Screening and Assessment Tools and Measures

Several recent articles listed below have reviewed tools that have been culturally validated, or adapted for use with Aboriginal and Torres Strait Islander people and tools being used without specific adaptation. These screening and assessment tools include structured or semi structured diagnostic interviews, survey and self-report questionnaires, measures of treatment outcome, and qualitative approaches.

Black, E. B., Toombs, M. R., & Kisely, S. (2018). The cultural validity of diagnostic psychiatric measures for Indigenous Australians. Australian Psychologist53(5), 383–393.

Objective: There is limited research available regarding the prevalence rates of psychiatric illness in Indigenous Australians, and the available literature varies widely in terms of methods and findings. Culturally valid and appropriate tools are needed to ensure accurate outcomes. The purpose of this review is to examine the methods used to diagnose psychiatric disorders in Indigenous Australians and identify whether these are culturally appropriate or valid. Method: A systematic search of available literature was undertaken in electronic databases (PubMed, Scopus, PsycInfo, PsycArticles, Web of Science, Medline, and Informit Health Indigenous Australians Peoples Collections). Narrative synthesis was used to analyse the data obtained, with a quantitative evaluations of study quality and cultural validity. Results: Twelve articles were included for review. Six studies were of diagnostic tools and none had been validated for use with Indigenous Australians. Another six used practitioner assessment. Some studies indirectly referenced cultural competence on behalf of the practitioner, but again on the whole this was lacking. Conclusions: Further validation of the use of diagnostic instruments in Indigenous Australians is needed so that the prevalence of psychiatric disorders in this population can be accurately determined. In addition, practitioners working with Indigenous Australians should have some training in cultural awareness or competence, and consider the cultural appropriateness of diagnostic tools when applied to this population.

Carlin, E., Atkinson, D., & Marley, J. (2019)  ‘Having a quiet word’: Yarning with Aboriginal women in the Pilbara region of Western Australia about mental health and mental health screening during the perinatal period, International Journal of Environmental Research and Public Health, 16(21), 4253.

Despite high rates of perinatal depression and anxiety, little is known about how Aboriginal women in Australia experience these disorders and the acceptability of current clinical screening tools. In a 2014 study, the Kimberley Mum’s Mood Scale (KMMS) was validated as an acceptable perinatal depression and anxiety screening tool for Aboriginal women in the Kimberley region of Western Australia. In the current study, we explored if it was appropriate to trial and validate the KMMS with Aboriginal women in the Pilbara. Yarning as a methodology was used to guide interviews with 15 Aboriginal women in the Pilbara who had received maternal and child health care within the last three years. Data were analysed thematically, the results revealing that this cohort of participants shared similar experiences of stress and hardship during the perinatal period. Participants valued the KMMS for its narrative-based approach to screening that explored the individual’s risk and protective factors. While support for the KMMS was apparent, particular qualities of the administering health care professional were viewed as critical to the tool being well received and culturally safe. Building on these findings, we will work with our partner health services in the Pilbara to validate the KMMS with Pilbara Aboriginal women.

Chan, A.W., Skerrington, P., Reid, C., & Marriott, R. (2018). Research protocol for the exploration of experiences of Aboriginal Australian mothers and healthcare professionals when using the Edinburgh Postnatal Depression Scale: A process-oriented validation study using triangulated participatory mixed methodsBMJ Open, 8, e022273.

Adopting a process-oriented framework for test validation can help to establish whether this tool has the potential to be an acceptable, valid and reliable indicator of depression for mothers and mothers-to-be. This mixed-methods research protocol seeks to explore the views and experiences of Aboriginal mothers and healthcare professionals in relation to the Edinburgh Postnatal Depression Scale (EPDS), and is intended to highlight potential barriers in perinatal mental health conceptualisation, engagement and response style.

Farnbach, S., Gee, G., Eades, A-M., Evans, J. R., Fernando, J., Hammond, B., Simms, M., DeMasi, K., Glozier, N., Brown, A., & Hackett, M. L. (2019). Process evaluation of the getting it right study and acceptability and feasibility of screening for depression with the aPHQ-9. BMC Public Health, 19, 1270.

