Three sets of screening scales were used in this research. This report presents the results of a methodological study that was conducted to select SMI screening scales for use in the NHSDA. The NHSDA is designed to allow direct state estimates for the 8 largest states and enough cases in the remaining states to allow small area estimation methods 3 to be used to produce indirect state-level estimates. The NHSDA is a nationally representative face-to-face survey that, beginning in 1999, includes about 70 000 respondents (45 000 adults). More precise estimates were consequently sought by developing screening scales for SMI that could be included in the annual SAMHSA National Household Survey on Drug Abuse (NHSDA). 1Īlthough preliminary state-level estimates of SMI were based on secondary analysis of existing epidemiological surveys, 2 these estimates were recognized to be merely provisional. The definition of SMI stipulated in PL 102-321 requires the person to have at least one 12-month DSM disorder, other than a substance use disorder, and to have "serious impairment." Subsequently, SAMHSA decided that "serious impairment" should be defined as a Global Assessment of Functioning (GAF) score of less than 60. The law also required the Substance Abuse and Mental Health Services Administration (SAMHSA) to develop an operational definition of SMI and to create an estimation method based on this definition for use by the states. The law required states to include incidence and prevalence estimates in their annual applications for block grant funds. PUBLIC LAW (PL) 102-321, the Alcohol, Drug Abuse, and Mental Health Administration Reorganization Act, established a block grant for states to fund community mental health services for adults with "serious mental illness"(SMI). Routine inclusion of either scale in clinical studies would create an important, and heretofore missing, crosswalk between community and clinical epidemiology. The most efficient screening scale, K6, had a sensitivity (SE) of 0.36 (0.08) and a specificity of 0.96 (0.02) in predicting SMI.Ĭonclusions The brevity and accuracy of the K6 and K10 scales make them attractive screens for SMI. The area under the receiver operating characteristic curve of SMI was 0.854 for K10 and 0.865 for K6. However, neither the CIDI-SF nor the WHO-DAS improved prediction significantly over the K10 or K6 scales. Results All screening scales were significantly related to SMI. We defined SMI as any 12-month DSM-IV disorder, other than a substance use disorder, with a GAF score of less than 60. An enriched convenience sample of 155 respondents was administered all screening scales followed by the 12-month Structured Clinical Interview for DSM-IV and the Global Assessment of Functioning (GAF). Methods Three SMI screening scales were developed for possible use in the SAMHSA National Household Survey on Drug Abuse: the Composite International Diagnostic Interview Short-Form (CIDI-SF) scale, the K10/K6 nonspecific distress scales, and the World Health Organization Disability Assessment Schedule (WHO-DAS). Shared Decision Making and Communicationīackground Public Law 102-321 established a block grant for adults with "serious mental illness" (SMI) and required the Substance Abuse and Mental Health Services Administration (SAMHSA) to develop a method to estimate the prevalence of SMI.Scientific Discovery and the Future of Medicine.Health Care Economics, Insurance, Payment.Clinical Implications of Basic Neuroscience.Challenges in Clinical Electrocardiography.
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