Screening for substance use and mental health problems in a cross-sectoral sample of Canadian youth

Abstract

Background: This project examines the substance use and mental health concerns of a cross-sectoral, national, service-seeking sample of adolescents and emerging adults using an extended version of the Global Appraisal of Individual Needs-Short Screener (GSS). It also aims to provide incremental evidence of the psychometric properties of the GSS.

Methods: A sample of 2313 youth aged 12-24 years who presented for service participated in the project. Youth were recruited from 89 participating services across Canada representing eight major clinical and non-clinical sectors. Participants completed the GSS and provided sociodemographic data.

Results: The majority of youth presenting for services endorsed concerns on the GSS and would be likely to meet diagnostic criteria for a disorder in a full diagnostic assessment according to the norms for the scale, while many endorsed multiple concerns. This was true in both clinical and non-clinical settings. Externalizing concerns and suicidality were significantly more common in younger participants, while substance use was significantly more common in older youth. Females were more likely to endorse internalizing and suicidality concerns, while males endorsed more substance use and crime/violence concerns. Internalizing and suicidality concerns were also more common in Canada's northerly regions. The reliability of the GSS was confirmed, however the factor structure revealed problems.

Conclusions: Youth presenting across clinical and non-clinical service sectors endorse high levels of need, supporting the importance of universal, cross-sectoral screening. The GSS is a practical tool that service providers across sectors can employ to identify the addiction and mental health service needs of youth, although further psychometric work is warranted. Implications for screening and treatment in community contexts are discussed.

Keywords: Cross-sectoral; Mental health; Screening; Substance use; Youth.

Fig. 1

Number of concerns endorsed by GSS domain. This figure shows the percentage of youth endorsing 0, 1–2, or 3+ concerns on each of the four GSS domains. INT internalizing domain, EXT externalizing domain, SUB substance use domain; CV crime/violence domain

Fig. 2

Recent clinical needs using high threshold (3+ endorsements) on GSS domains and past-year endorsement of suicidality, by service sector. This figure represents the proportion of youth endorsing each GSS domain using the high threshold, i.e., endorsing three or more concerns in that domain, and endorsing suicidal ideation. Results are illustrated based on the sector in which the participant entered the study

Fig. 3

Recent clinical needs using high threshold (3+ endorsements) on GSS domains and past-year endorsement of suicidality, by age group. This figure illustrates the proportion of youth endorsing each GSS domain using the high threshold, i.e., endorsing three or more concerns in that domain, and endorsing suicidal ideation, based on age category (12–15 years old, 16–18 years old, 19–24 years old)

Fig. 4

Recent clinical needs using high threshold (3+ endorsements) on GSS domains and past-year endorsement of suicidality, by sex. This figure shows the proportion of youth endorsing each GSS domain using the high threshold, i.e., endorsing three or more concerns in that domain, and endorsing suicidal ideation, based on sex. Participants identifying as “trans” were removed from the analysis due to a small sample size (n = 6)

Fig. 5

Endorsement of extension items, by sex. This figure shows the proportion of youth endorsing the extension items of the GSS, based on sex. Participants identifying as “trans” were removed from the analysis due to a small sample size (n = 6)

Fig. 6

Endorsement of concurrent disorders using high threshold (3+ endorsements). This figure illustrates the proportion of youth with overlapping concerns in the internalizing, externalizing and substance use domains of the GSS, using the high threshold, i.e., endorsing three or more concerns in that domain. 19.0% of respondents did not screen positive in any of the three categories

Fig. 7

Complexity of needs by service sector. This figure illustrates the proportion of participants endorsing complex needs, based on the service sector in which they entered the study. Complex needs were defined as the endorsement of three or more factors from among (1) housing (unstable/high risk), (2) educational/occupational risk, (3) legal involvement, (4) internalizing disorders, (5) externalizing disorders, and (6) substance use problems