title: Preconsult interactive computer-assisted client assessment survey for common mental disorders in a community health centre: a randomized controlled trial.
abstract: BACKGROUND
  Access disparities for mental health care exist for vulnerable ethnocultural and immigrant groups. Community health centres that serve these groups could be supported further by interactive, computer-based, self-assessments.
  
  
  METHODS
  An interactive computer-assisted client assessment survey (iCCAS) tool was developed for preconsult assessment of common mental disorders (using the Patient Health Questionnaire [PHQ-9], Generalized Anxiety Disorder 7-item [GAD-7] scale, Primary Care Post-traumatic Stress Disorder [PTSD-PC] screen and CAGE [concern/cut-down, anger, guilt and eye-opener] questionnaire), with point-of-care reports. The pilot randomized controlled trial recruited adult patients, fluent in English or Spanish, who were seeing a physician or nurse practitioner at the partnering community health centre in Toronto. Randomization into iCCAS or usual care was computer generated, and allocation was concealed in sequentially numbered, opaque envelopes that were opened after consent. The objectives were to examine the interventions' efficacy in improving mental health discussion (primary) and symptom detection (secondary). Data were collected by exit survey and chart review.
  
  
  RESULTS
  Of the 1248 patients assessed, 190 were eligible for participation. Of these, 148 were randomly assigned (response rate 78%). The iCCAS (n= 75) and usual care (n= 72) groups were similar in sociodemographics; 98% were immigrants, and 68% were women. Mental health discussion occurred for 58.7% of patients in the iCCAS group and 40.3% in the usual care group (p≤ 0.05). The effect remained significant while controlling for potential covariates (language, sex, education, employment) in generalized linear mixed model (GLMM; adjusted odds ratio [OR] 2.2; 95% confidence interval [CI] 1.1-4.5). Mental health symptom detection occurred for 38.7% of patients in the iCCAS group and 27.8% in the usual care group (p> 0.05). The effect was not significant beyond potential covariates in GLMM (adjusted OR 1.9; 95% CI 0.9-4.1).
  
