Validation of a brief screening instrument for substance abuse and mental illness in HIV-positive patients

J Acquir Immune Defic Syndr. 2005 Dec 1;40(4):434-44. doi: 10.1097/01.qai.0000177512.30576.9c.

Abstract

Background: Substance abuse (SA) and mental illness (MI) commonly co-occur with HIV infection in the United States and have important implications for clinical management of HIV/AIDS. Yet SA/MI often go untreated due in part to a lack of practical, validated screening tools.

Setting: HIV clinic in academic medical center.

Methods: The 16-item SA/MI Symptoms Screener (SAMISS) targets SA/MI in HIV-positive patients. Consecutive consenting HIV-positive patients completed the SAMISS and then a reference standard diagnostic tool, SCID, the Structured Clinical Interview for DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition).

Results: Twenty percent of participants (29/148) had an SA diagnosis and 41% (59/143) had an MI diagnosis in the past year on the SCID; 48% (68/143) had 1 or both. Thirty-seven percent (55/148) screened positive for SA and 69% (99/143) screened positive for MI on the SAMISS. The SAMISS had 86% (95% CI: 68%-96%) sensitivity and 75% (66%-82%) specificity for SA and 95% (86%-99%) sensitivity and 49% (38%-60%) specificity for MI. Patients with SA were likely to show up as false positives for MI and vice versa.

Conclusion: The SAMISS functioned well as a first-line screening tool for SA/MI in this HIV clinic population. It missed few cases and was easily incorporated into a busy clinical setting. Persons screening positive require a more rigorous confirmatory psychiatric evaluation.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.
  • Validation Study

MeSH terms

  • Adult
  • Female
  • HIV Infections / complications*
  • Humans
  • Male
  • Mental Disorders / complications
  • Mental Disorders / diagnosis*
  • Middle Aged
  • Predictive Value of Tests
  • Sensitivity and Specificity
  • Substance Abuse Detection / methods*
  • Substance-Related Disorders / complications
  • Substance-Related Disorders / diagnosis*
  • Surveys and Questionnaires*