Background: The Getting it Right study determined the validity, sensitivity, specificity and acceptability of the culturally adapted 9-item Patient Health Questionnaire (aPHQ-9) as a screening tool for depression in Aboriginal and Torres Strait Islander (hereafter referred to as Indigenous) people. In this process evaluation we aimed to explore staff perceptions about whether Getting it Right was conducted per protocol, and if the aPHQ-9 was considered an acceptable and feasible screening tool for depression in primary healthcare. This process evaluation will provide information for clinicians and policy makers about the experiences of staff and patients with Getting it Right and what they thought about using the aPHQ-9. Methods: Process evaluation using grounded theory approaches. Semi-structured interviews with primary healthcare staff from services participating in Getting it Right were triangulated with feedback (free-text and elicited) from participants collected during the validation study and field notes. Data were thematically analysed according to the Getting it Right study protocol to identify the acceptability and feasibility of the aPHQ-9. Results: Primary healthcare staff (n = 36) and community members (n = 4) from nine of the ten participating Getting it Right services and Indigenous participants (n = 500) from the ten services that took part. Most staff reported that the research was conducted according to the study protocol. Staff from two services reported sometimes recruiting opportunistically (rather than recruiting consecutive patients attending the service as outlined in the main study protocol), when they spoke to patients who they knew from previous interactions, because they perceived their previous relationship may increase the likelihood of patients participating. All Getting it Right participants responded to at least six of the seven feedback questions and 20% provided free-text feedback. Most staff said they would use the aPHQ-9 and most participants said that the questions were easy to understand (87%), the response categories made sense (89%) and that they felt comfortable answering the questions (91%). Conclusion: Getting it Right was predominantly conducted according to the study protocol. The aPHQ-9, the first culturally adapted, nationally validated, freely available depression screening tool for use by Indigenous people, appears to be acceptable and feasible to use.

Hackett, M. L., Farnbach, S., Glozier, N., Skinner, T., Teixeira-Pinto, A., Askew, D., Gee, G., Cass, A., & Brown, A. (2016). Getting it right: Study protocol to determine the diagnostic accuracy of a culturally-specific measure to screen for depression in Aboriginal and/or Torres Strait Islander people. BMJ Open, 6, e015009.

Introduction: A freely available, culturally valid depression screening tool is required for use by primary care services across Australia to screen for depression in Aboriginal and/or Torres Strait Islander populations. This is the protocol for a study aiming to determine the validity, sensitivity and specificity of the culturally adapted 9-item Patient Health Questionnaire (aPHQ-9). Methods and analysis: Cross-sectional validation study. A total of 500 people who self-identify as Aboriginal and/or Torres Strait Islander, are ≥18 years of age, attending 1 of 10 primary healthcare services or service events across Australia and able to communicate sufficiently to answer study questions will be recruited. All participants will complete the aPHQ-9 and the criterion standard MINI International Neuropsychiatric Interview (MINI) 6.0.0. The primary outcome is the criterion validity of the aPHQ-9. Process outcomes related to acceptability and feasibility of the aPHQ-9 will be analysed only if the measure is found to be valid. Ethics and dissemination: Lead ethical approval was obtained jointly from the University of Sydney Human Research Ethics Committee (project 2014/361) and the Aboriginal Health and Medical Research Council of New South Wales (project 1044/14). Results will be disseminated via the usual scientific forums, including peer-reviewed publications and presentations at international conferences following presentation to, discussion with and approval by participating primary healthcare service staff and community.

Jongen, C., Langham, E., Bainbridge, R., & McCalman, J. (2019). Instruments for measuring the resilience of Indigenous adolescents: An exploratory review. Frontiers in Public Health, 7(194).

