isiXhosa Translation of the Patient Health Questionnaire (PHQ-9): A Pilot Study of Psychometric Properties [Stage 1] (original) (raw)
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AIDS and Behavior, 2020
Screening measures for depression developed in high-income countries have not always demonstrated strong psychometric properties in South Africa and with people living with HIV (PLWH). The present study explored the psychometric properties of the 16-item South African Depression Scale (SADS) comprised of idioms of distress specific to isiXhosa culture in PLWH. The SADS was administered to 137 Xhosa-speaking PLWH who met diagnostic criteria for major depressive disorder (MDD) together with the Hamilton Depression Scale (HAM-D) and the Center for Epidemiological Studies Depression Scale (CES-D). We conducted exploratory factor analysis, correlation, and reliability statistics. Four factors of the SADS emerged: Sadness, lethargy/burdened, anhedonia/withdrawal, and cognitive/somatic. All factors correlated significantly with the HAM-D and CES-D. Internal consistency of the overall measure was high (α = .89). The SADS promises to be a robust measure of depression in isiXhosa-speaking PLWH in South Africa likely due to the inclusion of local idioms of distress. Keywords Psychometric properties • Depression • Measure • HIV • South africa RESUMEN Las medidas de detección de la depresión que se desarrollaron en países de altos ingresos no siempre han demostrado fuertes propiedades psicométricas en Sudáfrica y con personas que viven con el VIH (PVVS). El estudio actual exploró las propiedades psicométricas de la Escala de Depresión Sudafricana de 16 preguntas (SADS) compuesta por modismos de angustia específicos de la cultura isiXhosa en PVVS. El SADS se administró a 137 PVVS Xhosa que cumplieron los criterios diagnósticos para el trastorno depresivo mayor
Journal of Affective Disorders, 2014
Background Integration of depression screening into primary care may increase access to mental health services in sub-Saharan Africa, but this approach requires validated screening instruments. We sought to validate the Patient Health Questionnaire-9 (PHQ-9) as a depression screening tool at a high HIV-burden primary care clinic in Johannesburg, South Africa. Methods We conducted a validation study of an interviewer-administered PHQ-9 among 397 patients. Sensitivity and specificity of the PHQ-9 were calculated with the Mini International Neuropsychiatric Interview (MINI) as the reference standard; receiver operating characteristic (ROC) curve analyses were performed. Results The prevalence of depression was 11.8%. One-third of participants tested positive for HIV. HIV-infected patients were more likely to be depressed (15%) than uninfected patients (9%; p=0.08). Using the standard cutoff score of ¿10, the PHQ-9 had a sensitivity of 78.7% (95% CI: 64.3-89.3) and specificity of 83.4% (95% CI: 79.1-87.2). The area under the ROC curve was 0.88 (95% CI: 0.83-0.92). Test performance did not vary by HIV status or language. In sensitivity analyses, reference test bias associated with the MINI appeared unlikely. Limitations We were unable to conduct qualitative work to adapt the PHQ-9 to this cultural context. Conclusion This is the first validation study of the PHQ-9 in a primary care clinic in sub-Saharan Africa. It highlights the potential for using primary care as an access point for identifying depressive symptoms during routine HIV testing. The PHQ-9 showed reasonable accuracy in classifying cases of depression, was easily implemented by lay health workers, and is a useful screening tool in this setting. Disciplines Education | Social and Behavioral Sciences
Journal of Affective Disorders Reports, 2020
Background: Depression remains under-investigated in people living with HIV in sub-Saharan Africa due to paucity of adequately validated measures. This study aimed to validate an adapted version of the 9-item Patient Health Questionnaire (PHQ-9) among adults living with HIV compared to those from the community in Kilifi, Kenya. Methods: Analysis of data from 450 adults living with HIV and 337 adults from the community was conducted examining the reliability, factorial structure, measurement invariance and discriminant validity of intervieweradministered PHQ-9, Swahili version. Results: Internal consistency of the Swahili PHQ-9 was good overall, in adults living with HIV and those from the community (Macdonald's omega > 0.80). The two-week test-retest reliability was acceptable among adults living with HIV (ICC = 0.64). A one-factor confirmatory factor analysis (CFA) model indicated the Swahili PHQ-9 was unidimensional in the overall sample, in adults living with HIV and those from the community. Multi-group CFA substantiated measurement invariance of this unidimensional scale across participant group (adults living with HIV vs. community), sex (females vs. males) and age category (young, middle-age and elderly adults). The Swahili PHQ-9 exhibited good discriminant validity between the two participant groups. Limitations: No diagnostic interview for mental disorders was administered in the original studies limiting analysis of sensitivity and specificity of the Swahili PHQ-9. Conclusion: The Swahili PHQ-9 is a reliable and valid unidimensional scale. It appears a valuable tool for assessing depressive symptoms that can be generalized across different demographic groups, in primary HIV clinics and the general community within this and similar settings.
