“Thandi should feel embarrassed”: describing the validity and reliability of a tool to measure depression-related stigma among patients with depressive symptoms in Malawi

Dussault, Josée M.; Zimba, Chifundo; Malava, Jullita; Akello, Harriet; Stockton, Melissa; Udedi, Michael; Hosseinipour, Mina C.; Pence, Brian W.; Masiye, Jones

doi:10.1007/s00127-021-02202-w

Cited by 5 publications

(10 citation statements)

References 54 publications

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“…More research focusing on beliefs, stereotypes and stigma related to mental illness in Africa should be conducted to better inform content and relevance of existing and future MHL questionnaires. This also highlights a need for validity testing tools that measure mental health stigma in Malawi [ 26 ] and Africa more broadly.…”

Section: Discussionmentioning

confidence: 99%

Translation of the mental health literacy questionnaire for young adults into Chichewa for use in Malawi: preliminary validation and reliability results

Jumbe

Nyali²,

Newby

2023

Int J Ment Health Syst

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Background Mental Health Literacy (MHL) is the ability to recognise mental disorders, have knowledge of professional help available, effective self-help strategies, skills to give support to others, and knowledge of how to prevent mental disorders. Sufficient MHL is linked to better help seeking behaviour and management of mental illness. Assessing MHL importantly helps identify knowledge gaps and inaccurate beliefs about mental health issues, whilst informing development and better evaluation of MHL interventions. This study aimed to translate the English version of a self-reporting Mental Health Literacy questionnaire (MHLq) for young adult populations (16–30 years-old) into Chichewa for use in Malawi and evaluate the psychometric properties of this Chichewa version. Methods An established translation methodology was employed, involving back-translation, comparison, forward-translation, comparison, and piloting. The translated Chichewa questionnaire was initially piloted with 14 young adults in a Malawi university, then subsequently administered to 132 young adults in rural community settings across Malawi. Results Overall internal consistency of the Chichewa translated MHLq was good (Cronbach’s alpha = 0.67) although subscales’ scores ranged from acceptable (factor 1 and 3) to unacceptable (factor 2 and 4). Confirmatory factor analysis found Factor 1 (Knowledge of mental health problems), Factor 3 (First aid skills and help seeking behaviour) and Factor 4 (Self-help strategies) of the Chichewa version fit very well with related factors of the original English MHLq. For Factor 2 (Erroneous beliefs/stereotypes), 5 out of its 8 items correlated well with the original version. This suggests a four-factor solution is a reasonably good fit to the data. Conclusions Use of the Malawian MHLq among Chichewa speaking young adult populations is well supported for factors 1 and 3 but not for factors 2 and 4. More psychometric testing with a larger sample is vital to further validate the questionnaire. Further research is needed to carry out test/re-test reliability statistics.

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Section: Discussionmentioning

confidence: 99%

Translation of the mental health literacy questionnaire for young adults into Chichewa for use in Malawi: preliminary validation and reliability results

Jumbe

Nyali²,

Newby

2023

Int J Ment Health Syst

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“…The exposure of interest was high baseline treatment-related stigma (also referred to as treatment carryover), indicated by patients' responses to an instrument that our team has previously validated in this study population [13]. This instrument measures three domains of stigma: negative affect, or negative attitudes toward people with depression; disclosure carryover, or the stigma that participants expected would result from disclosing depression status; and treatment carryover, or participants' concerns that they would be treated as outsiders in their communities as a result of engaging in depression treatment [13,28,29]. The stigma instrument measured these domains using a vignette of a woman named Thandi and a series of eight prompts delivered on a 5-point Likert scale (see S1 Appendix for full prompts).…”

Section: Exposure Definitionmentioning

confidence: 99%

“…In previous mixed-methods research focused on patients who received depression treatment in Malawi, our study team found that some participants had concerns about treatmentrelated stigma when initiating depression treatment, and they expressed worry that this treatment-related stigma would influence their continued treatment engagement [14]. In Malawi, patients have also cited their support system, their ability to reach the clinic for appointments (NDA): https://nda.nih.gov/edit_collection.html?id= 2822.…”