Introduction: Resilience is enabled by internal, individual assets as well as the resources available in a person’s environment to support healthy development. For Indigenous people, these resources and assets can include those which enhance cultural resilience. Measurement instruments which capture these core resilience constructs are needed, yet there is a lack of evidence about which instruments are most appropriate and valid for use with Indigenous adolescents. The current study reviews instruments which have been used to measure the resilience of Indigenous adolescents in Canada, Australia, New Zealand, and the United States (the CANZUS nations). The aim is to provide guidance for the future use of instruments to measure resilience among Indigenous adolescents and provide recommendations for research to strengthen evidence in this area. Method: Instruments were identified through a systematic search of resilience intervention and indicator studies targeting Indigenous youth from CANZUS nations. The studies were analyzed for information on the constructs of resilience measured in the instruments, their use with the targeted groups, and their psychometric properties. A second search was conducted to fill in any gaps in information. Instruments were included if they measured at least one construct of resilience reflecting individual assets, environmental resources, and/or cultural resilience.  Results: A total of 20 instruments were identified that measured constructs of resilience and had been administered to Indigenous adolescents in the CANZUS nations. Instruments which measured both individual assets and environmental resources (n = 7), or only environmental resources (n = 6) were most common. Several instruments (n = 5) also measured constructs of cultural resilience, and two instruments included items addressing all three constructs of individual assets, environmental resources, and cultural resilience. The majority of the reviewed studies tested the reliability (75%) and content or face validity (80%) of instruments with the target population. Conclusion: There are several validated instruments available to appropriately measure constructs of resilience with Indigenous adolescents from CANZUS nations. Further work is needed on developing a consistent framework of resilience constructs to guide research efforts. Future instrument development and testing ought to focus on measures which include elements of all three core constructs critical to Indigenous adolescent resilience.

Kickett-Tucker, C., Christensen, D., Lawrence, D., Zubrick, S., Johnson, D., & Stanley, F. Development and validation of the Australian Aboriginal racial identity and self-esteem survey for 8–12 year old children (IRISE_C). International Journal for Equity in Health, 14, 103. 

Abstract: Introduction: In Australia, there is little empirical research of the racial identity of Indigenous children and youth as the majority of the current literature focuses on adults. Furthermore, there are no instruments developed with cultural appropriateness when exploring the identity and self-esteem of the Australian Aboriginal population, especially children. The IRISE_C (Racial Identity and Self-Esteem of children) inventory was developed to explore the elements of racial identity and self-esteem of urban, rural and regional Aboriginal children. This paper describes the development and validation of the IRISE_C instrument with over 250 Aboriginal children aged 8 to 12 years. Methods: A pilot of the IRISE C instrument was combined with individual interviews and was undertaken with 35 urban Aboriginal children aged 8–12 years. An exploratory factor analysis was performed to refine the survey and reduce redundant items in readiness for the main study. In the main study, the IRISE C was employed to 229 Aboriginal children aged 6–13 years across three sites (rural, regional and urban) in Western Australia. An exploratory factor analysis using Principal axis factoring was used to assess the fit of items and survey structure. A confirmatory factor analysis was then employed using LISREL (diagonally weighted least squares) to assess factor structures across domains. Internal consistency and reliability of subscales were assessed using Cronbach’s coefficient alpha. Results: The pilot testing identified two key concepts – children’s knowledge of issues related to their racial identity, and the importance, or salience, that they attach to these issues. In the main study, factor analyses showed two clear factors relating to: Aboriginal culture and traditions; and a sense of belonging to an Aboriginal community. Principal Axis Factoring of the Knowledge items supported a 2-factor solution, which explained 38.7 % of variance. Factor One (Aboriginal culture) had a Cronbach’s alpha of 0.835; Factor 2 (racial identity) had a Cronbach’s alpha of 0.800, thus demonstrating high internal reliability of the scales. Conclusion: The IRISE_C has been shown to be a valid instrument useful of exploring the development of racial identity of Australian Aboriginal children across the 8–12 year old age range and across urban, rural and regional geographical locations.