Journal of Adolescent Health, 2023
Our study aimed to validate culturally adapted English and Swahili versions of the Patient Health Questionnairee9 (PHQ-9) for use with adolescents in Kenya. Criterion validity was determined with clinician-administered diagnostic interviews using the Kiddie Schedule of Affective Disorders and Schizophrenia. Methods: A total of 250 adolescents comprising 148 (59.2%) females and 102 (40.8%) males aged 10e19 years (mean ¼ 14.76; standard deviation ¼ 2.78) were recruited. The PHQ-9 was administered to all respondents concurrently in English and Swahili. Adolescents were later interviewed by clinicians using Kiddie Schedule of Affective Disorders and Schizophrenia to determine the presence or absence of current symptoms of major depressive disorder. Sensitivity specificity, positive predictive value (PPV) and negative predictive value (NPV), and likelihood ratios for various cutoff scores for PHQ-9 were analyzed using receiver operating characteristic curves. Results: The internal consistency (Cronbach's a) for PHQ-9 was 0.862 for the English version and 0.834 for Swahili version. The area under the curve was 0.89 (95% confidence interval, 0.84e0.92) and 0.87 (95% confidence interval, 0.82e0.90) for English and Swahili version, respectively, on receiver operating characteristic analysis. A cutoff of ! 9 on the English-language version had a sensitivity of 95.0%, specificity of 73.0%, PPV of 0.23, and NPV of 0.99; a cutoff of ! 9 on the Swahili version yielded a sensitivity of 89.0%, specificity of 70.0%, PPV of 0.20, and NPV of 0.90. IMPLICATIONS AND CONTRIBUTION This study reports the psychometric properties of a culturally translated and adapted version of the PHQ-9 in Kenya for depression screening in adolescents aged 10e19 years and aged 15e19 years. The results provide information on a range of cutoff scores so that clinicians, policymakers, and researchers can use thresholds that best fit their intended objectives.
Understanding the experience of depression in people living with HIV/AIDS (PLWH) could aid in the detection and treatment of the disorder. Yet, there is limited knowledge of the subjective experience of depression amongst PLWH in low-and middle-income countries despite high rates of this disorder in this population. In the current study, semistructured interviews were conducted with depressed adults living with HIV attending a primary infectious disease clinic in South Africa. Interview transcripts were thematically analyzed. The construct of depression was consistent with DSM-IV criteria; however, the symptom presentation was distinctive. Somatic symptoms were most prominent in participants' initial presentations because participants perceived them as medically relevant. Affective, cognitive, and behavioral symptoms were not readily reported as participants did not perceive these symptoms as pertinent to their medical treatment. We identified several idioms of distress that could assist in screening for depression in this population. A valid, contextually developed screener for depression in PLWH awaits further investigation. Such a measure could play a key role in formulating a logistically feasible method of detection and treatment for depression in this population.
