4.2. Conclusions and Directions for Future Research
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Acknowledgments
Conflicts of Interest
References
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Screening Questionnaire | Features | Mental Disorders Screened | Cut-Off Scores | Study/Validation Sample | Psychometric Properties | |||||
---|---|---|---|---|---|---|---|---|---|---|
Symptom(s) | Sensitivity | Specificity | AUC | Cronbach’s α | Additional Reliability | |||||
90 to 120 Day Post-Deployment Psychological Short Screen | 15 items Combination of Yes/No response options and Likert type scales (various response options) | Symptoms related to a potentially traumatic stressor Depression Relationship Problems Alcohol Problems Anger Problems | ≥3 Yes responses ≥2 positive responses (More than Half the Days or Nearly Every Day) 2 Yes responses 2 Yes responses Sometimes–Very Often | 1578 US soldiers post-deployment and 356 soldiers pre-deployment in the United States [24] | Psychologically Traumatic Stress Depression Relationship Problems Alcohol Problems Anger Problems | 0.46 0.50–0.53 0.40–0.82 0.33 0.59 | 0.97 0.94–0.96 0.89–0.92 0.94 0.91 | Not reported | Not reported | Not reported |
Anxiety and Depression Detector (ADD) | 5 items Yes/No response option | PD PTSD SP GAD MDD | N/A | 801 primary care patients in the United States [25] | PD PTSD SP GAD MDD | 0.92 0.62 0.69 1.00 0.85 | 0.74 0.83 0.76 0.56 0.73 | Not reported | Not reported | Not reported |
Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST) | 8 items Yes/No qualifier response option for substance involvement (SI) 5-point Likert type scale for frequency of use (Never–Daily/Almost Daily) | Total Use/Abuse Total Abuse/Dependence Alcohol Use/Abuse Alcohol Abuse/Dependence Cannabis Use/Abuse Cannabis Abuse/Dependence Cocaine Use/Abuse Cocaine Abuse/Dependence Amphetamine Type Stimulant Use/Abuse Amphetamine Type Stimulant Abuse/Dependence Sedative Use/Abuse Sedative Abuse/Dependence Opioid Use/Abuse Opioid Abuse/Dependence | 14.5 28.5 5.5 10.5 1.5 10.5 0.5 8.5 0.5 11.5 9.5 10.5 0.5 14.5 | 1047 participants (697 primary health care patients; 350 patients attending specialized drug treatment facilities) across multiple sites (Australia, Brazil, India, Thailand, United Kingdom, United States, Zimbabwe) [26] | Total Use/Abuse Total Abuse/Dependence Alcohol Use/Abuse Alcohol Abuse/Dependence Cannabis Use/Abuse Cannabis Abuse/Dependence Cocaine Use/Abuse Cocaine Abuse/Dependence Amphetamine Type Stimulant Use/Abuse Amphetamine Type Stimulant Abuse/Dependence Sedative Use/Abuse Sedative Abuse/Dependence Opioid Use/Abuse Opioid Abuse/Dependence | 0.80 0.73 0.83 0.67 0.91 0.57 0.92 0.70 0.97 0.72 0.94 0.54 0.94 0.76 | 0.71 0.66 0.79 0.60 0.90 0.61 0.94 0.77 0.87 0.68 0.91 0.50 0.96 0.65 | 0.84 0.73 0.87 0.70 0.96 0.62 0.95 0.84 0.96 0.77 0.96 0.45 0.97 0.74 | Total SI 0.89 Tobacco Specific SI 0.80 Alcohol Specific SI 0.84 Cannabis Specific SI 0.86 Cocaine SI 0.93 Ampheta-mine Type Stimulant Specific SI 0.94 Sedative Specific SI 0.89 Opioid Specific SI 0.94 | Not reported |
