Reliability and Validity of the List of Mental Health Items (LISMEN)

Abstract

Background

The detection of risk factors is a key element in the prevention of mental health disorders. It is widely known that in the formation of personality and its disorders, relational experiences (vital events) in childhood condition both neurological and emotional development. The accumulation of these circumstances brings about altered life trajectories, which make people more vulnerable to mental health disorders.

Method

A structured interview called LISMEN was designed based on the scientific literature to detect the risk of developing mental health disorders. A descriptive, reliability, and validity statistical study was carried out on four samples, one of which was the control group. There were 372 subjects in total.

Results

The technique was highly reliable (kappa coefficient 0.7 [p < 0.05]) and internally consistent (Cronbach's alpha between 0.80 and 0.98). Sensitivity and specificity were high (AUC [Area Under Curve] OR = 1.18 [1]), with the cut-off point between 9 and 10.

Conclusions

LISMEN is a useful tool for detecting the risk of developing mental health disorders. A score of 10 or higher indicates that the subject belongs to the most sensitive or vulnerable population group at risk.

Introduction

The identification of factors that contribute to the development of an alteration in mental health is necessary for improving our understanding of mental health disorders, as well as facilitating their detection and prevention. Although there have been programs and papers in our field related to this investigation (Ezpeleta et al., 2000, Ferreros et al., 2011, Tizón et al., 2008, Tizón et al., 2009), the motivation behind the creation of LISMEN was the lack of an instrument that compiles these factors and can be used by non-specialized professionals.

In the years 2004, 2009, and 2011, we reviewed the scientific literature on mental health risk factors and those of serious mental disorders in childhood, and we compiled risk factors derived from significant recent studies (Artigue and Tizón, 2014).

We consider that risk factors must be studied starting from the first months of life or even before childbirth. Several authors have shown that this is possible (Choquet et al., 1982), and cohort studies confirm the influence of environmental factors occurring during pregnancy (Susser et al., 1996). In turn, both neurodevelopmental and psychoanalytic theories base their explanatory models on vital events that happen especially during the first months of life. The now-classic studies of adopted children (Tienari et al., 2004) were part of the impetus needed to overcome the diatribe between the aforementioned theories. Even when there has been an accumulation of biological risk factors, both parenting style and care received during childhood have an enormous influence on the subsequent development of some kind of mental health disorder, especially a more serious one. The emergence of such a disorder is associated with a vital trajectory altered by the influence of dire events or experiences (van Winkel et al., 2008).

Risk factors are not specific to a certain mental disorder, and their influence in the appearance of an alteration will depend on the care that the child may receive (Fish et al., 1992). However, it is evident that, once detected, preventive care is needed during its evolution (Scott et al., 2009, van Os et al., 2009).

In these types of preventive approaches, there is always a discussion (Jané-Llopis, 2004) about the identification of people, especially children, who accumulate risk factors but subsequently do not develop any kind of disorder, that is, false positives. This situation is common to any kind of preventive action; but nonetheless, in mental health, the social connotations that are associated with disorders and the stigma that they cause make these situations difficult to handle. This is not so much the case in other health specialties; for example, in cardiology, it is less complex from a technical, emotional, and ethical point of view to inform a patient about a predisposition to an alteration in the performance of the cardiovascular system.

However, there is evidence to justify the need to implement prevention programs: Each year 38.2% of the population in Europe suffers from a mental disorder, and 26.6% of the known disabilities in the adult population originate from mental disorders (Wittchen et al., 2011). The specific economic costs of mental disorders have almost doubled in Europe, from €477 billion in 2004 to €798 billion in 2010 (Gustavsson et al., 2011).

The evident emotional distress and economic costs that, especially, serious mental disorders bring about (Mangalore and Knapp, 2007) justify the need to implement prevention programs. Furthermore, various studies demonstrate that this prevention would be most effective in the population group ranging from 10 to 24 years of age (Gore et al., 2011).

Our goal was to create an instrument to facilitate the detection of non-specific risk factors. Thus, its purpose is to detect risk factors that can act as indicators or markers of the possible onset of a disorder, as well as raise professionals' awareness of related community services, by facilitating and systematizing data collection.