Validation of cross-cultural child mental health and psychosocial research instruments: adapting the Depression Self-Rating Scale and Child PTSD Symptom Scale in Nepal

BMC Psychiatry

Research Article

Nagendra P Luitel¹  Brandon A Kohrt¹  Sujen M Maharjan²  Nawaraj Upadhaya³  Mark JD Jordans⁴  Wietse A Tol⁵ 

[1] Transcultural Psychosocial Organization (TPO) Nepal, Baluwatar, Kathmandu, Nepal;Transcultural Psychosocial Organization (TPO) Nepal, Baluwatar, Kathmandu, Nepal;Central Department of Psychology, Tribhuvan University, Kirtipur, Nepal;Transcultural Psychosocial Organization (TPO) Nepal, Baluwatar, Kathmandu, Nepal;Dept of Anthropology, University of Amsterdam, Amsterdam, The Netherlands;Transcultural Psychosocial Organization (TPO) Nepal, Baluwatar, Kathmandu, Nepal;HealthNetTPO, Amsterdam, The Netherlands;Transcultural Psychosocial Organization (TPO) Nepal, Baluwatar, Kathmandu, Nepal;HealthNetTPO, Amsterdam, The Netherlands;Global Health Initiative, Yale University, New Haven, USA;

关键词: Focus Group;    Child Mental Health;    Depression Self Rate Scale;    Child Soldier;    Psychosocial Counselor;   

DOI  :  10.1186/1471-244X-11-127

 received in 2011-03-19, accepted in 2011-08-04,  发布年份 2011

来源: Springer

【 摘 要 】

BackgroundThe lack of culturally adapted and validated instruments for child mental health and psychosocial support in low and middle-income countries is a barrier to assessing prevalence of mental health problems, evaluating interventions, and determining program cost-effectiveness. Alternative procedures are needed to validate instruments in these settings.MethodsSix criteria are proposed to evaluate cross-cultural validity of child mental health instruments: (i) purpose of instrument, (ii) construct measured, (iii) contents of construct, (iv) local idioms employed, (v) structure of response sets, and (vi) comparison with other measurable phenomena. These criteria are applied to transcultural translation and alternative validation for the Depression Self-Rating Scale (DSRS) and Child PTSD Symptom Scale (CPSS) in Nepal, which recently suffered a decade of war including conscription of child soldiers and widespread displacement of youth. Transcultural translation was conducted with Nepali mental health professionals and six focus groups with children (n = 64) aged 11-15 years old. Because of the lack of child mental health professionals in Nepal, a psychosocial counselor performed an alternative validation procedure using psychosocial functioning as a criterion for intervention. The validation sample was 162 children (11-14 years old). The Kiddie-Schedule for Affective Disorders and Schizophrenia (K-SADS) and Global Assessment of Psychosocial Disability (GAPD) were used to derive indication for treatment as the external criterion.ResultsThe instruments displayed moderate to good psychometric properties: DSRS (area under the curve (AUC) = 0.82, sensitivity = 0.71, specificity = 0.81, cutoff score ≥ 14); CPSS (AUC = 0.77, sensitivity = 0.68, specificity = 0.73, cutoff score ≥ 20). The DSRS items with significant discriminant validity were "having energy to complete daily activities" (DSRS.7), "feeling that life is not worth living" (DSRS.10), and "feeling lonely" (DSRS.15). The CPSS items with significant discriminant validity were nightmares (CPSS.2), flashbacks (CPSS.3), traumatic amnesia (CPSS.8), feelings of a foreshortened future (CPSS.12), and easily irritated at small matters (CPSS.14).ConclusionsTranscultural translation and alternative validation feasibly can be performed in low clinical resource settings through task-shifting the validation process to trained mental health paraprofessionals using structured interviews. This process is helpful to evaluate cost-effectiveness of psychosocial interventions.

【 授权许可】

CC BY   
© Kohrt et al; licensee BioMed Central Ltd. 2011