Composite International Diagnostic-Screener (CID-S) | 12 items Yes/No response option | SD PD GAD SP Agoraphobia Specific Phobia Depressive Disorders Hypomania Mania AUD Prescription Drug Disorders Other Illicit Substance Disorders | N/A | Random sample of 1095 participants [27] | SD PD GAD SP Agoraphobia Specific Phobia MDD Mania Alcohol Dependence/Abuse Any Substance Disorder | 0.80 1.00 0.91 0.92 0.83 0.92 0.84 1.00 0.79 1.00 | 0.48 0.47 0.46 0.46 0.48 0.49 0.48 0.46 0.47 0.46 | Not reported | Not reported | Test–retest ϰ 0.64–0.92 |
Composite International Diagnostic Interview Screening Scale (CIDI-SC) | 9 preliminary 38 total items Yes/No response option | MDD GAD PD BPD | N/A | 3058 patients from primary care offices in the United States [28] | MDE GAD PD BPD | 0.80 0.68 0.76 0.74 | 0.90 0.94 0.94 0.99 | 0.93 0.88 0.90 0.97 | Not reported | Cohen’s ϰ 0.65 0.52 0.62 0.73 |
Five-Item Mental Health Inventory (MHI-5) | 5 items 6-point Likert type scale (All of the Time–None of the Time) | MDD Dysthymia BPD GAD PD Agoraphobia SP Simple Phobia OCD | Not reported | 213 individuals newly enrolled in the Harvard Community Health Plan in the United States [29] | Any Affective Disorder Anxiety Disorders MDD | Not reported | Not reported | 0.78 0.74 0.89 | Not reported | Not reported |
Maximum sensitivity and specificity MDD and Dysthymia 74 GAD 62 PD 70 OCD 78 | Random sample of 7076 participants in the Netherlands [30] | Any Mood Disorder MDD Dysthymia BPD Any Anxiety Disorder GAD PD Agoraphobia SP Simple Phobia OCD | 0.90 0.74 0.78 1.00 | 0.80 0.89 0.83 0.78 | 0.92 0.93 0.91 0.88 0.73 0.90 0.87 0.80 0.77 0.69 0.93 | 0.83 | Not reported | |||
4-week DSM-IV diagnoses Mood Disorders ≤60 Anxiety Disorders ≤70 SDs ≤60 SUDs ≤70 | Random sample of 4075 in Germany [31] | Mood Disorders Anxiety Disorders SDs SUDs | 0.83 0.73 0.43 0.67 | 0.78 0.60 0.78 0.58 | 0.88 0.71 0.65 0.66 | 0.74 | Not reported | |||
The Kessler Psychological Distress K6 Screening Scale (K6) | 6 items 5-point Likert type scale (None of the Time–All of the Time) | Broad screener for serious mental illness (SMI) | Probable Mental Disorder 13 to 24 Moderate Mental Disorder 5 | Nationally representative adult samples totaling 41,770 across multiple sites (Brazil, Bulgaria, Colombia, India, Japan, Lebanon. Mexico. New Zealand. Nigeria People’s Republic of China, People’s Republic of China Shenzhen, Romania. South Africa, Ukraine United States) [32] | SMI | Not reported | Not reported | 0.76 to 0.86 | Not reported | Not reported |
Not reported | 78 police officers in Canada [33] | Psychological Distress | Not reported | Not reported | Not reported | 0.81 | Not reported | |||
Not reported | 459 volunteer firefighters in Australia [34] | Not reported | Not reported | Not reported | Not reported | Not reported | Not reported | |||
The Mental Health Component Scale (MCS-12) | 12 items Yes/No response options and varying item length scaled responses per question Score range of 0 to 100 (lower scores reflect poorer mental health). | Broad screener for psychological symptoms and limitations | Depression ≤45 Any Anxiety Disorder ≤50 Any Common Mental Disorder ≤50 Severe Psychological Impairment ≤36 | National Survey of Mental Health and Wellbeing 10,504 in Australia [35] | Depression Anxiety Disorders Any common mental disorder | 0.87 0.81 0.84 | 0.83 0.73 0.74 | 0.92 0.83 0.86 | Not reported | Not reported |