Kotz, J., & Robinson, M. (2018).‘Baby coming – you ready?’ An audacious innovation to perinatal social and emotional wellbeing assessment screening and supportive management for vulnerable parents-to-be. Women and Birth, 31, 1, S3.
Introduction: ‘Baby Coming – You Ready?’ is an audacious innovation to perinatal social and emotional wellbeing assessment screening and supportive management for vulnerable parents-to-be. This digitalised screening rubric, called ‘Baby Coming-You Ready?’, uses touch screen images to provide an engaging culturally safe solution to the many barriers to effective screening and primary prevention currently faced by both non-Indigenous service providers and Indigenous women. It has been developed through a strong collaboration between Aboriginal Australians, midwives, child health nurses and researchers through the participatory action research (PAR) called Kalyakool Moort- Always Family. Indigenous Australians are historically cautious, acute observers and frequently over-ridden in research and health care processes. Embarking on PAR and adopting an Aboriginal world view in the research process has seen a curious interface of cultures that is both complex and challenging. However, it has been critical to its success. Aim: This paper describes this process which resulted in a solid effective research structure, a commitment to working from the Aboriginal world view and a strong research translational pathway. It will explain the significance of strong community commitment and the extensive organisational and community collaboration. Method: A desire based approach to narrative inquiry through an Indigenous lens is a key feature of this process. Through analysis of the current context of perinatal mental health screening among Indigenous mothers and fathers, the perspectives of three separate target groups has been included: that of Indigenous women, Indigenous fathers and health professionals involved in routine perinatal care. Data triangulation of results included a state-wide online questionnaires and thematic analysis of semi-structured interviews with health professionals, ‘yarning’ sessions with Indigenous women and fathers, extensive analysis of current screening surveillance data through a cultural lens and metasynthesis of current literature. Findings: Emergent from this process is the touch screen image driven screening and assessment ‘rubric’ called ‘Baby Coming-You Ready?’. It embodies four key elements: good engagement, a sense of safety, a trusting relationship, and the capacity to embrace the strengths in the Aboriginal and Torres Strait peoples cultural viewpoint which is central to family/community centred-care. This goes far beyond current woman/family-centred care. Culture is fluid, traditional roles/expectations are changing and many Indigenous Australian fathers are becoming increasingly vulnerable as a result. Therefore developing a parallel version of the ‘Baby Coming-You Ready? rubric for fathers was considered vital. Conclusion: Widespread community acceptance to this innovative approach to perinatal mental health screening and primary prevention is now possible as the ‘Baby Coming-You Ready?’ rubric is being piloted across the health care sector.

Lavrencic, L., Bennett, H., Daylight, G., Draper, B., Cumming, R., Mack, H., Garvey, G., Lasschuit, D., Hill, T. Y., Chalkley, S.,  Delbaere, K., Broe, G. A., & Radford, K. (2019). Cognitive test norms and comparison between healthy ageing, mild cognitive impairment, and dementia: A population‐based study of older Aboriginal Australians. Australian Journal of Psychology, 71(3), 249-260.
The prevalence of dementia and cognitive impairment is higher in Aboriginal Australians compared to the national population, increasing the need to understand cognitive impairment in this at‐risk population. This article reports normative data for a range of commonly used cognitive tests, in a population‐based small normative sample of older Aboriginal Australians living in urban/regional New South Wales.

Le Grande, M., Ski, C.F., Thompson, D.R., Scuffham, P., Kularatna, S., Jackson, A.C., &  Brown, A. (2017). Social and emotional wellbeing assessment instruments for use with Indigenous Australians: A critical review. Social Science & Medicine, 187, 164-173. 

