Principles of screening applied to psychiatric disorders

doi:10.1016/0163-8343(88)90017-5

General Hospital Psychiatry

Volume 10, Issue 3, May 1988, Pages 177-188

https://doi.org/10.1016/0163-8343(88)90017-5 Get rights and content

Abstract

The morbidity and mortality caused by psychiatric illness is a significant public health problem. The use of a psychiatric screening questionnaire has been one strategy to improve the recognition and treatment of psychiatric disorders in general medical settings. This paper discusses how well psychiatric screening procedures fulfill criteria outlined by the World Health Organization for evaluating the utility of general medical screening efforts. Current research on the utility of screening for psychiatric disorders is reviewed, and the lack of data on the treatment of psychiatric disorders is identified in the general medical sector is emphasized. The randomized clinical trial is offered as the best method to test the efficacy of screening by eliminating various biases outlined in the paper. Quantitative concepts such as positive predictive value and receiver operator characteristic analysis are discussed. The need for more research on the efficacy of early treatment of psychiatric disorders is emphasized.

References (62)

JW Frank
Occult-blood screening for colorectal carcinoma: The yield and costs
Am J Prev Med
(1985)
T Wise
Commentary: Psychiatry and primary care
Gen Hosp Psychiatry
(1985)
EW Hoeper et al.
The usefulness of screening for mental illness
Lancet
(1984)
MR Liebowitz
Imipramine in the treatment of panic disorder and its complications
Psychiatr Clin N
(1985)
S Cavanaugh et al.
Diagnosing depression in hospitalized medically ill
Psychosomatics
(1983)
A Johnstone et al.
Psychiatric screening in general practice
Lancet
(1976)
HC Schulberg et al.
A conceptual model for educating primary care providers in the diagnosis and treatment of depression
Gen Hosp Psychiatry
(1987)
D Regier et al.
The de facto US mental health services system: A public health perspective
Arch Gen Psychiatry
(1978)
R Schurman et al.
The hidden mental health network: Treatment of mental illness by nonpsychiatric physicians
Arch Gen Psychiatry
(1985)
M Shepherd et al.

E Mumford et al.

A new look at evidence about reduced cost of medical utilization following mental health treatment

Am J Psychiatry

(1984)

DL Sackett et al.

AL Cochrane et al.

Validation of screening procedures

Br Med Bull

(1971)

JMG Wilson et al.

LG Kessler et al.

Psychiatric diagnoses of medical service users: Evidence from the Epidemiological catchment area program

Am J Public Health

(1987)

EW Hoeper et al.

Estimated prevalence of RDC mental disorder in primary medical care

Int J Ment Health

(1979)

S Shapiro et al.

An experiment to change detection and management of mental morbidity in primary care

Med Care

(1987)

DB Kamerow et al.

Alcohol abuse, other drug abuse, and mental disorders in medical practice: Prevalence, costs, recognition, and treatment

JAMA

(1986)

MT Schecter et al.

Selection of women at high risk of breast cancer for initial screening

J Chron Dis

(1986)

JN Marks et al.

Determinants of the ability of general practitioners to detect psychiatric illness

Psychol Med

(1979)

LN Robins et al.

Lifetime prevalence of specific psychiatric disorders in three sites

Arch Gen Psychiatry

(1984)

M Kramer et al.

Patterns of mental disorders among the elderly residents of eastern Baltimore

J Am Geriatr Soc

(1985)

PS German et al.

Detection and management of mental health problems of older patients by primary care providers

JAMA

(1987)

GB Hutchinson

Evaluation of preventive services

J Chron Dis

(1960)

Veteran's Administration Cooperative Study on Antihypertensive Agents

Effects of treatment on morbidity in hypertension

JAMA

(1970)

S Shapiro

Evidence of screening for breast cancer from a randomized trial

Cancer

(1977)

M Feinleib et al.

Some pitfalls in the evaluation of screening programs

Arch Environ Health

(1969)

B Link

Mental patient status, work, and income: An examination of the effects of a psychiatric label

Am Sociol Rev

(1982)

D Phillips

Public identification and acceptance of the mentally ill

Am J Pub Health

(1966)

PJ Leaf et al.

Contact with health professionals for the treatment of psychiatric and emotional problems

Med Care

(1985)

H Bursztajn et al.