Mini-International Neuropsychiatric Interview (M.I.N.I.) | 21 preliminary items Yes/No response options with optional clinician/researcher rater inquiries | MDD Dysthymia Suicidality Mania PD Agoraphobia SP Specific Phobia OCD GAD Alcohol Dependence Alcohol Abuse Drug Dependence Drug Abuse Psychotic Disorder Anorexia Nervosa PTSD APD | N/A | 636 adult sample across the United States and France [10] | MDD Dysthymia Current Mania Lifetime Mania Current PD Lifetime PD Current Agoraphobia Lifetime Agoraphobia Current SP Lifetime SP Current Simple Phobia Lifetime Simple Phobia GAD OCD Current Psychotic Disorder Lifetime Psychotic Disorder Current Alcohol Dependence Current Drug Dependence Lifetime Drug Dependence Anorexia Bulimia PTSD | 0.96 0.67 0.82 0.81 0.84 0.88 0.85 0.82 0.81 0.81 0.78 0.70 0.91 0.62 0.84 0.88 0.80 0.45 0.77 0.90 0.92 0.85 | 0.88 0.99 0.95 0.94 0.93 0.93 0.88 0.92 0.86 0.90 0.90 0.93 0.86 0.98 0.89 0.92 0.95 0.96 0.92 1.00 0.99 0.96 | Not reported | Not reported | Interrater/Test–retest ϰ 1.00/0.87 Not reported 0.79/0.35 0.89/0.63 0.92/0.68 0.97/0.79 0.97/0.73 0.92/0.81 0.94/0.65 0.88/0.68 0.88/0.63 0.88/0.52 0.98/0.78 1.00/0.85 0.81/0.77 0.90./0.83 1.00/0.86 0.91/0.96 0.94/0.86 1.00/0.78 1.00/1.00 0.95/0.73 |
N/A | 100 emergency service personnel (police, firefighters, paramedics) in Australia [36] | Not reported | Not reported | Not reported | Not reported | Not reported | Not reported | |||
My Mood Monitor (M-3) Checklist | 27 items 5-point Likert type scale (Not at All–Most of the Time | MDD BPD GAD PD SAD OCD PTSD General Functional Impairment | ≥5 ≥2 ≥3 Not reported Not reported Not reported ≥2 | 647 primary care seeking adults in the United States [37] | MDD BPD Anxiety Disorders PTSD Any Psychiatric Disorder | 0.84 0.88 0.82 0.88 0.83 | 0.80 0.78 0.78 0.76 0.76 | Not reported | Not reported | Not reported |
Patient Health Questionnaire for Depression and Anxiety (PHQ-4) | 4 items 4-point Likert type scale (Not at All–Nearly Every Day) | MDD GAD | Not reported | 934 undergraduate students from a Midwestern university in the United States [38] | GAD MDD | Not reported | Not reported | 0.84 0.79 | GAD-2 0.84 PHQ-2 0.76 PHQ-4 0.81 | Test–retest ϰ 0.69–0.81 |
≥3 PHQ-2 (probable cases of MDD) ≥3 GAD-2 (probable cases of GAD) | 2149 patients from 15 primary care clinics in the United States [39] | GAD PD SAD PTSD GAD PD SAD PTSD | Not reported | Not reported | GAD-2 0.91 0.85 0.83 0.80 PHQ-2 0.81 0.75 0.78 0.77 | GAD-2 0.82 PHQ-2 0.75 PHQ-4 0.85 | Not reported | |||
843 police officers in Germany [40] | MDD GAD | Not reported | Not reported | Not reported | 0.79 | Not reported | ||||
Posttraumatic Adjustment Scale (PAS) | 10 items 5-point Likert type scale (Not at All–Totally) | PTSD MDE | ≥16 ≥4 | 527 hospitalized injury patients in Australia [41] | PTSD MDE | 0.82 0.72 | 0.84 0.75 | 0.84 0.73 | Not reported | Not reported |
Web Screening Questionnaire (WSQ) | 15 items Combination of Yes/No response options and Likert type scales (various response options) | MDD GAD PTSD SP PD Agoraphobia Specific Phobia OCD Alcohol Abuse/Dependence | MDD Q1 ≥ 5 and Q2 = 1 GAD Q3 ≥ 2 PD Q4 ≥ 1 PD with Agoraphobia Q4 ≥ 1 and Q5 = 1 Agoraphobia Q5 = 1 Specific Phobia Q6 or Q7 = 1 SP Q8 = 1 and Q9 = 1 PTSD Q10 = 1 or Q11 = 1 OCD Q12 ≥ 1 Alcohol Abuse/Dependence Q 13 ≥ 2 and Q14 ≥ 3 Suicide Q15 = 3 (exclusion) | 502 online participants in the Netherlands [42] | MDD GAD SP PD PD with Agoraphobia Agoraphobia Specific Phobia OCD PTSD Alcohol Abuse/Dependence | 0.85 0.93 0.72 0.90 0.86 1.00 0.80 0.80 0.83 0.83 | 0.59 0.45 0.73 0.44 0.77 0.63 0.47 0.69 0.47 0.72 | 0.72 0.78 0.72 0.76 0.82 0.81 Not reported 0.81 0.65 0.77 | Not reported | Not reported |
