Translation, cultural adaptation and validation of Patient Health Questionnaire and generalized anxiety disorder among adolescents in Nepal.
Adolescents
Cultural adaptation
Depression and anxiety
Nepal
Validation
Journal
Child and adolescent psychiatry and mental health
ISSN: 1753-2000
Titre abrégé: Child Adolesc Psychiatry Ment Health
Pays: England
ID NLM: 101297974
Informations de publication
Date de publication:
19 Jun 2024
19 Jun 2024
Historique:
received:
18
01
2024
accepted:
06
06
2024
medline:
20
6
2024
pubmed:
20
6
2024
entrez:
19
6
2024
Statut:
epublish
Résumé
Depression and anxiety are significant contributors to the global burden of disease among young people. Accurate data on the prevalence of these conditions are crucial for the equitable distribution of resources for planning and implementing effective programs. This study aimed to culturally adapt and validate data collection tools for measuring depression and anxiety at the population level. The study was conducted in Kathmandu, Nepal, a diverse city with multiple ethnicities, languages, and cultures. Ten focus group discussions with 56 participants and 25 cognitive interviews were conducted to inform adaptations of the Patient Health Questionnaire adapted for Adolescents (PHQ-A) and Generalized Anxiety Disorder (GAD-7). To validate the tools, a cross-sectional survey of 413 adolescents (aged 12-19) was conducted in three municipalities of Kathmandu district. Trained clinical psychologists administered the Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS-DSM 5 version) to survey participants. A number of cultural adaptations were required, such as changing statements into questions, using a visual scale (glass scale) to maintain uniformity in responses, and including a time frame at the beginning of each item. For younger adolescents aged 12 to 14 years, a PHQ-A cut-off of > = 13 had a sensitivity of 0.93, specificity of 0.80, positive predictive value (PPV) of 0.33, and negative predictive value (NPV) of 0.99. For older adolescents aged 15-19, a cut-off of > = 11 had a sensitivity of 0.89, specificity of 0.70, PPV of 0.32, and NPV of 0.97. For GAD-7, a cut-off of > = 8 had a sensitivity of 0.70 and specificity of 0.67 for younger adolescents and 0.71 for older adolescents, with a PPV of 0.39 and NPV of 0.89. The individual symptom means of both PHQ-A and GAD-7 items showed moderate ability to discriminate between adolescents with and without depression and anxiety. The PHQ-A and GAD-7 demonstrate fair psychometric properties for screening depression but performed poorly for anxiety, with high rates of false positives. Even when using clinically validated cut-offs, population prevalence rates would be inflated by 2-4 fold with these tools, requiring adjustment when interpreting epidemiological findings.
Sections du résumé
BACKGROUND
BACKGROUND
Depression and anxiety are significant contributors to the global burden of disease among young people. Accurate data on the prevalence of these conditions are crucial for the equitable distribution of resources for planning and implementing effective programs. This study aimed to culturally adapt and validate data collection tools for measuring depression and anxiety at the population level.
METHODS
METHODS
The study was conducted in Kathmandu, Nepal, a diverse city with multiple ethnicities, languages, and cultures. Ten focus group discussions with 56 participants and 25 cognitive interviews were conducted to inform adaptations of the Patient Health Questionnaire adapted for Adolescents (PHQ-A) and Generalized Anxiety Disorder (GAD-7). To validate the tools, a cross-sectional survey of 413 adolescents (aged 12-19) was conducted in three municipalities of Kathmandu district. Trained clinical psychologists administered the Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS-DSM 5 version) to survey participants.
RESULTS
RESULTS
A number of cultural adaptations were required, such as changing statements into questions, using a visual scale (glass scale) to maintain uniformity in responses, and including a time frame at the beginning of each item. For younger adolescents aged 12 to 14 years, a PHQ-A cut-off of > = 13 had a sensitivity of 0.93, specificity of 0.80, positive predictive value (PPV) of 0.33, and negative predictive value (NPV) of 0.99. For older adolescents aged 15-19, a cut-off of > = 11 had a sensitivity of 0.89, specificity of 0.70, PPV of 0.32, and NPV of 0.97. For GAD-7, a cut-off of > = 8 had a sensitivity of 0.70 and specificity of 0.67 for younger adolescents and 0.71 for older adolescents, with a PPV of 0.39 and NPV of 0.89. The individual symptom means of both PHQ-A and GAD-7 items showed moderate ability to discriminate between adolescents with and without depression and anxiety.
CONCLUSION
CONCLUSIONS
The PHQ-A and GAD-7 demonstrate fair psychometric properties for screening depression but performed poorly for anxiety, with high rates of false positives. Even when using clinically validated cut-offs, population prevalence rates would be inflated by 2-4 fold with these tools, requiring adjustment when interpreting epidemiological findings.
Identifiants
pubmed: 38898474
doi: 10.1186/s13034-024-00763-7
pii: 10.1186/s13034-024-00763-7
doi:
Types de publication
Journal Article
Langues
eng
Pagination
74Informations de copyright
© 2024. The Author(s).