Facilitating patient acceptance of a psychiatric referral

Arch Intern Med

(1985)

Cited by (29)

Self-recognition of mental disorders and mental problems in the adult population from the Colombian National Mental Health Survey
2021, Revista Colombiana de Psiquiatria
Los trastornos mentales son muy prevalentes en la población general; a pesar de ello, solo alrededor de un tercio reconoce que los tiene y accede a los servicios de salud. El objetivo es determinar los potenciales factores asociados con la falta de autorreconocimiento de trastornos y problemas mentales entre la población colombiana.
En la Encuesta Nacional de Salud Mental 2015 (ENSM 2015) realizada en Colombia, se recogieron las respuestas de los adultos mayores de 18 años a la pregunta sobre si tenían algún problema o trastorno mental que hayan puntuado positivo en trastornos mentales medidos por el CIDI 3.0 o en problemas mentales detectados por el SRQ-20. Se realizó un análisis bivariable con posibles variables relacionadas y otro multivariable de regresión logística.
Se obtuvo una muestra de 10.870 adultos; el 12,25% (1.332) sufría trastornos y el 30,2% (3.282), problemas. Del total de personas con trastornos y problemas, el 7,9% se autorreconoció con ellos. Las variables asociadas con el autorreconocimiento de trastornos o problemas fueron: ser mujer (OR = 1,8; IC95%, 1,4-2,3), tener disfunción familiar (OR = 1,5; IC95%, 1,2-2,0), haber sufrido un evento traumático (OR = 1,8; IC95%, 1,4-2,2), consumir sustancias psicoactivas (OR = 0,5; IC95%, 0,4-0,7), no ser pobre (OR = 1,9; IC95%, 1,2-3,0) y tener enfermedades crónicas (OR = 1,6; IC95%, 1,3-2,1), entre otras variables asociadas.
El autorreconocimiento de los adultos es de gran relevancia para iniciar el acceso a la atención. Los resultados proveen variables asociadas que permiten planear intervenciones para promover el autorreconocimiento en esta población.
Mental disorders are very prevalent in the general population. Despite this, it is estimated that only about a third of the people affected is able to recognise problems on their own and to access health services. The aim was to determine the factors associated with the lack of self-recognition of mental problems and disorders in the Colombian population.
The National Mental Health Survey (ENSM-2015) conducted in Colombia identified adults over 18 years that answered “yes’ to the question ‘Have you had a mental problem or disorder?’, had a positive score in mental disorders measured by the Composite International Diagnostic Interview (CIDI) 3.0, or in mental problems detected by the SRQ-20. A bivariate analysis, as well as a logistic regression, were performed with possible related variables.
A sample of 10, 870 adults was obtained, of whom 12.25% (1,332) had mental disorders and 30.2% (3282) had mental problems. Of those individuals with disorders and problems, 7.9% recognised themselves as affected. The variables associated with self-recognition of disorders or problems were, among others: being female (OR = 1.8; 95%CI, 1.4-2.3), family dysfunction (OR = 1.5; 95%CI, 1.2-2.0), to have experienced a traumatic event (OR = 1.8; 95%CI, 1.4-2.2), illegal substance consumption (OR = 0.5; 95%CI, 0.4-0.7), not being poor (OR = 1.9; 95%CI, 1.2-3.0), and having chronic illnesses (OR = 1.6; 95%CI, 1.3-2.1).
Self-recognition is of great relevance to improve access to care by adults. The results provide associated variables that allow planning interventions that can promote the recognition of mental problems or disorders in this population.
Associated factors for recognition of mental problems and disorders in adolescents in the Colombian National Mental Health Survey
2021, Revista Colombiana de Psiquiatria
Los problemas y los trastornos mentales son prevalentes en la población adolescente. Se calcula que alrededor de un 10% de los adolescentes sufren trastornos mentales que requieren atención y, en general, no se reconocen como tales. El objetivo es determinar potenciales factores asociados con que se reconozcan o no los trastornos y problemas mentales en la población colombiana.
De la Encuesta Nacional de Salud Mental (ENSM) del 2015 realizada en Colombia, se recogió a los adolescentes de 12-17 años que respondieron a si algún profesional los había diagnosticado un problema o trastorno de salud mental y se los comparó con los que puntuaron positivo en trastornos mentales medidos por el CIDI 3.0 o en problemas mentales detectados por el SRQ-20.
Se obtuvo una muestra de 1.754 adolescentes, de los que el 7,3% (n = 129) tenían trastornos y el 22,6% (n = 396) tenían problemas. Del total con trastornos y problemas, reconocen que los tienen el 13,9% (n = 18) de las personas con trastornos y el 8,3% (n = 33) de aquellos con problemas. Se realizaron análisis bivariables con posibles variables relacionadas y, con los resultados, se construyó un modelo multivariable de regresión que evidenció factores asociados con el reconocimiento de trastornos o problemas, como disfunción familiar (OR = 2,5; IC del 95%, 1,3-4,5) y acudir a familiar en caso de problemas económicos (OR = 2,7; IC del 95%, 1,0-7,2).
El reconocimiento es de gran relevancia para que los adolescentes inicien el acceso a la asistencia. Los resultados proveen variables asociadas que permiten planear intervenciones que promuevan la detección de trastornos y problemas en esta población.
