title: Yield and Efficiency of Mental Health Screening: A Comparison of Screening Protocols at Intake to Prison.
abstract: The value of screening for mental illness has increasingly been questioned in low prevalence settings due to high false positive rates. However, since false positive rates are related to prevalence, screening may be more effective in higher prevalence settings, including correctional institutions. We compared the yield (i.e. newly detected cases) and efficiency (i.e. false positives) of five screening protocols to detect mental illness in prisons against the use of mental health history taking (the prior approach to detecting mental illness).
  
  
  
  We estimated the accuracy of the six approaches to detect an Axis I disorder among a sample of 467 newly admitted male inmates (83.1% participation rate). Mental health history taking identified only 41.0% (95% CI 32.1, 50.6) of all inmates with mental illness. Screening protocols identified between 61.9 and 85.7% of all cases, but referred between 2 and 3 additional individuals who did not have a mental illness for every additional case detected compared to the mental health history taking approach. In low prevalence settings (i.e. 10% or less) the screening protocols would have had between 4.6 and 16.2 false positives per true positive.
  
  
  
  While screening may not be practical in low prevalence settings, it may be beneficial in jails and prisons where the prevalence of mental illness is higher. Further consideration of the context in which screening is being implemented, and of the impacts of policies and clinical practices on the benefits and harms of screening is needed to determine the effectiveness of screening in these settings.
authors.affiliation: School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Michael S
authors.identifier: 0000-0002-5056-618X
authors.initials: MS
authors.lastname: Martin
authors.affiliation: School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Beth K
authors.initials: BK
authors.lastname: Potter
authors.affiliation: Department of Psychiatry, McGill University and Douglas Mental Health University Institute Research Centre, Montreal, Quebec, Canada.
authors.forename: Anne G
authors.identifier: 0000-0003-0571-8890
authors.initials: AG
authors.lastname: Crocker
authors.affiliation: School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: George A
authors.initials: GA
authors.lastname: Wells
authors.affiliation: School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Ian
authors.initials: I
authors.lastname: Colman
mesh_terms: D000328:Adult; D003951:Diagnostic Errors / Q000706:statistics & numerical data; D004608:Eligibility Determination / Q000191:economics / Q000941:ethics*; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods*; D001523:Mental Disorders / Q000145:classification / Q000175:diagnosis* / Q000503:physiopathology; D008603:Mental Health / Q000706:statistics & numerical data; D011329:Prisoners / Q000523:psychology*; D011330:Prisons / Q000458:organization & administration