Not reported | 1292 adults (1117 general population, 175 psychiatric outpatients) in the Netherlands [43] | MDD PD PD with Agoraphobia Agoraphobia SP Specific Phobia GAD PTSD OCD Alcohol Abuse/Dependence | 0.58 1.00 0.90 0.81 0.79 1.00 0.66 0.79 0.67 0.56 | 0.94 0.89 0.97 0.95 0.93 0.73 0.90 0.52 0.91 0.93 | 0.83 0.98 0.99 0.80 0.95 0.93 0.89 0.86 0.82 0.82 | Not reported | Not reported |
Screening Questionnaire | Features | Mental Disorders Screened | Cut-Off Scores | Study/Validation Sample | Psychometric Properties | |||||
---|---|---|---|---|---|---|---|---|---|---|
Symptoms | Sensitivity | Specificity | AUC | Cronbach’s α | Additional Reliability | |||||
Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) | 3 items 5-point Likert type scale of alcohol consumption (Never/0 Drinks–6 or More Times a Week/10 or More Drinks) | Alcohol Abuse/Dependence Heavy Drinking | ≥3 for sensitivity ≥4 for specificity | 243 VA general medical clinic patients in the United States [68] | Alcohol Abuse/Dependence Heavy Drinking | 0.90 0.98 | 0.45 0.56 | 0.79 0.89 | Not reported | Not reported |
Alcohol misuse ≥4 for males and ≥3 for females | 944 firefighters in the United States [71] | Alcohol Abuse/Dependence and Heavy Drinking | Not reported | Not reported | Not reported | 0.80 | Not reported | |||
Not reported | 266 women firefighters in the United States [72] | Alcohol Abuse/Dependence and Heavy Drinking | Not reported | Not reported | Not reported | 0.67 | Not reported | |||
Any AUD ≥7.5 Alcohol Dependence ≥8.5 | 222 public first responders in South Korea [70] | Any AUD Alcohol Dependence | 0.82 0.86 | 0.80 0.86 | Not reported | Not reported | Test–retest ICC 0.91 | |||
Alcohol misuse ≥4 for males and ≥3 for females | 184 police officers in the United States [73] | Not reported | Not reported | Not reported | Not reported | Not reported | Not reported | |||
Not reported | 321 career firefighters 204 volunteer firefighters in the United States [74] | Alcohol Abuse/Dependence and Heavy Drinking | Not reported | Not reported | Not reported | 0.81 | Not reported | |||
Brief Panic Disorder Severity—Self Report (Brief PDSS-SR) | 2 items | PD | >3 | 5103 clients with PD, SAD, or MDD [75] | PD | 0.85 | 0.66 | 0.82 | Not reported | ωC = 0.74 |
Brief PTSD Screen (Brief PSS) | 3 items 4-point Likert type scale (Not at All–Five or More Times per Week/Very Much) | PTSD comorbid with severe mental illness (SMI) | ≥3 | 220 clients with a SMI diagnosis in the United States [76] | PTSD | 0.94 | 0.85 | 0.96 | 0.81 | Not reported |
Panic Disorder Screener (PADIS) | 4 items Q1 5-point Likert type scale for number of panic episodes (None–11 or more) Q1 response of 0 does not require completion of remaining items Q 2-4 4-point Likert type scale (Never–All of the Time) | PD | ≥4 | 12,336 young adults in Australia [77] | PD | 0.77 | 0.84 | 0.87 | 0.86 | Not reported |
