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

BMC Psychiatry

Catherine Panter-Brick¹  Mark Eggerman¹  Amelia Sancilio¹  Peter Ventevogel³  Andrew Rasmussen² 

[1] Yale University, New Haven, CT, USA;Fordham University, Dealy Hall 226, 441 East Fordham Rd, Bronx, NY 11215, USA;UNHCR, Geneva, Switzerland

关键词: Afghanistan;    Syndrome;    Gender;    Aggression;    Idioms of distress;    Transcultural research;    Cultural concepts;    Assessment;    Validity;   

Others  :  1123458
DOI  :  10.1186/1471-244X-14-206

 received in 2014-03-14, accepted in 2014-07-10,  发布年份 2014

【 摘 要 】

Background

The 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.

Methods

We 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.

Results

EFA 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.

Conclusions

Two 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.

【 授权许可】

   
2014 Rasmussen et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

Figure 1.

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