Rationale: There is growing recognition that in addition to universally recognised domains and indicators of wellbeing (such as population health and life expectancy), additional frameworks are required to fully explain and measure Indigenous wellbeing. In particular, Indigenous Australian wellbeing is largely determined by colonisation, historical trauma, grief, loss, and ongoing social marginalisation. Dominant mainstream indicators of wellbeing based on the biomedical model may therefore be inadequate and not entirely relevant in the Indigenous context. It is possible that “standard” wellbeing instruments fail to adequately assess indicators of health and wellbeing within societies that have a more holistic view of health. Objective: The aim of this critical review was to identify, document, and evaluate the use of social and emotional wellbeing measures within the Australian Indigenous community. Method: The instruments were systematically described regarding their intrinsic properties (e.g., generic v. disease-specific, domains assessed, extent of cross-cultural adaptation and psychometric characteristics) and their purpose of utilisation in studies (e.g., study setting, intervention, clinical purpose or survey). We included 33 studies, in which 22 distinct instruments were used. Results: Three major categories of social and emotional wellbeing instruments were identified: unmodified standard instruments (10), cross-culturally adapted standard instruments (6), and Indigenous developed measures (6). Recommendations are made for researchers and practitioners who assess social and emotional wellbeing in Indigenous Australians, which may also be applicable to other minority groups where a more holistic framework of wellbeing is applied. Conclusion: It is advised that standard instruments only be used if they have been subject to a formal cross-cultural adaptation process, and Indigenous developed measures continue to be developed, refined, and validated within a diverse range of research and clinical settings

Marley, J. V., Kotz, J., Engelke, C., Williams, M., Stephen, D., Coutinho, S., & Trust, S. K. (2017). Validity and acceptability of Kimberley mum’s mood scale to screen for perinatal anxiety and depression in remote aboriginal health care settingsPLoS ONE, 12(1), e0168969.

Background: The Edinburgh Postnatal Depression Scale (EPDS) is widely recommended for perinatal anxiety and depression screening. However, many Aboriginal women find EPDS language complex and confusing, and providers find using it with Aboriginal women challenging. The two part Kimberley Mum’s Mood Scale (KMMS) was developed to improve screening: Part 1 is a Kimberley version of EPDS; Part 2 is a psychosocial tool that enables contextualisation of Part 1 scores. We aimed to determine if KMMS is a valid and acceptable method of identifying Kimberley Aboriginal perinatal women at risk of anxiety or depressive disorders compared to a semi-structured clinical interview. Methods: Across 15 sites in the Kimberley, Western Australia, 97 Aboriginal women aged 16 years and older who intended to continue with their pregnancy or had a baby within the previous 12 months were administered the KMMS by trained healthcare providers who provided an overall assessment of no, low, moderate or high risk; 91 participants were then independently assessed by a blinded clinical expert using Diagnostic and Statistical Manual of Mental Disorders, 4th Edition criteria. A qualitative approach was used to determine KMMS’ acceptability. Results: Part 1 had high internal consistency (Cronbach’s alpha, 0.89), and overall KMMS risk equivalence for screening for anxiety or depressive disorders was moderate (sensitivity, 83%; specificity, 87%; positive predictive value, 68%). Participants found the process easy and useful, and healthcare providers found KMMS more useful than EPDS. Part 2 allowed healthcare providers to ask questions that gave participants an opportunity to express themselves, resulting in a deeper understanding between them. Conclusion: KMMS is an effective tool for identifying Kimberley Aboriginal perinatal women at risk of anxiety and depressive disorders. Adoption of KMMS with culturally safe training and support is likely to improve screening processes, and with further validation may have broader applicability across remote Australia.

Nasir, B.F., Toombs, M., Kondalsamy-Chennakesavan, S., Kisely, S., Gill, N., Black, E., Hayman, N., Ranmuthugala, G., Beccaria, G., Ostini, R., & Nicholson, G. (2018) Common mental disorders among Indigenous people living in regional, remote and metropolitan Australia: a cross-sectional study. BMJ Open8(6), e020196.

To determine, using face-to-face diagnostic interviews, the prevalence of common mental disorders (CMD) in a cohort of adult Indigenous Australians, the cultural acceptability of the interviews, the rates of comorbid CMD and concordance with psychiatrists’ diagnoses. Cross-sectional study July 2014-November 2016. Psychologists conducted Structured Clinical Interviews for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision Axis I Disorders (SCID-I) (n=544). Psychiatrists interviewed a subsample (n=78). Four Aboriginal Medical Services and the general community located in urban, regional and remote areas of Southern Queensland and two Aboriginal Reserves located in New South Wales.