Aids Care-psychological and Socio-medical Aspects of Aids/hiv, 2014
Understanding the experience of depression in people living with HIV/AIDS (PLWH) could aid in the detection and treatment of the disorder. Yet, there is limited knowledge of the subjective experience of depression amongst PLWH in low-and middle-income countries despite high rates of this disorder in this population. In the current study, semistructured interviews were conducted with depressed adults living with HIV attending a primary infectious disease clinic in South Africa. Interview transcripts were thematically analyzed. The construct of depression was consistent with DSM-IV criteria; however, the symptom presentation was distinctive. Somatic symptoms were most prominent in participants' initial presentations because participants perceived them as medically relevant. Affective, cognitive, and behavioral symptoms were not readily reported as participants did not perceive these symptoms as pertinent to their medical treatment. We identified several idioms of distress that could assist in screening for depression in this population. A valid, contextually developed screener for depression in PLWH awaits further investigation. Such a measure could play a key role in formulating a logistically feasible method of detection and treatment for depression in this population.
Journal of Adolescent Health
Screening tools such as the Patient Health Questionnaire-9 (PHQ-9) and the Generalized Anxiety Disorder-7 (GAD-7) could potentially be used in resource-limited settings to identify adolescents who need mental health support. We examined the criterion validity of the isiXhosa versions of the PHQ-9 and GAD-7 in detecting depression and anxiety among adolescents (10e19 years) in South Africa. Methods: Adolescents were recruited from the general population and from nongovernmental organizations working with adolescents in need of mental health support. The PHQ-9 and GAD-7 were culturally adapted and translated into isiXhosa and administered to 302 adolescents (56.9% female). The Kiddie Schedule for Affective Disorders and Schizophrenia was administered by trained clinicians as the gold standard diagnostic measure for depression and anxiety. Results: For the PHQ-9, the area under the curve was 0.88 for the full sample of adolescents (10 e19 years old). A score of 10 had 91% sensitivity and 76% specificity for detecting adolescents with depression. For the GAD-7, the area under the curve was 0.78, and cutoff scores with an optimal sensitivity-specificity balance were low (6). A score of 6 had 67% sensitivity and 75% specificity for detecting adolescents with anxiety. IMPLICATIONS AND CONTRIBUTIONS This study determined the psychometric properties of the culturally adapted isiXhosa versions of the Patient Health Questionnaire-9 and Generalized Anxiety Disorder-7 for a range of cutoff scores, for use with adolescents. These findings make a meaningful contribution to establishing tools to measure adolescent mental health at a population level in South Africa and other Conflicts of interest: The authors have no conflicts of interest or competing interests relevant to this work. The funder (Bill & Melinda Gates Foundation) had no role to play in the study design, data collection, analysis, or manuscript preparation. Disclaimer: The article was published as part of supplement that was supported by the Bill & Melinda Gates Foundation [INV-001395] and UNICEF.
HIV/AIDS - Research and Palliative Care, 2012
HIV treatment programs are in need of brief, valid instruments to identify common mental disorders such as depression. To translate and culturally adapt the Self-Reporting Questionnaire (SRQ-20) for use in Uganda and to investigate its psychometric properties in this setting. Following an initial translation of the SRQ-20 from English to Luganda, key informant interviews and focus-group discussions were used to produce a culturally adapted version of the instrument. The adapted SRQ-20 was administered to 200 HIV-positive individuals in a rural antiretroviral therapy program in southern Uganda. All study participants were also evaluated by a psychiatric clinical officer with the Mini International Neuropsychiatric Interview (MINI). Receiver-operating-characteristic analysis was used to examine the sensitivity and specificity of the SRQ-20 compared to the clinical diagnosis generated by the MINI. The prevalence estimates of any depressive disorder and current depression were 24% (n = 48) and 12% (n = 24), respectively. The SRQ-20 scores discriminated well between subjects with and without current depression based on the MINI, with an area under the curve of 0.92, as well as between subjects with and without any current or past depressive disorder, with an area under the curve of 0.75. A score of 6 or more had 84% sensitivity and 93% specificity for current depression, and 75% sensitivity and 90% specificity for any depressive disorder. The SRQ-20 appears to be a reliable and valid screening measure for depression among rural HIV-positive individuals in southern Uganda. The use of this screening instrument can potentially improve detection and management of depression in this setting.