Comparing the validity of the self reporting questionnaire and the Afghan symptom checklist: dysphoria, aggression, and gender in transcultural assessment of mental health

Abstract

BackgroundThe relative performance of local and international assessment instruments is subject to ongoing discussion in transcultural research on mental health and psychosocial support. We examined the construct and external validity of two instruments, one developed for use in Afghanistan, the other developed by the World Health Organization for use in resource-poor settings.MethodsWe used data collected on 1003 Afghan adults (500 men, 503 women) randomly sampled at three sites in Afghanistan. We compared the 22-item Afghan Symptom Checklist (ASCL), a culturally-grounded assessment of psychosocial wellbeing, with Pashto and Dari versions of the 20-item Self-Reporting Questionnaire (SRQ-20). We derived subscales using exploratory and confirmatory factor analyses (EFA and CFA) and tested total and subscale scores for external validity with respect to lifetime trauma and household wealth using block model regressions.ResultsEFA suggested a three-factor structure for SRQ-20 - somatic complaints, negative affect, and emotional numbing - and a two-factor structure for ASCL - jigar khun (dysphoria) and aggression. Both factor models were supported by CFA in separate subsamples. Women had higher scores for each of the five subscales than men (p < 0.001), and larger bivariate associations with trauma (rs .24 to .29, and .10 to .19, women and men respectively) and household wealth (rs -.27 to -.39, and .05 to -.22, respectively). The three SRQ-20 subscales and the ASCL jigar khun subscale were equally associated with variance in trauma exposures. However, interactions between gender and jigar khun suggested that, relative to SRQ-20, the jigar khun subscale was more strongly associated with household wealth for women; similarly, gender interactions with aggression indicated that the aggression subscale was more strongly associated with trauma and wealth.ConclusionsTwo central elements of Afghan conceptualizations of mental distress - aggression and the syndrome jigar khun – were captured by the ASCL and not by the SRQ-20. The appropriateness of the culturally-grounded instrument was more salient for women, indicating that the validity of instruments may be gender-differentiated. Transcultural validation processes for tools measuring mental distress need to explicitly take gender into account. Culturally relevant measures are worth developing for long-term psychosocial programming.

Community based system dynamic as an approach for understanding and acting on messy problems: a case study for global mental health intervention in Afghanistan

“…Findings illustrate the complexity of defining psychiatric and psychological disorders as well as learning disability in Dari and Pashto – two main languages used in Afghanistan - as also shown by previous work done in Afghanistan around mental health [55–58]. Dari and Pashto do not have clearly specified terms for mental illness.…”

“Thinking too much”: A systematic review of a common idiom of distress

“…For example, Miller and colleagues (2006) used “quick ethnography” to develop the Afghan Symptom Checklist (ASCL), which drew on idioms of distress including “thinking too much.” Rasmussen and colleagues (2014) then compared the locally-developed ASCL to the Self-Reporting Questionnaire (SRQ-20). They found that the SRQ-20 failed to capture aggression and dysphoria, elements of mental distress that were particularly locally salient.…”

Afghan Refugee Explanatory Models of Depression: Exploring Core Cultural Beliefs and Gender Variations

“…There are several possible explanations: (1) there is evidence that women generally tend to somaticize more than men (Wool and Barsky ); (2) Afghan men are more involved in the public sphere, thus they are more likely to recognize the more general modes of distress‐related expression (Rasmussen et al. ); and (3) men are more acculturated, educated, and hence more exposed to Western biomedical models of depression (Angel and Thoits ). However, an expected finding was that men and women aligned their views of depressive symptoms with culturally salient idioms of distress such as asabi, gham, goshagir y , and jigar khuni, along with items found in measures validated with Western populations such as the Beck Depression Inventory (indecisiveness, concentration difficulty, change in appetite).…”

“…Men and women inhabit different social and emotional spaces, according to Rasmussen et al. (), as men are more involved in the public sphere and women have limited social interactions outside the home. In a segregated society, men and women may have different experiences with depression and psychological distress, resulting in different beliefs.…”