Patient Health Questionnaire-2 | 2 items 4-point Likert type scale (Not at All–Nearly Every Day) | MDD | ≥3 | 6000 patients in primary care and obstetrics-gynecology clinics in the United States [63] | MDD | 0.83 | 0.92 | 0.93 | Not reported | Not reported |
Not reported | 184 police officers in the United States [73] | Not reported | Not reported | Not reported | Not reported | Not reported | Not reported | |||
Primary Care Posttraumatic Stress Disorder screen (PC-PTSD-5) | 5 items Yes/No response options | PTSD | ≥3 Yes | 398 VA primary care clients in the United States [78] | PTSD | 0.95 | 0.85 | 0.94 | Not reported | Not reported |
Short-Form PCL-5 | 4 items 5-point Likert type scale (Not at All–Extremely) | PTSD | Not reported | 8917 active duty military to select items; 11728 for validation [79] | PTSD | 0.99 | 0.88 | 0.93 | Not reported | Not reported |
Short Forms of PTSD Checklist (PCL-C-SF) | 2 items to 6 items 5-point Likert type scale (Not at All–Extremely) | PTSD | 6 items | 986 first responders (police, firefighters, paramedics) [80] | PTSD | Not reported | Not reported | Not reported | 0.88 | Not reported |
2 items ≥4 6 items ≥14 | 221 VA primary care female patients 154 VA primary care patients in the United States [81] | PTSD | 2-item version 0.80–0.96 6-item version 0.80–0.92 | 2-item version 0.58–0.65 6-item version 0.72–0.86 | 2-item version 0.73–0.88 6-item version 0.84–0.89 | Not reported | Not reported | |||
4 items ≥9 | Primary care VA patients seeking treatment in SUD specialty treatment (158) and general mental health treatment (242) [82] | PTSD | 2-item version 0.72 4-item version 0.65 6-item version 0.75 | 2-item version 0.73 4-item version 0.90 6-item version 0.78 | 2-item version 0.81 4-item version 0.85 6-item version 0.84 | Not reported | Not reported | |||
Short Posttraumatic Stress Disorder Rating Interview (SPRINT) | 8 items 5-point Likert type scale (Not at All–Very Much) | PTSD and related symptoms | 14 to 17 | 83 outpatients in clinical trial of PTSD and 630 randomly selected participants in the United States [83] | PTSD and related symptoms | Total sample 0.95 Clinical sample 0.62 | Total sample 0.96 Clinical sample 0.94 | Not reported | 0.78–0.88 | Test–retest ICC 0.78 Interrater ICC 1.00 |
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Shields, R.E.; Korol, S.; Carleton, R.N.; McElheran, M.; Stelnicki, A.M.; Groll, D.; Anderson, G.S. Brief Mental Health Disorder Screening Questionnaires and Use with Public Safety Personnel: A Review. Int. J. Environ. Res. Public Health 2021, 18, 3743. https://doi.org/10.3390/ijerph18073743
Shields RE, Korol S, Carleton RN, McElheran M, Stelnicki AM, Groll D, Anderson GS. Brief Mental Health Disorder Screening Questionnaires and Use with Public Safety Personnel: A Review. International Journal of Environmental Research and Public Health. 2021; 18(7):3743. https://doi.org/10.3390/ijerph18073743
Chicago/Turabian StyleShields, Robyn E., Stephanie Korol, R. Nicholas Carleton, Megan McElheran, Andrea M. Stelnicki, Dianne Groll, and Gregory S. Anderson. 2021. "Brief Mental Health Disorder Screening Questionnaires and Use with Public Safety Personnel: A Review" International Journal of Environmental Research and Public Health 18, no. 7: 3743. https://doi.org/10.3390/ijerph18073743