Mental problems and disorders are prevalent in the adolescent population. It is estimated that around 10% of adolescents have mental disorders that require attention and are generally not recognised as such. The aim was to determine potential factors associated with whether or not mental disorders and problems are recognised in the Colombian population.
Adolescents aged 12 to 17 who said they had been diagnosed with a mental health problem or disorder by a healthcare professional were identified from the National Mental Health Survey conducted in Colombia in 2015. This group was compared with those who scored positive for mental disorders measured by CIDI 3.0 or mental problems detected by SRQ-20.
A sample of 1,754 adolescents was obtained, of whom 7.3% (n = 129) had disorders and 22.6% (n = 396) had problems. Of the total with disorders and problems, 13.9% (n = 18) of people with disorders and 8.3% (n = 33) with problems knew they had them. Bivariate analyses were performed with the possible related variables, and with the results we constructed a multivariate regression model that identified factors associated with the recognition of disorders or problems, such as family dysfunction (OR = 2.5; 95% CI, 1.3-4.5) or counting on family when having financial problems (OR = 2.7; 95% CI, 1.0-7.2).
Recognition is of great importance for initiating access to care by adolescents. The results provide associated variables which can aid planning of interventions to improve the detection of disorders and problems in this population.
Design and Implementation of the Data Collection Tools for National Mental Health Survey of Colombia, 2015
2016, Revista Colombiana de Psiquiatria
Como parte de los insumos necesarios para la creación, la implementación y la evaluación de políticas relacionadas con la salud mental, en todo el mundo y como iniciativa de la Organización Mundial de la Salud, se llevan a cabo encuestas poblacionales relacionadas con el tema. Durante el primer semestre de 2015, se llevó a cabo la cuarta Encuesta Nacional de Salud Mental (ENSM 2015), con una muestra de 2.727 niños entre 7 y 12 años, 1.754 adolescentes y 10.870 adultos seleccionados de diferentes lugares del país.
Describir la selección y definición de los instrumentos que utilizar para la medición de la salud mental (incluyendo cognición social y violencias), los problemas, los trastornos mentales y la valoración de estados de salud, así como los mecanismos empleados para derivar en el instrumento final de recolección.
La medición de trastornos mentales en niños se realizó utilizando el Diagnostic Interview Schedule for Children (DISC), y para adolescentes y adultos se utilizó el Composite International Diagnostic Interview (CIDI). Para los demás componentes evaluados en la ENSM 2015, se realizó una búsqueda de los instrumentos utilizados dentro y fuera de Colombia. La selección de los instrumentos utilizados para la evaluación se basó en las preguntas de cada instrumento, así como la validez científica que se podría obtener en los resultados. En algunos casos se utilizó el instrumento completo (como fue validado), se construyó uno nuevo uniendo partes de diferentes instrumentos o se redactaron las preguntas partiendo de los conceptos o características que se va a medir. Se realizó una validación de contenido, de concepto y de semántica de todos los instrumentos, incluyendo CIDI y DISC. Los instrumentos resultantes se aplicaron a un grupo de sujetos de diferentes características y se detectaron algunas aclaraciones necesarias para la comprensión de algunas preguntas. Dado que la recolección de la información en la encuesta sería totalmente en formato electrónico, tras la construcción y la redacción de cada instrumento, se generó un formato de flujo para orientar la implementación del formato en el software Blaise. Luego de la implementación, tuvo lugar un proceso de validación de la encuesta implementada para garantizar la integridad en el orden de las preguntas y los saltos. Para este proceso se generaron casos ficticios y también se contó con la participación de voluntarios para realizar las pruebas.
Se presentan los apartes del instrumento utilizado en la ENSM 2015.
Population surveys on mental health are performed as part of the inputs required for the creation, implementation and evaluation of policies related to mental health, worldwide, and as an initiative of the World Health Organisation (WHO). was held The fourth National Survey of Mental Health (ENSM 2015) was carried out during the first half of 2015 on a representative sample of 2,727 children between 7 and 11 years of age, 1,754 adolescents, and 10, 870 adults who were selected throughout the country.
To describe the selection and definition of the tools used to measure mental health (including social cognition and violence), problems, mental disorders, and the evaluation of health states, as well as to describe the process used to develop the data collection tools finally used.
