Validation of Global Mental Health Assessment Tool in Western Development Region, Nepal: A Cross Sectional Study
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Abstract
Introduction: Global Mental Health Assessment Tool Primary Care Version (GMHAT/PC) is comprehensive tool that can encompass wide array of mental health problems. This can be used by health professionals in detecting and managing mental disorders in primary care and general health settings.
Methodology: A Cross sectional study was carried out in western regional hospital Kaski to validate and examine feasibility of Global Mental Health Assessment Tool Primary Care Version (GMHAT/PC) in Western Development Region, Nepal. The GMHAT/PC tool and semi structured questionnaire was used to collect data. Interview was taken by the paramedical person with Proficiency Certificate Level (PCL) in General medicine qualification.
Data were analyzed using SPSS-16 version. Sensitivity and specificity were calculated to measure the validity of GMHAT/PC. Positive Predictive Value (PPV) and Negative Predictive Value (NPV) of tool, positive and negative likelihood ratio were calculated. Cohen's Kappa statistics was calculated to determine inter-rater reliability for the tool. Average time taken for the interview, patient satisfaction and completion of interview by the patient was taken as an indicator of feasibility.
Result: The tool had good sensitivity 0.79 (95% CI: 0.73-0.85) and excellent specificity 0.94 (95% CI: 0.83 – 1). Overall there was a good level of agreement between psychiatrist and GMHAT/PC tool 0.76 (95% CI: 0.67 – 0.84). Likewise, overall Positive Predictive Value (PPV) of the test was excellent 0.98 (95% CI: 0.94 – 0.99) while Negative Predictive Value (NPV was fair 0.40 (95% CI: 0.24 – 0.56). And Likelihood Ratio Positive (LR +ve) of diagnostic agreement of the GMHAT/PC tool was 13.17 (95% CI: 2.01 – 90.67) and Likelihood Ratio Negative (LR –ve) was 0.22 (95% CI: 0.15 – 0.31).
Conclusion: This study provides proven evidence to use Global Mental Health Assessment Tool Primary Care Version in specialist limited healthcare setting of Nepal. Findings of this study also support mid-level health workers and possibly others health workers having some training, can use the computer assisted programme GMHAT/PC to make a valid assessment and diagnosis for early detection and management of mental health related problem.
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