The Global Mental Health Assessment Tool-Validation in Hindi: A Validity and Feasibility Study

Article excerpt

Byline: Vimal. Sharma, Savita. Jagawat, Aarti. Midha, Anil. Jain, Anil. Tambi, Leena. Mangwani, Bhawna. Sharma, Parul. Dubey, Vipin. Satija, John. Copeland, Peter. Lepping, Steven. Lane, Murali. Krishna, Ashok. Pangaria

Background: A computer-assisted interview, the Global Mental Health Assessment Tool-validation (GMHAT/PC) has been developed to assist general practitioners and other health professionals to make a quick, convenient, yet reasonably comprehensive standardized mental health assessment. GMHAT/PC has been translated into various languages including Hindi. This is the first study conducted in India, using the Hindi version GMHAT/PC of the series of studies assessing its validity in different cultures. Aim: The study aims to assess the feasibility of using a computer assisted diagnostic interview by health professionals and to examine the level of agreement between the Hindi version GMHAT/PC diagnosis and psychiatrists' ICD-10 based clinical diagnosis. Design: Cross-sectional validation study. Setting : Psychiatric clinic of a General Hospital and an out patient (Neurology) clinic in the Teaching General Hospital in Jaipur, India. Materials and Methods: All consecutive patients attending the psychiatric out patient clinic were interviewed using GMHAT/PC and psychiatrists made a diagnosis applying ICD-10 criteria for a period of six weeks. A small sample of subjects was interviewed in a similar way in a Neurology clinic for four weeks. Results: The mean duration of interview was under 17 minutes. Most patients were pleased that they were asked about every aspect of their mental health. The agreement between psychologists' GMHAT/PC interview diagnoses and psychiatrists' clinical diagnoses was excellent (Kappa 0.96, sensitivity 1.00, and specificity 0.94). Conclusion: GMHAT/PC Hindi version detected mental disorders accurately and it was feasible to use GMHAT/PC in Indian settings.

Introduction

Mental health problems are one of the leading causes of disability in the world (WHO 2001). [sup][1] A vast majority of people with mental disorders including with severe mental illness view primary care as the cornerstone of their health care system. [sup][2] It takes about six years to train a doctor and a further 6 years to train as a psychiatrist. The low and middle-income countries therefore have few doctors and even fewer psychiatrists, because of the high cost of medical education and the problems with retention of doctors once they have qualified. There is no foreseeable answer to this problem. As a result many thousands of mentally ill people remain untreated. The challenges of establishing satisfactory community mental health services in developing countries have been addressed by Murthy and Kumar highlighting the need for training on mental health to health workers and utilizing community resources in providing care to the mentally ill. [sup][3]

Sharma and Copeland have developed a computer-assisted semi-structured, interviewer rated package, the Global Mental health Assessment Tool (GMHAT/PC), with primary care workers, which has already been translated into a number of languages of low- and middle-income countries. The package is an innovative way to address this problem. This method aims to improve the recognition of mental illness in primary care and initiation of appropriate treatments by skilling up primary care workers. The use of computers could be a restriction, but we are developing the program to be installed on a touch-screen PDA, making it easy to use anywhere. These methods which have so far taken 7 years to adapt and develop are based on many years of developing and using computer-assisted research diagnostic tools.

Our research so far demonstrated the feasibility of using this method in primary care and general health setting. [sup][4],[5],[6] Patients on the whole received the GMHAT/PC assessment well and said they found it helpful as it covered more aspects of their mental health than the usual consultation. …