Challenges in measuring depression among Ugandan fisherfolk: a psychometric assessment of the Luganda version of the Center for Epidemiologic Studies Depression Scale (CES-D)

Abstract

Background: Depression is a prevalent and serious mood disorder and a major source of disability adjusted life years (DALY) in Uganda. Furthermore, evidence from Uganda and other countries throughout sub-Saharan Africa suggests that nearly a third of persons living with human immunodeficiency virus (HIV) suffer from depression and it adversely affects healthcare seeking behavior. The high burden of disease attributable to depression makes data on the prevalence of depression in Uganda, a country with a generalized HIV epidemic, a public health priority. This paper describes the psychometric properties of the Center for Epidemiologic Studies-Depression (CES-D) measure when administered to men and women residing in three fishing communities along the shore of Lake Victoria. Methods: We applied methods based on item response theory and classical test theory approaches to assess individual item characteristics, conducted exploratory factor analysis and assessed internal reliability, and construct and content validity of the measure. All analyses were performed in R Studio. Results: The study sample consisted of 300 residents of fishing communities in Wakiso District, Uganda. Fifty-six percent of the sample was female and 19.7% reported being HIV positive. Seven items of the measure that did not perform well, either because they could not differentiate between levels of the latent trait or because they did not map onto the primary factor, were removed from the scale. A single factor structure best fit our final set of 13items and we found an overall coefficient alpha of 0.89, indicating high internal consistency in this population. Conclusions: Based on our findings, we recommend that future use of the CES-D in this population utilize our revised scale with the final set of 13-items. The addition of other measures that can improve the rigor of CES-D validation efforts, such as inclusion of a clinical depression measure and administration in both a clinical and a general population sample in this setting are needed.

Water and mental health

“…One of the primary challenges in eliciting and measuring mental health symptoms in a standardized fashion is the fact that the measurement scales that currently dominate the field were developed in native English-speaking populations (Bagby, Ryder, Schuller, & Marshall, 2004;Beck et al, 1988Beck et al, , 1996Goldberg, 1972aGoldberg, , 1972bGoldberg & Williams, 1988). Straightforward translation of scale items from English to a non-English language, even where care is taken to avoid literal translation of western idioms (e.g., "shake the blues"), may obscure some items' intended meanings (Miller, Kintu, & Kiene, 2020). Translation can be challenging because the vocabulary of emotional distress and mental ill-health can vary greatly due to cultural and language differences (Kleinman, 1977).…”

Prevalence of depression in Uganda: A systematic review and meta-analysis

“…to understand its effects and design possible interventions [14][15][16][17]. Ugandan clinicians and researchers have employed various psychometrically validated tools to screen and diagnose depression among Ugandans, including the Patient Health Questionnaire (PHQ), Beck's Depression Inventory (BDI), Hamilton Rating Scale for Depression, Symptom Checklist-20, Center for Epidemiologic Studies-Depression Scale, Akena Visual Depression Inventory, and the Mini-International Neuropsychiatric Interview (MINI) [18][19][20][21][22][23][24].…”

Not Enough Money and Too Many Thoughts: Exploring Perceptions of Mental Health in Two Ugandan Districts Through the Mental Health Literacy Framework

“…Surveys conducted among specific populations (e.g., persons living with HIV, university students) and geographic regions of Uganda have estimated the prevalence of specific MHDs, such as depression (Ovuga et al, 2006;Ssebunnya et al, 2019). Psychometric assessment work has also been completed on a number of depression screening and diagnostic tools (e.g., Center for Epidemiologic Studies Depression Scale (CES-D) (Radloff, 2016), for improved accuracy in specific Ugandan languages and populations (A. P. Miller et al, 2020;Natamba et al, 2014). Other research groups have focused on identifying risk factors and correlates of depression in Uganda within specific populations, such as experiences of war torture, child abuse, and intimate partner violence (IPV) among those living in post-conflict settings (Amone-P'Olak et al, 2015) and sexual risk taking among university students (Agardh et al, 2012).…”

“…Surveys conducted among specific populations (e.g., persons living with HIV, university students) and geographic regions of Uganda have estimated the prevalence of specific MHDs, such as depression (Ovuga et al, 2006; Ssebunnya et al, 2019). Psychometric assessment work has also been completed on a number of depression screening and diagnostic tools (e.g., Center for Epidemiologic Studies Depression Scale (CES-D) (Radloff, 2016), for improved accuracy in specific Ugandan languages and populations (A. P. Miller et al, 2020; Natamba et al, 2014).…”