A new 13-question mental health assessment combines various screening instruments into a single tool to rapidly identify a range of psychiatric disorders in patients seeking emergency treatment.

The 13-item Mental Wellness Tool (mwTool-13) detected common or severe mental disorders, substance use disorders (SUDs), and suicide risk among patients in a psychiatric emergency department (ED). Compared to a routine psychiatric ED assessment, the tool identified the various conditions with high sensitivity and specificity.

Typical screening for this range of mental disorders can take well over 45 minutes and require the use of several assessment tools, the investigators noted. The mwTool-13 accomplished this task in 2-10 minutes, with the presence of any psychiatric disorder detected with just the first three questions.

While it has been validated internationally, this is the first assessment of the tool’s utility among a US population.

“The mwTool-13 may help increase mental health equity by facilitating efficient, comprehensive community screening for early detection of treatable conditions among hard-to-reach populations that may otherwise not seek mental healthcare,” lead investigator Annika Sweetland, DrPH, associate professor of clinical sociomedical sciences in psychiatry at Columbia University in New York City, and colleagues wrote.

The study was published online on September 3 in Psychiatric Services.

A Path to Health Equity

Existing mental health screening tools typically only assess for one disorder, and the most commonly used scales in primary care don’t screen for more severe disorders or suicide risk.

A tool that could simultaneously screen for various mental disorders could improve detection among marginalized groups who may not engage with the mental health system, the investigators noted.

The mwTool-13 is a short, two-step tool that screens for various conditions, including common disorders such as depression and anxiety, as well as psychosis, mania, and other severe disorders. It also screens for SUDs and suicide risk.

Items on the mwTool-13 were based on existing standardized screening instruments such as the Patient Health Questionnaire, Psychosis Screening Questionnaire, and Generalized Anxiety Disorder assessment.

The first three questions in the assessment seek to identify whether the patient has any mental disorder. The remaining 10 categorize what type of mental disorder is present. Results from the tool were compared to those from routine assessment by attending psychiatrists at the hospital.

The investigators included 269 patients receiving ED psychiatric care in a New York City hospital between 2021 and 2022 in their analysis (mean age, 40 years; 53% female; 47% Latinx). Patients were given the option to interview in Spanish or English.

Patients without a mental disorder were the controls in the specificity analyses for all disorders. Those with one diagnosed mental disorder served as controls in specificity calculations for the disorders they did not have.

Consistent Performance

Two fifths of patients had a disorder in more than one category, with the most common combination being suicide risk and common mental disorders.

Around half of the patients were diagnosed with a common mental disorder, 44% with a severe mental disorder, and 23% with an SUD; 22% had a high risk for suicide.

The first three questions on the mwTool-13 identified any mental disorder with 95% sensitivity (95% CI, 0.91-0.97).

The complete tool showed 97% sensitivity for common mental disorders (95% CI, 0.92-0.99) and 93% sensitivity for suicide risk (95% CI, 0.83-0.98). The tool was less sensitive in detecting SUDs (0.80) and severe mental disorders (0.65).

The highest specificity was reported for severe mental disorders (0.71; 95% CI, 0.62-0.78), followed by common mental disorders (0.67), SUDs (0.58), and suicide risk (0.50).

The findings were largely consistent regardless of gender or race/ethnicity.

“The mwTool-13, which can be administered in 2-10 minutes, facilitates a more efficient and targeted assessment, thereby reducing the burden on healthcare providers and on individuals seeking care,” they wrote.

“Furthermore, pairing the mwTool-13 with brief evidence-based interventions for mild-to-moderate common mental disorders, substance use disorders, and suicide risk — and triggering immediate referrals for more severe symptoms — could facilitate a stratified approach to care that maximizes resources, personalizes care, and reduces waitlists for specialized services,” they added.

Limitations of the study were that the standard comparator was a psychiatrist’s diagnosis and that the type of psychiatric conditions in an ED may differ from those in community settings.

This study was funded by the National Institute of Mental Health and the Fogarty International Center at the National Institutes of Health. The authors reported no relevant disclosures.