Section: Introductionmentioning

confidence: 98%

“…For instance, participants attributed the cause of mental illness to God's punishment or other spiritual causes while also attributing mental illness to brain disorders [12]. Our study team has also contributed to the literature around depression stigma in Malawi specifically by validating an instrument to measure treatment-related, disclosurerelated, and negative affect stigma within a population of patients with depression [13]. The scale-up of antidepressant treatment is a high priority for the Malawi Ministry of Health, and quantifiable information about the barriers to such a scale-up, such as stigma, is therefore relevant.…”

Section: Introductionmentioning

confidence: 99%

“…(either due to material resources, transit access, or work/scheduling), and stressful life events (e.g., a dispute with a partner or family member) as key determinants to attending their care appointments [14][15][16]. Research in other social contexts has also demonstrated that suboptimal treatment engagement may reduce the effectiveness of depression treatment and increase time to depression remission [7].…”

Section: Introductionmentioning

confidence: 99%

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Estimating the effect of anticipated depression treatment-related stigma on depression remission among people with noncommunicable diseases and depressive symptoms in Malawi

Dussault¹,

Zimba²,

Akello³

et al. 2023

PLoS ONE

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Purpose While mental health stigma research is sparse in Malawi, research in other settings suggests that stigma represents a barrier to mental health treatment and recovery. Accordingly, we conducted an analysis to understand the role of treatment-related stigma in depression care in Malawi by estimating the effect of patients’ baseline anticipated treatment-related stigma on their 3-month probability of depression remission when newly identified with depression. Methods We conducted depression screening and treatment at 10 noncommunicable disease (NCD) clinics across Malawi from April 2019 through December 2021. Eligible cohort participants were 18–65 years with depressive symptoms indicated by a PHQ-9 score ≥5. Questionnaires at the baseline and 3-month interviews included a vignette-based quantitative stigma instrument that measured treatment-related stigma, i.e., concerns about external stigma because of receiving depression treatment. Using inverse probability weighting to adjust for confounding and multiple imputation to account for missing data, this analysis relates participants’ baseline levels of anticipated treatment stigma to the 3-month probability of achieving depression remission (i.e., PHQ-9 score < 5). Results Of 743 included participants, 273 (37%) achieved depression remission by their 3-month interview. The probability of achieving depression remission at the 3-month interview among participants with high anticipated treatment stigma (0.31; 95% Confidence Interval [CI]: 0.23, 0.39)) was 10 percentage points lower than among the low/neutral stigma group (risk: 0.41; 95% CI: 0.36, 0.45; RD: -0.10; 95% CI: -0.19, -0.003). Conclusion In Malawi, a reduction in anticipated depression treatment-related stigma among NCD patients initiating depression treatment could improve depression outcomes. Further investigation is necessary to understand the modes by which stigma can be successfully reduced to improve mental health outcomes and quality of life among people living with depression.

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Intersectional HIV- and Depression-Related Stigma Among People with HIV Entering HIV Care in Cameroon

Filiatreau,

Ebasone,

Dzudie

et al. 2024

AIDS Behav

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“Thandi should feel embarrassed”: describing the validity and reliability of a tool to measure depression-related stigma among patients with depressive symptoms in Malawi

Cited by 5 publications

References 54 publications

Translation of the mental health literacy questionnaire for young adults into Chichewa for use in Malawi: preliminary validation and reliability results

Translation of the mental health literacy questionnaire for young adults into Chichewa for use in Malawi: preliminary validation and reliability results

Estimating the effect of anticipated depression treatment-related stigma on depression remission among people with noncommunicable diseases and depressive symptoms in Malawi

Intersectional HIV- and Depression-Related Stigma Among People with HIV Entering HIV Care in Cameroon

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