The measurement of mental disorders in children was performed using the Diagnostic Interview Schedule for Children (DISC), and the Composite International Diagnostic Interview (CIDI) was used for adolescents and adults. For the remaining components evaluated in the survey, a search was conducted on the tools used at a national and international level. The selection of the toos used for the evaluation was based on the questions made by each tool, as well as the scientific validity that could be obtained from the results. In some cases the complete tool (as published) was used, in other cases the tools were constructed unifying parts of different ones, or questions were written based on the concepts or characteristics to be measured. Subsequently, a validation of content, concept and semantic of every tool was carried out, including the CIDI and DISC. The resulting tools were used on a group of people with different characteristics. It was noted that further clarification was necessary for some people to fully understand what was being asked. Because the collection of all the information in the survey would be computer assisted, a stream format was generated to guide the implementation in Blaise software, after the creation and wording of each tool in order to review the validation process of the survey and to ensure the integrity in the order of questions and their format. Fictitious cases were generated during the process, and volunteers participated in the testing.
The tools for information collection used in the National Survey of Mental Health 2015 are presented.
Mental Problems, Mood and Anxiety Disorders in The Population Displaced by Violence in Colombia; Results of The National Mental Health Survey 2015
2016, Revista Colombiana de Psiquiatria
Colombia tiene una gran población expuesta a la violencia, con una cifra importante de desplazados por esta, quienes se encuentran en mayor riesgo de vulnerabilidad, por lo que es necesario evaluar en ellos problemas y trastornos mentales para definir intervenciones específicas necesarias.
Determinar la prevalencia de problemas y trastornos mentales de la población colombiana desplazada por el conflicto armado interno.
Datos emanados de la Encuesta Nacional de Salud Mental 2015. Se realizó la entrevista diagnóstica internacional compuesta (CIDI-CAPI) y el Cuestionario de Síntomas (SRQ) como indicador de posible enfermedad psiquiátrica; el consumo de alcohol se evaluó con el test de identificación de trastornos por consumo de alcohol (AUDIT); se diseñó una encuesta basada en la Prueba de Detección de Consumo de Alcohol, Tabaco y Sustancias (ASSIST); se modificó la Lista de Chequeo de Estrés Postraumático (PCL-C) para determinar posible estrés postraumático y se aplicó el Índice Multidimensional de Pobreza (IPM) y el APGAR familiar a los datos generales del individuo y del hogar.
Se detectó a 943 personas desplazadas por la violencia. Se presenta SQR positivo en el 16,4% (intervalo de confianza del 95% [IC95%], 13,2%-20,1%); la prevalencia de cualquiera de los trastornos mentales medidos (CIDI-CAPI) alguna vez en la vida es del 15,9% (IC95%, 11,9%-21,1%); la de ideación suicida es del 12,5% (IC95%, 9,0%-17,1%); la de consumo de alcohol excesivo, del 10,1% (IC95%, 7,2%-13,9%); el 35,6% (IC95%, 30,7%-40,8%) de las personas reportan que han vivido o presenciado o les han contado que alguien cercano ha tenido un evento traumático relacionado con el conflicto armado; se reporta un mayor riesgo de estrés postraumático en personas desplazadas que han reportado por lo menos un evento traumático (3,6%; IC95%, 2,2%-5,9%); la disfunción familiar en desplazados es ausente (74,8%; IC95%, 70,4%-78,8%).
La población desplazada tiene una alta prevalencia de problemas y trastornos mentales, lo que ratifica la situación de desventaja en que se encuentran.
Colombia has a large population exposed to violence. Our data suggest a significant number displaced by the conflict. As there is an increased risk of vulnerability, their problems and mental disorders need to be assessed in order to determine specific treatments.
To determine the prevalence of problems and mental disorders in those internally displaced by the conflict.
Data was obtained from the National Mental Health Survey 2015. The diagnostic tools used were the composite international diagnosis interview (CIDI-CAPI), Self-reporting questionnaire (SQR). Alcohol consumption was assessed with the Alcohol Use Disorders Identification test (AUDIT). A survey based on the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) was developed. The modified Post-traumatic Stress Disorder (PTSD) Checklist-Civilian version (PCL-C) was used to determine possible post-traumatic stress Disorder. Multidimensional poverty index (MPI) and Family-Apgar questionnaire were applied to general individual and household data.
A total of 943 persons displaced by the conflict were reported, with self-report of symptoms in 16.4% (95% CI, 13.2-20.1). The prevalence of any of the measured mental disorders (CIDI-CAPI) ever in life was 15.9% (95% CI, 11.9-21.1), with a suicidal ideation of 12.5% (95%CI, 9.0-17.1), and excessive alcohol consumption in 10.1% (95% CI, 7.2-13.9). More than one-third (35.6%, (95% CI, 30.7-40.8) of people report having experienced, witnessed, or been told that someone close had had a traumatic event related to the armed conflict. An increased risk of PTSD is reported by 3.6% (95% CI, 2.2-5.9) displaced people that had reported at least one traumatic event. Family dysfunction in the displaced population is absent (74.8% (95%.CI, 70.4-78.8).
The displaced population has a high prevalence of problems and mental disorders, which confirms their disadvantaged situation.
Colombia 2015 National Mental Health Survey. Study Protocol
2016, Revista Colombiana de Psiquiatria
La Encuesta Nacional de Salud Mental 2015 (ENSM 2015) es la cuarta que se realiza en el país y se enmarca en el Sistema Nacional de Encuestas y estudios poblacionales para salud de Colombia.
