Epidemiological and clinical use of GMHAT-PC (Global Mental Health assessment tool - primary care) in cardiac patients

Abstract

Background: A computer assisted interview, the GMHAT/PC has been developed to assist General Practitioners and other Health Professionals to make a quick, convenient and comprehensive standardised mental health assessment. It has proved to be a reliable and valid tool in our previous studies involving General Practitioners and Nurses. Little is known about its use in cardiac rehabilitation settings.

Aim: The study aims to assess the feasibility of using a computer assisted diagnostic interview by nurses for patients attending Cardiac Rehabilitation Clinics and to examine the level of agreement between the GMHAT/PC diagnosis and a Psychiatrist clinical diagnosis. Prevalence of mental illness was also measured.

Design: Cross sectional validation and feasibility study.

Methods: Nurses using GMHAT/PC examined consecutive patients presenting to a cardiac rehabilitation centre. A total of 118 patients were assessed by nurses and consultant psychiatrist in cardiac rehabilitation centres. The kappa coefficient (kappa), sensitivity, and specificity of the GMHAT/PC diagnosis were analysed as measures of validity. The time taken for the interview as well as feedback from patients and interviewers were indicators of feasibility. Data on prevalence of mental disorders in an outpatient cardiac rehabilitation setting was collected.

Results: The mean duration of the interview was 14 minutes. Feedback from patients and interviewers indicated good practical feasibility. The agreement between GMHAT/PC interview-based diagnoses and consultant psychiatrists' ICD-10 criteria-based clinical diagnosis was good or excellent (kappa = 0.76, sensitivity = 0.73, specificity = 0.90). The prevalence of mental disorders in this group was 22%, predominantly depression. Very few cases were on treatment.

Conclusion: GMHAT/PC can assist nurses in making accurate mental health assessments and diagnoses in a cardiac rehabilitation setting and is acceptable to cardiac patients. It can successfully be used to gather epidemiological data and help in managing mental health problems in this group of patients.