Primary Objective: Alcohol abuse and dependence (from here: alcohol abuse) and psychological problems are common among homeless people. Unfortunately, only a small part of this group will be referred to appropriate care. (Early) detection of alcohol…
ID
Source
Brief title
Condition
- Psychiatric disorders NEC
Synonym
Research involving
Sponsors and support
Intervention
Outcome measures
Primary outcome
Besides the items identified in phase 1, the CIDI will be used as a gold
standard used to determine depression, psychotic disorders, alcohol abuse and
dependence. Then, calculations are made to determine if specific items from the
instrument derived from phase I correctly identify clients with a disorder
(i.e. according to the CIDI diagnosis), above chance level. This is done by
calculating a ROC curve (receiver operating curve). This curve indicates how
well an item predicts if someone has a disorder - or not. At an Area under the
Curve of 1 the prediction is perfect, while an area under the curve of 0,5
indicates chance level results. Promising items will be checked for quality
(sensitivity, specificity, predictive value).
In the screener of the pilot study (2007), for example, an item aimed at
measuring alcohol abuse was the following: "How often do you have six (women:
four) or more drinks in one day?". The response categories ranged from 1
("never") to 5 ("daily"). The area under the curve for this question was 0.91,
which indicates good quality. Subsequently, the sensitivity and specificity
were calculated for various cut-off scores. A cut-off score of 3 ('1 -3 times
per month ') was related to the highest sensitivity, 90%. This means that 90%
of those with a diagnosis of alcohol abuse scored 3 or higher, and therefore
were correctly detected. Specificity was relatively high as well at 78%. This
means that 22% of the screened non-abusers were erroneously classified as
abuser.
The above analysis will be performed separately for alcohol abuse, for
depression, and for psychotic disorders. In this way, a screener will be
developed which shall preferably consist of one question per disorder. However,
analyses will also check if combinations of items lead to better prediction
than individual items.
Secondary outcome
n.v.t.
Background summary
The number of homeless people in homeless organisations (MO) is estimated at
57,000 in 2006 (Ministerie van VWS, 2008). Moreover, the percentage of homeless
people with alcohol dependence and / or a mental disorder is very high. Studies
have shown that in The Hague and Utrecht approximately 20% of the homeless
suffers from alcohol addiction (Reinking & Kroon, 1998; J. Wolf et al., 2002).
In Zeeland this is 15% (Jansen, Mensink, & Judith Wolf, 2007), and in Rotterdam
it is 32% (Van Rooij, Mulder, Wits, Van der Poel, & Van de Mheen, 2007). In
these studies, the prevalence of mental disorders was very high as well: 30%
for depression, and 5-15% for psychotic disorder. However, only a minority of
the respondents in these studies were referred to for specialist care. This is
troubling, and it should be noted that alcohol abuse can lead to physical
disorders, brain damage, mental, and social problems. Early detection of
clients with an alcohol problem speeds up treatment which should increase the
standard of living. Given the high prevalence of alcohol abuse and mental
disorders among homeless people there is much to be gained from effective early
detection and subsequent timely care.
Unfortunately, many workers in the MO do not have psychiatric expertise and
tools they use to determine mental disorders are not reliable enough.
Therefore, the MO has a need for a sensitive and valid screening instrument.
Using such an instrument will lead to better referral to specialist care,
including the general mental healthcare (GGZ). It is important that this
"screener" is simple, requires little training, and can be quickly administered.
Pilot Study
A 2006 pilot study by IVO developed and tested a screener in the city of
Rotterdam (Van Rooij, Mulder, Wits, Van der Poel, & Van de Mheen, 2007). It was
tested for overall quality in terms of sensitivity and specificity. If a
screener correctly detects high percentage of clients with a disorder correctly
it is said to be sensitive, and if it correctly detects a high percentage of
the clients with no disorder it is said specific. The two statistics are
related: more sensitivity generally results in lower specificity. For alcohol
abuse the 2006 screener was found to be highly sensitive and specific, but for
depression and psychotic disorders there was room for improvement. More
specifically, too many people would be referred to care for these disorders if
the screener was the only source of information. The current project aims to
develop better screener items for depression and psychoses. Additionally, it
aims to test if the alcohol items do equally well in a wider sample, in
preparation of nation wide use of the screener.
Study objective
Primary Objective:
Alcohol abuse and dependence (from here: alcohol abuse) and psychological
problems are common among homeless people. Unfortunately, only a small part of
this group will be referred to appropriate care. (Early) detection of alcohol
abuse and mental disorders is important. Early detection supports efforts by
health care professionals to offer targeted treatment and to prevent
exacerbation of existing problems. In this study we want to develop a simple,
short and valid questionnaire, a screener, which aims to measure alcohol abuse
and common psychiatric disorders. The goal is to implement this screener in
homeless organisations (MO). This is the point from which referral to mental
health care services or within the MO takes place. It is also a point where the
care for this client group can be significantly improved. The screener, which
we aim to develop, will be field-tested by MO professionals and will thus fit
the requirements of those professionals particularly well.
Secondary Objective(s):
After its construction and statistical examination, the study will focus on the
wide dissemination of the screener to different institutions in the
Netherlands. This will enable these institutions to refer and help their
clients more effectively.
Study design
The proposed project consists of three phases in which a screener is developed
and tested. In Phase I, a literature study will be performed in order to obtain
a preliminary selection of screener items that will be tested in Phase II. The
(international) literature will be searched for shorter and longer
questionnaires which are commonly used for detection of alcohol abuse,
depression and psychotic disorders.
Specifically, we will search for instruments that are both brief, have a high
sensitivity, and a high specificity. Based on the review of the literature, a
selection of questionnaires will be chosen. This selection will serve as the
foundation for the questionnaire which will be tested in Phase II of the
project. This questionnaire will also include the most effective items from the
screener which was developed in the earlier, 2006, screener study. Finally, in
Phase III, the usefulness of the screener will be examined by testing it in two
MO institutions.
Study burden and risks
No clear risks. When the subject indicates needing assistance with their
psychiatric problems after the interview, we will arrange for proper
communication with the mental health institutions.
Heemraadssingel 194
3021DM Rotterdam
NL
Heemraadssingel 194
3021DM Rotterdam
NL
Listed location countries
Age
Inclusion criteria
- Present in homeless care
- Signed consent form
Exclusion criteria
- Acute psychosis
- Acute intoxication
Design
Recruitment
Followed up by the following (possibly more current) registration
No registrations found.
Other (possibly less up-to-date) registrations in this register
No registrations found.
In other registers
| Register | ID |
|---|---|
| CCMO | NL34787.078.10 |