Comparative Validity of Screening Instruments for Mental Distress in Zambia

Abstract

Background:The recognition of mental health as a major contributor to the global burden of disease has led to an increase in the demand for the inclusion of mental health services in primary health care as well as in community-based health surveys in order to improve screening, diagnosis and treatment of mental distress. Many screening instruments are now available. However, the cultural validity of these instruments to detect mental distress has rarely been investigated in developing countries. In these countries, limited trained staff and specialized psychiatric facilities hamper improvement of mental health services. It is therefore imperative to develop a quick, low cost screening instrument that does not require specialized training. We validated different well established screening instruments among primary health care clinic attendees in Lusaka, Zambia. We also assess the face, content and criterion validity of the SRQ’s and determined the most commonly reported symptoms for mental distress.Methods:The screening instruments, SRQ-20, SRQ-10 and GHQ-12 were used as concurrent criteria for each other and compared against a gold standard, DSM-IV. Their correlation, sensitivity and specificity were assessed. All instruments were administered to 400 primary health care clinic attendees. In-depth interviews were also conducted with 28 of these clinic attendees.Results:Both the SRQ-20 and SRQ-10 had high properties for identifying mental distress correctly with an AUC of 0.96 and 0.95 respectively while the GHQ-12 had modest properties (AUC, 0.81). The optimum cut-off points for this population were 7 and 3 for the SRQ and GHQ-12 respectively. The SRQ was also found to have good face and content validity. Conclusion:The study establishes the utility of the SRQ-20 for detecting mental distress cases and also underscores the importance of validating instruments to suit the context of the target population. It also validates the SRQ-10 as the first reliable abbreviated and easy-to-use screening instrument for mental distress in primary health care facilities in Zambia.

Cost-effectiveness of the Mental Health and Development model for schizophrenia-spectrum and bipolar disorders in rural Kenya

“…The GHQ has been validated in this setting previously, with research from Kenya (Njenga, 2000, Jenkins et al, 2013 suggesting a cut-off of 3 (0-2 healthy, 3-12 sick). This is more conservative than literature from Nigeria (Gureje and Obikoya, 1990), but is consistent with Zambia (Chipimo and Fylkesnes, 2010), and aligns with recommendations of the tool's authors (Goldberg et al, 1998). The GHQ is a general measure of emotional distress, which we considered important to report in this diagnostically heterogeneous sample.…”

Questionário de Saúde Geral (QSG-12): o efeito de itens negativos em sua estrutura fatorial

“…A versão com 12 itens deste instrumento 1 é a mais curta e, provavelmente, uma das mais empregadas para medir o bem-estar psicológico 6 . Conta com o atrativo de ser de fácil aplicação, além de apresentar uma característica comum em medidas atitudinais: os itens são igualmente distribuídos entre os redigidos como positivos (e.g., "Tem se sentido capaz de tomar decisões?")…”

One size does not fit all: Psychometric properties of the Shona Symptom Questionnaire (SSQ) among adolescents and young adults in Zimbabwe

“…The SRQ-20 has been translated into several languages and validated in many cultural settings and age groups including but not limited to regions of SSA (Maziak et al, 2002;Aidoo and Harpham, 2001;Araya et al, 1992;Bhagwanjee et al, 1998;Chipimo and Fylkesnes, 2010;Feijo et al, 1997;Giang et al, 2006;Hanlon et al, 2008;Ludermir and Lewis, 2001;NakimuliMpungu et al, 2012;Scholte et al, 2011;Stewart et al, 2009;Winston and Smith, 2000). The SSQ, developed more recently, is intended for Shona-speaking countries including Zimbabwe, Botswana, and Mozambique.…”

“…Although initially intended for primary health care settings, the SRQ-20 has also been used as a screening tool within community settings. Studies have used various cut points based on the scale's discriminate ability to capture cases and non-cases of depression within their sample (Araya et al, 1992;Chipimo and Fylkesnes, 2010;Harding et al, 1980;Scholte et al, 2011). The most common cut point used to determine depression, and one recommended by the WHO, is a positive response to eight or more of the 20 questions (WHO, 1994).…”

“…Criterion validity has been established in various studies across continents and assessed against gold-standard diagnostic tools including the Clinical Interview Schedule-Revised (CIS-R), the Diagnostic Interviewer Schedule (DIS), and the Diagnostic and Statistical Manual of Mental Disorders 4th edition (DSM-IV) (Araya et al, 1992;Chipimo and Fylkesnes, 2010;Feijo et al, 1997). This suggests that the SRQ-20, while not specifically designed for one country, is culturally adaptable, easy to use and administer, and is consistently valid in measuring psychiatric symptoms across populations (Aidoo and Harpham, 2001;Araya et al, 1992;Bhagwanjee et al, 1998;Chen et al, 2009;Chipimo and Fylkesnes, 2010;Feijo et al, 1997;Giang et al, 2006;Hanlon et al, 2008;Ludermir and Lewis, 2001;Maziak et al, 2002;Nakimuli-Mpungu et al, 2012;Scholte et al, 2011;Stewart et al, 2009;Winston and Smith, 2000).…”