Newton, D. , Day, A. , Gillies, C., & Fernandez, E. (2015). The assessment of social and emotional well‐being in Indigenous patients. Australian Psychologist, 50, 40-50.

Addressing low levels of social and emotional well‐being (SEWB) in Indigenous communities has been a national strategic priority for over 10 years and yet progress in assessing the impact of interventions has been slow. One of the key factors limiting the development of evidence‐based practice has been the lack of well‐validated instruments to assess SEWB and how it changes over time as a result of intervention. This article systematically reviews available measures, classifying them in terms of the evidence base that exists to support their use. It is concluded that there is an ongoing need to develop psychometrically sound, comprehensive, culturally appropriate measures to operationalise Indigenous SEWB at a population health, programme evaluation, and clinical level. It is suggested that seven pathways be followed to achieve this goal, including the need to recognise that the gold standard status for Indigenous measurement tools cannot be ascribed based on evidence‐based assessment criteria alone.

Smith, K., Gilchrist, L., Taylor, K., Clinch, C., LoGiudice, D., Edgill, P., Ratcliffe, J., Flicker, L., Douglas, H., Bradley, K., & Bessarab, D. (2019). Good spirit, good life: A quality of life tool and framework for older Aboriginal peoples. Gerontologist, XX(X), 1-10. 

Background and Objectives: The lack of appropriate quality of life (QoL) measures is a major barrier to planning and delivering health and aged care services for older Indigenous peoples worldwide. QoL is dependent on cultural values and priorities may vary between age groups. This project aims to develop a QoL tool for older Aboriginal Australians. Research Design and Methods: The study was completed with Aboriginal Australians aged over 45 years living in Perth and Melbourne, Australia. Participatory Action Research methods were applied with an Indigenous research paradigm. Semi-structured interviews were undertaken to identify the factors important to having a good life. Factors were further explored in yarning groups with older Aboriginal peoples to develop the draft QoL tool questions. Face validity of the tool was completed in two regions. Results: The participants preferred the term “a good life” to QoL. Having a good spirit is at the core of having a good life. The protective factors for a good life were family and friends, health, culture, Elder role, respect, Country, spirituality, services and supports, community, future plans, safety and security, and basic needs. Discussion and Implications: Twelve factors were identified and developed into key questions for the Good Spirit, Good Life tool. The draft tool will undergo quantitative validity testing, prior to embedding in service provision to inform care for older Aboriginal peoples. With local adaptation, the tool, accompanying framework, and participatory methods for development may have wider applicability to other Indigenous populations worldwide

Stephens, A., Bohanna, I., & Graham, D. (2017). Expert consensus to examine the cross-cultural utility of substance use and mental health assessment instruments for use with Indigenous clients. Evaluation Journal of Australasia, 17(3), 14-22.

Evaluation of minority-culture specific treatment centres for substance use and mental health is challenging. The challenge is compounded by a paucity of validated instruments for assessing substance use and mental ill health. In the field of Australian Indigenous alcohol and other drug service provision there are few guidelines to determine which instruments should be targets for validation for use with Indigenous clients. As such, reliable, validated, evaluable data on the client population is limited, posing multifaceted concerns for clinicians and service providers as well as evaluators. The aim of this study was to pilot the use of a participatory expert consensus approach to evaluate, rate and select suitable majority-culture substance use and mental health assessment instruments for use with their clients. Eight practitioners of an Indigenous-specific substance misuse residential treatment centre participated. The findings reinforce the value of consensus approaches for stakeholder engagement and to provide a sense of ownership of the results. In this setting, consensus on the implementation of an agreed set of Indigenous-specific and non-Indigenous specific instruments improved the ownership of the instruments by clinicians allowing for the use of valid and/or reliable instruments that also had good face validity. This makes it more probable that reliable client wellbeing data will be collected. This is crucial to program evaluation at a later point in time. This study was a novel approach to generating evidence to inform practice in the absence of normative practice guidelines.

The Getting it Right Collaborative Group. (2019). Getting it right: Validating a culturally specific screening tool for depression (aPHQ-9) in Aboriginal and Torres Strait Islander Australians. The Medical Journal of Australia, 211(1), 24-30.

