Asking for help is helpful: validation of a brief lifestyle and mood assessment tool in primary health care.
OBJECTIVE
The short, validated, self-administered, Case-finding and Help Assessment Tool (CHAT) for lifestyle and mental health assessment of adult patients in primary health care addresses inactivity, tobacco use, alcohol and other drug misuse, problem gambling, depression, anxiety and stress, abuse, and anger problems. For each issue patients are asked whether they would like help, either during the consultation or at a later date. This study aims to assess the value of the help question.


METHODS
Validation of the CHAT was conducted according to the STAndards for Reporting of Diagnostic accuracy studies statement for diagnostic tests. The setting was Auckland primary care practices with populations ranging from socioeconomically advantaged to deprived. Participants were 755 consecutive primary care patients who completed the CHAT plus the help question and reference standards. Sensitivity, specificity, and likelihood ratios with and without the addition of help the question were calculated.


RESULTS
Sensitivity ranged from 80% to 98% for the more-common conditions (depression, nicotine dependency, anxiety, problematic drinking). For each condition, specificity increased with the addition of the help question: depression increased from 73% to 98%; anxiety 77% to 99%; drinking 85% to 99%; verbal anger 92% to 99%; verbal abuse 97% to 99%; problematic drinking and gambling 98% to 99%.


CONCLUSIONS
The help question increased specificity without compromising sensitivity and reduced false positives, thereby increasing the positive predictive value. It allowed patients with comorbidities to prioritize issues they wished to address, indicate their readiness to change, promote self-determination, and give the clinician an indication of which topics to pursue.
Department of General Practice & Primary Health Care, The University of Auckland, Auckland PB 92019, New Zealand. f.goodyear-smith@auckland.ac.nz
Felicity
F
Goodyear-Smith
Bruce
B
Arroll
Nicole
N
Coupe
D000339:Affect; D015897:Comorbidity; D006801:Humans; D008019:Life Style; D001523:Mental Disorders / Q000453:epidemiology / Q000523:psychology*; D008603:Mental Health; D009520:New Zealand / Q000453:epidemiology; D010342:Patient Acceptance of Health Care; D011320:Primary Health Care; D011569:Psychiatric Status Rating Scales / Q000592:standards*; D012680:Sensitivity and Specificity; D019966:Substance-Related Disorders / Q000453:epidemiology / Q000523:psychology*