A screening instrument for mental illness in black patients in primary health care settings

Abstract

English: Mental illness is to an alarming extent undetected among black people and specifically in the Primary Health Care (PHC) setting. The main reason for this is that black people with mental health needs present with somatic symptoms. This results in unnecessary tests and inappropriate treatment. Although there is an instrument (Self Reporting Questionnaire) that was specifically designed to detect mental illness in the PHC setting, literature indicates some concerns in the usage of this instrument. This study is the development of a screening instrument to detect mental illness among black people in the PHC. A non-experimental design which explored, described, developed and assessed was used in the development of the instrument. Several research techniques were used to obtain the information on which the instrument was based, i.e. a literature survey, focus group interview, patient record audit and the Delphi technique. Thereafter the instrument was subjected to a clinical assessment. The instrument consists of two parts. Part I is very brief with the objective of identifying the need for further screening. Part II is longer and aims to identify the presence of mental illness. The clinical assessment of the instrument resulted in a sensitivity of 79% and a specificity 70%. These results are very promising especially when considering that some of the problems of the SRQ seem to be counteracted. Furthermore this is an instrument that has been developed at grass roots level. To enhance the value of the instrument the following recommendations were made. The instrument should be assessed in a broader geographical area as well as the specific time it took to implement. This may act as additional motivation for a wider application of the instrument.

Afrikaans: Die vlak waartoe geestesongesteldheid onder veral swart mense in die Primêre Gesondheidsorg-omgewing, nie geïdentifiseer word nie, is kommerwekkend. Die hoofrede vir dié toedrag van sake is dat swart persone hulle geestesgesondheidbehoeftes deur middel van somatiese simptome openbaar. Dit lei tot onnodige toetse en ontoepaslike behandeling. Alhoewel daar 'n instrument spesifiek ontwerp is (Self Reporting Quetionnaire) om geestesongesteldheid in die PGS te identifiseer dui studies in die literatuur daarop dat hierdie instrument sekere probleme het. Hierdie studie behels die ontwikkeling van 'n siftingsinstrument om geestesongesteldheid by swart persone in PGS te identifiseer. 'n Nieeksperimentele ontwerp wat geëksploreer, beskryf, ontwikkel en evalueer is in die ontwikkeling van die instrument gebruik. Etlike navorsingstegnieke is gebuik om die inligting, waarop die instrument gebaseer is, te bekom, naamlik 'n literatuuroorsig, fokusgroep onderhoude, pasiënt rekord oudit en die Delphi tegniek. Daarna is die instrument aan 'n kliniese evaluering onderwerp. Die kliniese evaluering van die instrument het 'n sensitiwiteit van 79% en 'n spesifisiteit van 70% getoon. Hierdie is belowende resultate veral aangesien sommige van die probleme van die SRQ blyk aangespreek te wees. Verder is die instrument ontwikkel op voetsooi vlak. Om die waarde van die instrument te verhoog is die volgende aanbevelings gemaak. Die instrument moet in 'n wyer geografiese area evalueer word en die spesifieke tyd wat dit neem om die instrument te implementeer moet evalueer word. Dit kan as addisionele motivering dien om die instrument wyer te gebruik.