Developing a Mental Health Measurement Strategy to Capture Psychological Problems among Lower Caste Adolescent Girls in Rural, South India

Abstract

Adolescent girls vulnerable to early marriage and school dropout in rural India may be at elevated risk of psychosocial problems. However, few screening instruments have been culturally adapted and validated to measure this risk. This paper describes the process by which the Primary Health Questionnaire PHQ-9, a screening instrument for depression, was tested for cultural validity as part of the Samata evaluation - an intervention to support low caste adolescent girls in rural south India to attend and complete secondary school and to delay marriage until adulthood. Three focus groups discussions (FGDs) were held with 20 adolescent girls and six outreach workers of the Samata programme in rural north Karnataka, south India. The FGDs were used to explore local expressions of psychosocial problems and to understand the acceptability and appropriateness of PHQ-9 items. A thematic content analysis was conducted on the transcripts of the FGDs. Descriptions of local expressions of psychosocial problems generally matched the items on the PHQ-9. However, not all representations of psychological symptoms were captured by this tool. Persistent worry, loneliness and isolation, and externalised behaviours were also described by participants as common expressions of psychosocial distress. Based on the limitations of translation methods, local stakeholders must be involved in evaluating the cultural appropriateness of mental health screening tools. The current research demonstrates a strategy by which to assess the cultural validity of Western psychiatric instruments with key stakeholders in low- and middle-income settings.

Adapting culturally appropriate mental health screening tools for use among conflict-affected and other vulnerable adolescents in Nigeria

“…It might be that final translations were more acceptable for one language than another, which might reflect difficulties balancing comprehensibility and acceptability in adapting items. Significantly, several authors have found suicidal ideation to be considered unacceptable during qualitative research that informs cultural adaptation, but that participants nevertheless endorse such experiences in piloting and validation studies (Hanlon et al ., 2008; Kaiser et al ., 2013; Kohrt et al ., 2016; Housen et al ., 2018; Mazzuca et al ., 2019). We similarly found suicidal ideation to be considered unacceptable to ask about in some FGDs but that such experiences were endorsed by participants.…”

“…For example, several items were interpreted in FGDs as non-specific to mental illness, such as tummy aches, not enjoying food, or trouble sleeping. Previous studies have likewise found that such items require specific adaptations to differentiate them from experiences of diarrheal disease, hunger, or other stressors (Kohrt et al ., 2007, 2011, 2016; Hanlon et al ., 2008; Kaiser et al ., 2013; Haroz et al ., 2017; Mazzuca et al ., 2019). While some of these items appeared to function well following adaptation (e.g., not enjoying food), other items (e.g., tummy aches) were endorsed in a different pattern than other items, suggesting that they might continue to be endorsed outside the experience of emotional distress.…”

“…We similarly found suicidal ideation to be considered unacceptable to ask about in some FGDs but that such experiences were endorsed by participants. It might be that experiences that are highly stigmatized like suicidal behavior are reported as unacceptable by some groups but as important signs of distress to others, particularly vulnerable groups (Kohrt et al ., 2016; Mazzuca et al ., 2019). It is therefore important to elicit perspectives from multiple groups – including particularly vulnerable groups – to understand how best to incorporate questions about significant forms of distress.…”

Investigation of Early Marriage: A Phenomenology Study in the Society of Bawean Island, Indonesia

“…Furthermore, psychological disorders are also motivated by trauma caused by violence or coercion. This case is like physical violence, household quarrels, and sexual behavior (Mazzuca et al, 2019;Nguyen et al, 2016).…”

A Scoping Review and Content Analysis of Common Depressive Symptoms of Young People

“…In the additional search conducted in March 2021, 460 articles published between 2018 and March 2021 were identified; a total of eight peer-reviewed articles were selected to verify the findings above (Achterbergh et al, 2020;Burke et al, 2018;Couture et al, 2020;Mazzuca et al, 2019;Morey-Nase et al, 2019;Reed-Berendt et al, 2019;Watson et al, 2020;Willis et al, 2018;Supplemental Figure S2). Seven articles used qualitative approaches and one applied qualitative meta-synthesis to explore the loneliness experience of young people with depression from 14 studies.…”