Validation of a screening tool to detect in the community and refer young methamphetamine (Ice) users suffering from mental health disorders



Psychiatric comorbidities are very common among people who use drugs and are associated with poorer outcomes on several dimensions. Increase of Ice use observed among young people who use drugs (YPUD) in Vietnam is a major concern, as in several countries around world, due to the association with frequent psychiatric complications, particularly psychotic episodes, and the vulnerability of this population. The aim of this study is to develop and validate a quick screening tool to be used in the community by peers in order to detect and appropriately refer as early as possible YPUD suffering from psychiatric disorders.


YPUD aged 16-24 years were recruited through peer network in the city of Hanoi, Vietnam. They were eligible if they reported drug use subsequently confirmed by urine test. After obtaining informed consent to participate in the study, they were screened for mental disorder by trained peers with a 9 questions tools associating the PHQ4 for screening on anxiety and depression, 2 questions on suicide (current suicidal ideation and past suicide attempt) and 3 questions on psychotic symptoms adapted from the MINI (auditory hallucinations, persecution ideas, mindreading). They met a psychiatrist for clinical assessment and submission of the MINI (MINI international neuropsychiatric interview, version 5.0) which is a structured diagnostic questionnaire based on DSM criteria.


319 YPUD were recruited between 18 of May and 02 of June in 3 community-based organizations (CBO) in Hanoi, of whom 316 had complete data. 79% were male, 18% female and 3% transgender; median age was 20 years. Drugs most often used during the past month were Ice (62%), cannabis (22%), synthetic cannabis (7%) and MDMA (5%); 87%, 14%, 20% and 8% had urine test positive for Ice, cannabis, MDMA and opiates respectively. According to the MINI, 58% presented a major depressive disorder, 42% a suicidal risk (including 17% a severe suicidal risk) and 51% a psychotic syndrome. 67% were positive with the screening tool. The sensitivity, specificity, positive predictive value and negative predictive value of the screening tool were 73%, 56%, 86% and 35.6% respectively. According to peers from the CBO, the screening tool was well accepted by YPUDs.


In our population sample, rate of psychiatric disorders is dramatically high and emphasizes the need for interventions targeting mental health. The characteristics of this screening tool appear to be acceptable for use in the community to detect mental health disorders among YPUD. The tool was well accepted by peers and YPUD, and constitute a convenient support to introduce mental health concern in this highly exposed and vulnerable population. In a second phase, a large-scale intervention targeting YPUD suffering from mental health disorders will be implemented in different provinces of Vietnam.


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