Performance replication of the Hospital Mental Health Risk Screen in ethnoracially diverse U.S. patients admitted through emergency care

• Published in: PloS one 2024-10, Vol.19 (10), p.e0311256
• Main Authors: Carlson, Eve B, Barlow, M Rose, Palmieri, Patrick A, Shieh, Lisa, Mellman, Thomas A, Cooksey, Erika, Parker, Jada, Williams, Mallory, Spain, David A
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Anxiety disorders; Breast cancer; Diagnosis; Emergency medical care; Emergency Medical Services; Emergency service; Emergency Service, Hospital; Evaluation; Female; Health problems; Health risk assessment; Health risks; Hospitalization; Hospitals; Humans; Illnesses; Injury prevention; Male; Mammography; Mass Screening; Medical screening; Medicine and Health Sciences; Mental depression; Mental disorders; Mental Disorders - diagnosis; Mental Disorders - epidemiology; Mental Health; Mental illness; Middle Aged; Patients; Performance prediction; Population studies; Post traumatic stress disorder; Prospective Studies; Replication; Risk Assessment; Risk factors; Subgroups; Trauma; Trauma centers; United States - epidemiology; Young Adult
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0311256

Patients admitted to hospitals after emergency care for injury or acute illness are at risk for later mental health problems. The American College of Surgeons Committee on Trauma Standards for care of injured patients call for mental health risk screening, and the Hospital Mental Health Risk Screen (HMHRS) accurately identified at-risk patients in a developmental study that included patients from five ethnoracial groups. Replication of these findings is essential, because initial positive results for predictive screens can fail to replicate if the items were strongly related to outcomes in the development sample but not in a new sample from the population the screen was intended for. Replication of the predictive performance of the 10-item HMHRS was studied prospectively in ethnoracially diverse patients admitted after emergency care for acute illness or injury in three hospitals across the U.S. Risk screen scores and follow-up mental health outcomes were obtained for 452 of 631 patients enrolled (72%). A cut score of 10 on the HMHRS correctly identified 79% of the patients who reported elevated levels of depression, anxiety, and PTSD symptoms two months post-admission (sensitivity) and 72% of the patients whose symptoms were not elevated (specificity). HMHRS scores also predicted well for patients with acute illness, for patients with injuries, and for patients who reported an Asian American/Pacific Islander, Black, Latinx, Multirace, or White identity. Predictive performance of the HMHRS was strong overall and within all five ethnoracial subgroups. Routine screening could reduce suffering and health care costs, increase health and mental health equity, and foster preventive care research and implementation. The performance of the HMHRS should be studied in other countries and in other populations of recent trauma survivors, such as survivors of disaster or mass violence.