Ten questions predict mental health risk after emergency hospitalizations

Prioritizing sensitivity

Importantly, the latest study validates the screening tool in a new set of patients. This is essential to confirm that the screening is generalizable, the researchers said.

The new study included adult patients from three hospitals in California, Ohio and Washington, DC, who had diverse educational, economic and ethnic backgrounds. Patients took the screening within a few days of being admitted and could do so in English, Chinese or Spanish. Around 450 patients completed the study, including patients from five self-identified ethnoracial groups: Asian American/Pacific Islander, American Indian or Alaska Native, Black, Hispanic, and white.

At the two-month follow-up, the patients’ mental health was assessed by standard measures for depression, anxiety and PTSD.

Overall, the screening correctly predicted 79% of patients who had a mental health diagnosis at two months — a measure known as sensitivity. It correctly predicted 72% of patients who had no mental health diagnosis at two months — a measure known as specificity.

The screening predicted well for all ethnoracial groups, with slightly higher sensitivity for multiracial, Asian American/Pacific Islander, Black and Hispanic patients and slightly higher specificity for white and Hispanic patients. There was no difference between injury and acute illness patients.

In choosing the cut-off score that distinguishes low-risk from high-risk patients, the researchers prioritized sensitivity over specificity — meaning they prioritized capturing all high-risk patients, even if some low-risk patients were included.

“There are some people you may refer for help and resources who don’t need it, but you want to make sure you don’t miss people who are going to have symptoms,” Spain said.

The next — and more challenging — step is to evaluate resources that could help those at high-risk to lower their risk.

“Very few hospitals in the U.S. have the capacity to provide professional preventive mental health care,” Carlson said. “Unfortunately, most referrals to mental health care don’t result in care being obtained.”

Instead, the researchers are developing self-help programs that patients could use at home that would direct them to professional care if needed. Coaching programs for family members to better support patients could also help.

Though designed for the hospital, the new screening could be adapted for survivors of other types of trauma — such as natural disasters or mass shootings.

“Based on what I’ve seen, I think it would work in other situations,” Spain said.

Researchers from the Veterans Affairs Palo Alto Health Care System, Summa Health and Howard University College of Medicine contributed to the work.  

The study received funding from the National Institute on Minority Health and Health Disparities (grant R01MD012273).