The development of a contextually appropriate measure of psychological distress in Sierra Leone

Abstract

Background Studies of psychological distress in Sierra Leone have typically used measures which were developed for use in other contexts, and which often have not been adapted or validated for use in Sierra Leone. This has resulted in a lack of reliable information about the patterns of psychological distress within the population, which is a barrier to the development of effective and appropriate mental health services. The aim of the study was to develop a locally-appropriate measure of psychological distress for Sierra Leone. Methods The new measure consists of two instruments: the Sierra Leone Psychological Distress Scale (SLPDS) and a gendered measure of ability to carry out daily tasks—a Function scale—as an indication of the severity of distress. A three-phase mixed methods exploratory sequential study was conducted. Phase 1 was item generation and testing, leading to the development of a set of potential items for both instruments. Phase 2 was a small pilot study (N = 202) leading to the selection of the final set of items for both measures. Phase 3 was a validation phase where the SLPDS and the Function scale were administered with a larger sample of 904 respondents. Item analysis was used to assess the internal consistency of the scales, and Exploratory Factor Analysis to explore the properties of the SLPDS. Results Exploratory factor analysis using the principal axis factoring with an oblique rotation identified a three-factor structure for the 18-item SLPDS. Internal consistency for the SLPDS (Cronbach’s alpha = 0.89) and three subscales was good (Cronbach’s alpha > 0.73). The internal reliability of the male and female versions of the Function scale was also found to be acceptable (Cronbach’s alpha = 0.90 for the female scale and 0.79 for the male scale). Conclusions Together the SLPD and Function scales provide a locally-validated tool which will enable government bodies and local and international non-governmental organisations in Sierra Leone to assess mental health and psychosocial needs. This will support both effective service provision and the evaluation of initiatives designed to improve mental health and psychosocial wellbeing.

Social determinants of psychological distress in Sierra Leone

“…The survey questionnaire contained the Sierra Leone Psychological Distress (SLPD) scale to measure psychological distress. This scale was developed and validated in a three-phase mixed-method exploratory sequential study to produce a locally appropriate measure of psychological distress for Sierra Leone [ 15 ]. The final SLPD scale consisted of 18 items and showed good internal consistency (Cronbach's alpha = 0.89).…”

“…Since the survey was conducted to validate a new measure of psychological distress for Sierra Leone [15], our sample size estimations were guided by the literature on determining the sample size for factor analyses [19][20][21]. With reference to Mundfrom and colleagues [21], we envisaged our sample to have a variables-to-factors ratio of four, wide communality (between 0.2 and 0.8), and excellent coefficient congruence (K value 0.98).…”

“…Subsequently, we developed a measure of psychological distress specifically for the Sierra Leone context [ 15 ] (Psychology paper). The study reported here brought these two elements of our work together to investigate the impact of distressing events and day-to-day living conditions on psychological distress in Sierra Leone.…”