Objectives: To determine the validity, sensitivity, specificity and acceptability of the culturally adapted nine-item Patient Health Questionnaire (aPHQ-9) as a screening tool for depression in Aboriginal and Torres Strait Islander people. Design: Prospective observational validation study, 25 March 2015 – 2 November 2016. Setting, participants: 500 adults (18 years or older) who identified as Aboriginal or Torres Strait Islander people and attended one of ten primary health care services or service events in urban, rural and remote Australia that predominantly serve Indigenous Australians, and were able to communicate sufficiently to respond to questionnaire and interview questions. Main outcome measures: Criterion validity of the aPHQ-9, with the depression module of the Mini-International Neuropsychiatric Interview (MINI) 6.0.0 as the criterion standard. Results: 108 of 500 participants (22%; 95% CI, 18–25%) had a current episode of major depression according to the MINI criterion. The sensitivity of the aPHQ-9 algorithm for diagnosing a current major depressive episode was 54% (95% CI, 40–68%), its specificity was 91% (95% CI, 88–94%), with a positive predictive value of 64%. For screening for a current major depressive episode, the area under the receiver operator characteristic curve was 0.88 (95% CI, 0.85–0.92); with a cut-point of 10 points its sensitivity was 84% (95% CI, 74–91%) and its specificity 77% (95% CI, 71–83%). The aPHQ-9 was deemed acceptable by more than 80% of participants. Conclusions: Indigenous Australians found the aPHQ-9 acceptable as a screening tool for depression. Applying a cut-point of 10 points, the performance characteristics of the aPHQ were good.

Toombs, M., Nasir, B., Kisely, S., Ranmuthugala, G., Gill, Neeraj S., Beccaria, G., Hayman, N., Kondalsamy-Chennakesavan, S., & Nicholson, G. C. (2019) Cultural validation of the structured clinical interview for diagnostic and statistical manual of mental disorders in Indigenous Australians. Australasian Psychiatry27(4), 362-365.

Adams, Y., Drew, N., & Walker, R. (2014).  Principles of practice in mental health assessment with Aboriginal Australians. In P. Dudgeon, H. Milroy & R. Walker (Eds). Working together: Aboriginal and Torres Strait Islander mental health and wellbeing principles and practice (2nd ed.),(Ch. 16) (pp. 271-288). Commonwealth of Australia.

In this chapter, concepts and history of assessment and testing in the context of Aboriginal and Torres Strait Islander social and emotional wellbeing and mental health are discussed. Importantly, recently revised diagnostic guidelines and the National Practice Standards for the Mental Health Workforce 20131 and their appropriateness for meeting the distinctive needs of Aboriginal people are reviewed. Various assessment tools and measures that have been validated or proved appropriate for use with particular Aboriginal populations, i.e. youth, women and older people, are described. We conclude that practitioners need to be critically reflective in their role in assessment, and position themselves to play an important transformative role in conducting assessment. This extends to acknowledging and enacting culturally responsive principles, procedures and practices to ensure that Aboriginal people have access to effective, culturally secure mental health care.

Choo, Carol C., Harris, Keith M., Chew, Peter K.H., & Ho, Roger C. (2019). Clinical assessment of suicide risk and suicide attempters’ self-reported suicide intent: A cross sectional study. PLoS One, 14(7), e0217613. 

This study explored medical doctors’ clinical assessment of suicide risk and suicide attempters’ self-reported suicide intent. Three years of archival assessment records related to suicide attempters who were admitted to the emergency department of a large teaching hospital in Singapore were subjected to analysis. Records related to 460 suicide attempters (70.4% females; 28.6% males) were analysed using logistic regressions. Their ages ranged from 12 to 85 (M = 29.08, SD = 12.86). The strongest predictor of suicide intent was habitual poor coping, followed by serious financial problems, and expressed regret. The strongest predictor of suicide risk was hiding the attempt followed by prior planning. The findings were discussed in regards to implications in clinical assessments and suicide prevention efforts.