Mental Health Survey Of General Hospital Inpatients And Reliability And Validity Analysis Of HIS Scale Among General Hospital Patients

Research Objectives:The Happiness Index Scale(HIS)is a newly developed scale by our group to screen for common psychological illnesses among non-psychiatric inpatients in general hospitals.This study aimed to analyze the reliability,validity and screening effect of the HIS scale applied to non-psychiatric inpatients in general hospitals.It also aims to understand the mental health status of non-psychiatric inpatients in general hospitals,analyze its influencing factors,and provide reference for screening and identifying mental health and constructing intervention models for non-psychiatric inpatients.Materials and Methods:From April 1,2021 to December 31,2021,8405 non-psychiatric inpatients were selected from a large Class III A general hospital in Guangzhou,Guangdong Province,China.Using a cross-sectional survey design,each participant was assessed with the Patient Health Questionnaire-9(PHQ-9),Generalized Anxiety Disorder-7(GAD-7),Athens Insomnia Scale(AIS),Columbia Suicide Severity Rating Scale(C-SSRS)and HIS within 24 h of admission.Mc Donald’s ω coefficient,the Guttman split-half coefficient and the test-retest reliability coefficient were used to evaluate the reliability of the HIS.The construct validity,criterion validity and discriminant validity of the HIS scale were calculated.The PHQ-9,GAD-7,AIS,and C-SSRS scales were combined as the standard screening tool to analyze the screening effect of HIS scale.Standard screening tool were used to assess the mental health status of non psychiatric inpatients,and univariate analysis and multivariate logistic regression analysis were used to identify risk factors that may affect the mental health of patients.Results:Standard screening tool detected a total of 1,896 inpatients with positive psychological problems,with a positive detection rate of 22.6%.Binary logistic regression analysis showed that being female(OR= 1.383,P< 0.001),age range from 18 to 59 years old(OR= 2.036,P= 0.004),age range from 60 years old and above(OR= 1.971,P= 0.007),years of education more than 9 years old(OR= 1.232,P< 0.001),unmarried(OR= 1.584,P< 0.001),and internal medicine inpatients(OR=1.461,P= 0.004)were predictive factors of positive mental health screening.Welch’s t-test showed that the average score of HIS of female(0.400 ± 0.662),18 to 59 years old(0.367 ± 0.626),more than 9 years of education(0.395 ± 0.631),unmarried(0.455 ± 0.717),internal medicine inpatients(0.387 ± 0.660)and obstetrics and gynecology(0.438 ± 0.613)inpatients was significantly higher than that of other people in the same group(P< 0.01).The HIS exhibited very good reliability,with a Mc Donald’s ω coefficient of0.825,a Guttman split-half coefficient of 0.920 and a test-retest reliability coefficient of 0.745(P< 0.05).Confirmatory factor analysis showed a satisfactory model fitting index with a χ2/df = 2.602,a Root Mean Squared Error of Approximation(RMSEA)of 0.014,a Standardized Root Mean Square Residual(SRMR)of 0.010,a Comparative Fit index(CFI)of 0.992,and a Tucker-Lewis index(TLI)of 0.983.The scale showed good criterion validity,with a correlation coefficient between each factor score and the corresponding criterion total score ranging from 0.854 to 0.949(P< 0.01).The scale showed good discrimination validity.The Average Variance Extracted(AVE)root value of each factor was greater than the correlation coefficient between this factor and the other three factors(AVE root value: depression= 0.403,anxiety= 0.390,insomnia= 0.539,suicide= 0.151;r: depression: 0.006 ～ 0.138,anxiety: 0.007 ～ 0.138,insomnia: 0.006 ～ 0.132,suicide: 0.006 ～ 0.007,P< 0.01).The HIS scale as a whole demonstrated good discrimination,with the mean HIS score of patients screened positive for psychological problems by the standard screening tool being significantly higher than the mean HIS score of patients screened negative for psychological problems(t = 3790.619,P< 0.01).The effect size was very large(Cohens d = 2.695,95% CI = 2.630 ～ 2.761).Item analysis showed significant differences in mean scores for each HIS entry in both high and low subgroups of patients(P< 0.01),and the Critical Ratio(CR)value was greater than 3.0,indicating that each item in the scale had a good effect in distinguishing.Kappa consistency test results showed that approximately 90.2% of the positive and negative screening results of the HIS were matched with the standard screening tool,with a kappa value of 0.747(P< 0.01).The screening effect index showed that the sensitivity(true positive rate)of the HIS scale was 92.9%,and the specificity(true negative rate)was 89.5%.Conclusion:(1)The mental health status of non-psychiatric inpatients in general hospitals is generally low,which is mainly influenced by various factors such as gender,age,years of education,marital status,and inpatient ward.The clinical staff should actively pay attention to the mental health status of female,over 18 years old,high school and above education,unmarried,and internal medicine inpatients,and use portable and effective tools to help non-psychological medical staff strengthen the early screening and recognition of the mental health of inpatients.(2)The HIS scale exhibited satisfactory reliability,validity,and screening effect,with a shorter and more convenient and efficient version than commonly used screening scales,and has a clinically meaningful screening effect to effectively identify admitted patients with comorbid psychological problems who need further intervention.Therefore,it can be used as a preliminary screening tool for mental health of inpatients in general hospitals,which can help non-psychiatric medical teams to identify patients’ psychological problems at an early stage and promote the capacity of psychiatric mental health services for inpatients in general hospitals.