  
  CONCLUSIONS
  The studied intervention holds potential for community health centres to improve mental health discussion. Further research with larger samples should examine the impact on detection and enhance generalizability.Trial registration:ClinicalTrials.gov, no: NCT02023957, registered on Dec. 12, 2013.
authors.affiliation: School of Health Policy and Management (Ahmad, Ginsburg, Dinca-Panaitescu), York University; Biostatistics Division (Lou), Dalla Lana School of Public Health, University of Toronto; Access Alliance Multicultural Health and Community Services (Shakya, Ledwos); School of Administrative Studies (Ng), York University; Women's College Hospital (Rashid); Department of Family and Community Medicine (Rashid), University of Toronto; Centre for Addiction and Mental Health (McKenzie); The Wellesley Institute (McKenzie), Toronto, Ont.
authors.forename: Farah
authors.initials: F
authors.lastname: Ahmad
authors.affiliation: School of Health Policy and Management (Ahmad, Ginsburg, Dinca-Panaitescu), York University; Biostatistics Division (Lou), Dalla Lana School of Public Health, University of Toronto; Access Alliance Multicultural Health and Community Services (Shakya, Ledwos); School of Administrative Studies (Ng), York University; Women's College Hospital (Rashid); Department of Family and Community Medicine (Rashid), University of Toronto; Centre for Addiction and Mental Health (McKenzie); The Wellesley Institute (McKenzie), Toronto, Ont.
authors.forename: Wendy
authors.initials: W
authors.lastname: Lou
authors.affiliation: School of Health Policy and Management (Ahmad, Ginsburg, Dinca-Panaitescu), York University; Biostatistics Division (Lou), Dalla Lana School of Public Health, University of Toronto; Access Alliance Multicultural Health and Community Services (Shakya, Ledwos); School of Administrative Studies (Ng), York University; Women's College Hospital (Rashid); Department of Family and Community Medicine (Rashid), University of Toronto; Centre for Addiction and Mental Health (McKenzie); The Wellesley Institute (McKenzie), Toronto, Ont.
authors.forename: Yogendra
authors.initials: Y
authors.lastname: Shakya
authors.affiliation: School of Health Policy and Management (Ahmad, Ginsburg, Dinca-Panaitescu), York University; Biostatistics Division (Lou), Dalla Lana School of Public Health, University of Toronto; Access Alliance Multicultural Health and Community Services (Shakya, Ledwos); School of Administrative Studies (Ng), York University; Women's College Hospital (Rashid); Department of Family and Community Medicine (Rashid), University of Toronto; Centre for Addiction and Mental Health (McKenzie); The Wellesley Institute (McKenzie), Toronto, Ont.
authors.forename: Liane
authors.initials: L
authors.lastname: Ginsburg
authors.affiliation: School of Health Policy and Management (Ahmad, Ginsburg, Dinca-Panaitescu), York University; Biostatistics Division (Lou), Dalla Lana School of Public Health, University of Toronto; Access Alliance Multicultural Health and Community Services (Shakya, Ledwos); School of Administrative Studies (Ng), York University; Women's College Hospital (Rashid); Department of Family and Community Medicine (Rashid), University of Toronto; Centre for Addiction and Mental Health (McKenzie); The Wellesley Institute (McKenzie), Toronto, Ont.
authors.forename: Peggy T
authors.initials: PT
authors.lastname: Ng
authors.affiliation: School of Health Policy and Management (Ahmad, Ginsburg, Dinca-Panaitescu), York University; Biostatistics Division (Lou), Dalla Lana School of Public Health, University of Toronto; Access Alliance Multicultural Health and Community Services (Shakya, Ledwos); School of Administrative Studies (Ng), York University; Women's College Hospital (Rashid); Department of Family and Community Medicine (Rashid), University of Toronto; Centre for Addiction and Mental Health (McKenzie); The Wellesley Institute (McKenzie), Toronto, Ont.
authors.forename: Meb
authors.initials: M
authors.lastname: Rashid
authors.affiliation: School of Health Policy and Management (Ahmad, Ginsburg, Dinca-Panaitescu), York University; Biostatistics Division (Lou), Dalla Lana School of Public Health, University of Toronto; Access Alliance Multicultural Health and Community Services (Shakya, Ledwos); School of Administrative Studies (Ng), York University; Women's College Hospital (Rashid); Department of Family and Community Medicine (Rashid), University of Toronto; Centre for Addiction and Mental Health (McKenzie); The Wellesley Institute (McKenzie), Toronto, Ont.
authors.forename: Serban
authors.initials: S
authors.lastname: Dinca-Panaitescu
authors.affiliation: School of Health Policy and Management (Ahmad, Ginsburg, Dinca-Panaitescu), York University; Biostatistics Division (Lou), Dalla Lana School of Public Health, University of Toronto; Access Alliance Multicultural Health and Community Services (Shakya, Ledwos); School of Administrative Studies (Ng), York University; Women's College Hospital (Rashid); Department of Family and Community Medicine (Rashid), University of Toronto; Centre for Addiction and Mental Health (McKenzie); The Wellesley Institute (McKenzie), Toronto, Ont.
authors.forename: Cliff
authors.initials: C
authors.lastname: Ledwos
authors.affiliation: School of Health Policy and Management (Ahmad, Ginsburg, Dinca-Panaitescu), York University; Biostatistics Division (Lou), Dalla Lana School of Public Health, University of Toronto; Access Alliance Multicultural Health and Community Services (Shakya, Ledwos); School of Administrative Studies (Ng), York University; Women's College Hospital (Rashid); Department of Family and Community Medicine (Rashid), University of Toronto; Centre for Addiction and Mental Health (McKenzie); The Wellesley Institute (McKenzie), Toronto, Ont.
authors.forename: Kwame
authors.initials: K
authors.lastname: McKenzie