Validity of brief screening questionnaires to detect depression in primary care in Ethiopia

JOURNAL OF AFFECTIVE DISORDERS

卷:186

Article

Hanlon, Charlotte^1,2  Medhin, Girmay³  Selamu, Medhin¹  Breuer, Erica⁴  Worku, Benyam¹  Hailemariam, Maji¹  Lund, Crick⁴  Prince, Martin²  Fekadu, Abebaw^1,5 

[1] Univ Addis Ababa, Coll Hlth Sci, Sch Med, Dept Psychiat, Addis Ababa, Ethiopia

[2] Kings Coll London, Inst Psychiat Psychol & Neurosci, Ctr Global Mental Hlth, Hlth Serv & Populat Res Dept, London WC2R 2LS, England

[3] Univ Addis Ababa, Aklilu Lemma Inst Pathobiol, Addis Ababa, Ethiopia

[4] Univ Cape Town, Alan J Flisher Ctr Publ Mental Hlth, Dept Psychiat & Mental Hlth, ZA-7700 Rondebosch, South Africa

[5] Kings Coll London, Ctr Affect Disorders, Inst Psychiat Psychol & Neurosci, Dept Psychol Med, London WC2R 2LS, England

关键词: Depression;    Validation;    Primary health care;    Sub-Saharan Africa;    Developing country;    Screening;   

DOI  :  10.1016/j.jad.2015.07.015

来源: Elsevier

【 摘 要 】

Background: Brief depression screening questionnaires may increase detection of depression in primary care settings but there have been few validation studies carried out in typical populations in low-income countries. Methods: Cultural validation of the Patient Health Questionnaire (PHQ-9/PHQ-2), the 20-item Self-Reporting Questionnaire (SRQ-20) and the Kessler scales (K6/K10) was carried out in 306 adults consecutively attending primary care facilities in small towns in Ethiopia. To assess criterion validity, the gold standard assessment for presence of Major Depressive Disorder (MOD) was made by Ethiopian psychiatric nurses using the Mini International Neuropsychiatric Interview. Results: The prevalence of gold standard MDD was 5.9%, with irritability more common than depressed mood or anhedonia. The area under the receiver operating characteristic curve indicated good performance of the PHQ-9, SRQ-20,1(6 and KID (0.83-0.85) but only fair for the PHQ-2 (0.78). No cut-off score had acceptable sensitivity combined with adequate positive predictive value. All screening questionnaires were associated with disability and the PHQ-9 and SRQ-20 were associated with higher health service contacts, indicating convergent validity. Construct validity of all scales was indicated by uni-dimensionality on exploratory factor analysis. Limitations: Test-retest reliability was not assessed. Conclusions: Brief depression screening questionnaires were found to be valid in primary care in this low-income country. However, these questionnaires do not have immediate applicability in routine clinical settings. Further studies should evaluate utility of indicated screening embedded within health system changes that support MDD detection. Investigation of irritability as a core depression symptom is warranted. (C) 2015 Elsevier B.V. All rights reserved.

【 授权许可】

Free