Validation of a brief screener for broad-spectrum mental and substance-use disorders in South Africa

• Published in: Global mental health Vol. 11; p. e4
• Main Authors: Stockton, Melissa Ann, Mazinyo, Ernesha Webb, Mlanjeni, Lungelwa, Nogemane, Kwanda, Ngcelwane, Nondumiso, Sweetland, Annika C., Basaraba, Cale Neil, Bezuidenhout, Charl, Sansbury, Griffin, Lovero, Kathryn L., Olivier, David, Grobler, Christoffel, Wall, Melanie M., Medina-Marino, Andrew, Nobatyi, Phumza, Wainberg, Milton L.
• Format: Journal Article
• Language: English
• Published: Cambridge, UK Cambridge University Press 2024
• Subjects: assessment tools; cross-cultural; developing countries; Integration into primary health care; Measurement; Multi-context tools; primary care; psychometric evaluations; Quality of Care; assessment tools; primary care; developing countries; psychometric evaluations; cross-cultural
• ISSN: 2054-4251; 2054-4251
• DOI: 10.1017/gmh.2023.89

In low-resource settings, valid mental health screening tools for non-specialists can be used to identify patients with psychiatric disorders in need of critical mental health care. The Mental Wellness Tool-13 (mwTool-13) is a 13-item screener for identifying adults at risk for common mental disorders (CMDs) alcohol-use disorders (AUDs), substance-use disorders (SUD), severe mental disorders (SMDs), and suicide risk (SR). The mwTool-13 is administered in two steps, specifically, only those who endorse any of the initial three questions receive the remaining ten questions. We evaluated the performance of mwTool-13 in South Africa against a diagnostic gold standard. We recruited a targeted, gender-balanced sample of adults, aged ≥18 years at primary and tertiary healthcare facilities in Eastern Cape Province. Of the 1885 participants, the prevalence of CMD, AUD, SMD, SR, and SUD was 24.4%, 9.5%, 8.1%, 6.0%, and 1.6%, respectively. The mwTool-13 yielded high sensitivities for CMD, SMD, and SR, but sub-optimal sensitivities for AUD and SUD (56.7% and 64.5%, respectively). Including a single AUD question in the initial question set improved the tool’s performance in identifying AUD and SUD (sensitivity > 70%), while maintaining brevity, face-validity, and simplicity in the South African setting.