Se presenta una descripción narrativa de los antecedentes, los referentes, el proceso de elaboración y las características del protocolo de la ENSM 2015. La ENSM 2015 y el protocolo parten de unos requisitos que dan soporte a las políticas nacionales en salud e internacionales relacionadas con salud mental. Para su elaboración se trabaja junto con el Ministerio de Salud y Protección Social para definir los objetivos, los instrumentos de recolección, la muestra y el plan operativo. Como objetivo principal se definió brindar información actualizada acerca de la salud mental, los problemas, los trastornos mentales, la accesibilidad de los servicios y la valoración de estados de salud, de la población colombiana rural y urbana mayor de 7 años de edad, en la que privilegió su comprensión desde los determinantes sociales y la equidad. Para ello se decidió realizar un estudio observacional de corte transversal en el ámbito nacional, con representatividad nacional, regional y por franjas de edad: 7-11, 12-17 y ≥ 18 años. Las regiones consideradas fueron: Central, Oriental, Atlántica, Pacífica y Bogotá, con un tamaño de muestra total calculado como mínimo de 12.080 sujetos y máximo de 14.496.
Se presenta un breve resumen del protocolo que puede ser consultado en su totalidad en la página web del MSPS que incluye los instrumentos de recolección.
The 2015 National Mental Health Survey (NMHS) is the fourth mental survey conducted in Colombia, and is part of the National System of Surveys and Population Studies for health.
A narrative description is used to explain the background, references, the preparation, and characteristics of the 2015 NMHS. The 2015 NMHS and its protocol emerge from the requirements that support the national and international policies related to mental health. Together with the Ministry of Health and Social Protection, the objectives, the collection tools, the sample, and the operational plan are defined. The main objective was to obtain updated information about the mental health, mental problems and disorders, accessibility to health services, and an evaluation of health conditions. Participants were inhabitants from both urban and rural areas, over 7 years old, and in whom the comprehension of social determinants and equity were privileged. An observational cross-sectional design with national, regional and age group representativity, was used. The age groups selected were 7-11, 12-17, and over 18 years old. The regions considered were Central, Orient, Atlantic, Pacific, and Bogota. The calculated sample had a minimum of 12,080 and a maximum of 14,496 participants.
A brief summary of the protocol of the 2015 NMHS is presented. The full document with all the collection tools can be consulted on the Health Ministry webpage.
A Cross-sectional Study of School dropout in adolescents: National Mental Health Survey Colombia 2015
2016, Revista Colombiana de Psiquiatria
La deserción escolar de los adolescentes puede tener consecuencias negativas no solo para el individuo y su núcleo familiar, sino también para la sociedad. Identificar características relacionadas con la ocurrencia de este evento puede contribuir a la planeación de estrategias de prevención.
Evaluar la relación entre características individuales y del hogar y la deserción escolar de adolescentes de 12−17 años en Colombia.
Este es un estudio transversal, la información se extrajo de la Encuesta Nacional de Salud Mental de 2015, y se estudió la relación entre características individuales y del hogar y la deserción escolar de adolescentes de 12−17 años.
Se observó un mayor porcentaje de adolecentes no escolarizados en los grupos de más edad, de sexo femenino o que han tenido hijos. Entre las características del hogar se identificó que los hogares con 2 personas, de zona rural o en estado de pobreza presentan un mayor porcentaje de adolescentes no escolarizados.
Las estrategias cuyo objetivo sea prevenir la deserción escolar deben considerar a las poblaciones con mayores porcentajes de adolescentes no escolarizados (mujeres, hogares de zona rural y hogares en estado de pobreza). Acciones de prevención del embarazo adolescente pueden contribuir a evitar la deserción.
School dropout in adolescents can have negative consequences, not only for the individual and the family, but also for the society. To identify the characteristics associated with the occurrence of this event might contribute to the planning of a prevention strategy.
To evaluate the relationship between the individual and home characteristics and school dropout in adolescents from 12 to 17 years old in Colombia.
A cross sectional study was conducted from information taken from the results obtained in the 2015 National Mental Health Survey. A study was made of the relationship between the individual and home characteristics and school dropout in adolescents from 12 to 17 years old
A higher percentage of school dropouts was found in the older adolescents, females, and those who have children. Among the home characteristics, it was observed that those homes with more than two people, located in rural area, or that are classified as poor, have an increased percentage of school dropout adolescents.
Strategies for which the main goal is to prevent school dropout should consider populations with higher prevalence of out-of-school adolescents (female, homes in rural area, or household poverty). Preventive actions of adolescent pregnancy might contribute to reduce the school dropout rate.

