Clinical validation of brief mental health scales for use in South African occupational healthcare

Abstract

ORIENTATION: South Africa carries a high burden of mental ill-health. Screening to identify individuals for further referral is emerging as one pathway to promote access to mental health interventions. Existing occupational health surveillance infrastructure may be a useful mechanism for clinical mental health screening. RESEARCH PURPOSE: This study explored the clinical validity of a range of brief mental health measures in the context of occupational health surveillance. MOTIVATION FOR THE STUDY: To meaningfully screen for mental health as part of occupational health surveillance, tools are required that are empirically validated, clinically useful, locally available and practical to administer. RESEARCH APPROACH/DESIGN AND METHOD: Workers (n = 1816), recruited through workplace occupational health surveillance programmes, completed the Patient Health Questionnaire-9, Brief Symptom Inventory 18-somatisation subscale, Generalised Anxiety Disorder scale-7, Primary Care Post-Traumatic Stress Disorder Screen, Intense (panic-like) anxiety scale and CAGE scale and partook in a diagnostic interview with a clinical psychologist. MAIN FINDINGS: Basic psychometric characteristics were reported, including confirmatory factor analyses, measurement invariance, internal consistencies and socio-demographic effects. Clinical utility was explored through receiver operating/operator characteristics curve analyses, and calculations of positive and negative predictive values, as well as sensitivity and specificity. These indicators provided evidence of clinical validity in the study context. PRACTICAL/MANAGERIAL IMPLICATIONS: The findings support the use of psychological screening as a brief, practicable and easily accessible mode of occupational mental health support. CONTRIBUTION/VALUE-ADD: This article presented evidence of structural and criterion validity for these scales and described their clinical application for practical use in occupational mental health surveillance.