View all citing articles on Scopus

View full text

Principles of screening applied to psychiatric disorders

Abstract

Am J Prev Med

Gen Hosp Psychiatry

Lancet

Psychiatr Clin N

Psychosomatics

Lancet

Gen Hosp Psychiatry

The de facto US mental health services system: A public health perspective

Arch Gen Psychiatry

The hidden mental health network: Treatment of mental illness by nonpsychiatric physicians

Arch Gen Psychiatry

A new look at evidence about reduced cost of medical utilization following mental health treatment

Am J Psychiatry

Validation of screening procedures

Br Med Bull

Psychiatric diagnoses of medical service users: Evidence from the Epidemiological catchment area program

Am J Public Health

Estimated prevalence of RDC mental disorder in primary medical care

Int J Ment Health

An experiment to change detection and management of mental morbidity in primary care

Med Care

Alcohol abuse, other drug abuse, and mental disorders in medical practice: Prevalence, costs, recognition, and treatment

JAMA

Selection of women at high risk of breast cancer for initial screening

J Chron Dis

Determinants of the ability of general practitioners to detect psychiatric illness

Psychol Med

Lifetime prevalence of specific psychiatric disorders in three sites

Arch Gen Psychiatry

Patterns of mental disorders among the elderly residents of eastern Baltimore

J Am Geriatr Soc

Detection and management of mental health problems of older patients by primary care providers

JAMA

Evaluation of preventive services

J Chron Dis

Effects of treatment on morbidity in hypertension

JAMA

Evidence of screening for breast cancer from a randomized trial

Cancer

Some pitfalls in the evaluation of screening programs

Arch Environ Health

Mental patient status, work, and income: An examination of the effects of a psychiatric label

Am Sociol Rev

Public identification and acceptance of the mentally ill

Am J Pub Health

Contact with health professionals for the treatment of psychiatric and emotional problems

Med Care

Facilitating patient acceptance of a psychiatric referral

Arch Intern Med