Références
American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders, DSM-5 (Vol. 17).
Borghero F, Martínez V, Zitko P, Vöhringer PA, Cavada G, Rojas G. [Screening depressive episodes in adolescents. Validation of the Patient Health Questionnaire-9 (PHQ-9)]. Rev Med Chil. 2018;146(4):479–86. https://doi.org/10.4067/s0034-98872018000400479 .
doi: 10.4067/s0034-98872018000400479
pubmed: 29999123
Carroll HA, Hook K, Perez OFR, Denckla C, Vince CC, Ghebrehiwet S, Henderson DC. Establishing reliability and validity for mental health screening instruments in resource-constrained settings: systematic review of the PHQ-9 and key recommendations. Psychiatry Res. 2020;291:113236. https://doi.org/10.1016/j.psychres.2020.113236 .
doi: 10.1016/j.psychres.2020.113236
pubmed: 32593853
pmcid: 7484202
Carvajal-Velez L, Ahs JW, Requejo JH, Kieling C, Lundin A, Kumar M, Kohrt BA. Measurement of Mental Health among adolescents at the Population Level: a Multicountry Protocol for Adaptation and Validation of Mental Health Measures. J Adolesc Health. 2023;72(1s):S27–33. https://doi.org/10.1016/j.jadohealth.2021.11.035 .
doi: 10.1016/j.jadohealth.2021.11.035
pubmed: 36528384
Central Bureau of Statistics. Population Monograph of Nepal-Population dynamics. Volume I. Kathmandu: Government of Nepal; 2014.
Cleary M, Raeburn T, Escott P, West S, Lopez V. Walking the tightrope’: the role of peer support workers in facilitating consumers’ participation in decision-making. Int J Ment Health Nurs. 2018;27(4):1266–72. https://doi.org/10.1111/inm.12474 .
doi: 10.1111/inm.12474
pubmed: 29741237
Dangal MR, Bajracharya LS. Students anxiety experiences during COVID-19 in Nepal. Kathmandu Univ Med J (KUMJ). 2020;18(70):53–7.
doi: 10.3126/kumj.v18i2.32957
pubmed: 33605239
Dhimal M, Dahal S, Adhikari K, Koirala P, Bista B, Luitel N, Jha AK. A Nationwide Prevalence of Common Mental disorders and Suicidality in Nepal: evidence from National Mental Health Survey, 2019–2020. J Nepal Health Res Counc. 2022;19(4):740–7. https://doi.org/10.33314/jnhrc.v19i04.4017 .
doi: 10.33314/jnhrc.v19i04.4017
pubmed: 35615831
Gautam P, Dahal M, Ghimire H, Chapagain S, Baral K, Acharya R, Neupane A. Depression among adolescents of Rural Nepal: A Community-based study. Depress Res Treat. 2021;2021:7495141. https://doi.org/10.1155/2021/7495141 .
doi: 10.1155/2021/7495141
pubmed: 33628501
pmcid: 7880710
Hayes J, Carvajal-Velez L, Hijazi Z, Ahs JW, Doraiswamy PM, Azzouzi E, Wolpert FA, M. You can’t manage what you do not measure - why adolescent Mental Health monitoring matters. J Adolesc Health. 2023;72(1s):S7–8. https://doi.org/10.1016/j.jadohealth.2021.04.024 .
doi: 10.1016/j.jadohealth.2021.04.024
pubmed: 36229393
IBM Corp. IBM SPSS statistics for Windows, Version 28.0. Armonk, NY: IBM Corp; 2021.
Institute of Health Metrics (IHME). (2021). Global Burden of Disease Collaborative Network. Global Burden of Disease Study 2019 (GBD 2019). Seattle, United States of America.
Jordans MJD, Kohrt BA, Luitel NP, Lund C, Komproe IH. Proactive community case-finding to facilitate treatment seeking for mental disorders, Nepal. Bull World Health Organ. 2017;95(7):531–6. https://doi.org/10.2471/blt.16.189282 .
doi: 10.2471/blt.16.189282
pubmed: 28670018
pmcid: 5487974
Karki A, Thapa B, Pradhan PMS, Basel P. Depression, anxiety and stress among high school students: a cross-sectional study in an urban municipality of Kathmandu, Nepal. PLOS Glob Public Health. 2022;2(5):e0000516. https://doi.org/10.1371/journal.pgph.0000516 .
doi: 10.1371/journal.pgph.0000516
pubmed: 36962418
pmcid: 10022099
Kaufman J, Boris B, David A, Francheska P, David B, Neal R. "K-SADS-PL DSM-5." Pittsburgh: Western Psychiatric Institute and Clinic; Child and Adolescent Research and Care Program, Yale University. 2016. https://doi.org/10.1097/00004583-199707000-00021 .
doi: 10.1097/00004583-199707000-00021
Kessler RC, Angermeyer M, Anthony JC, Demyttenaere RDEG, Gasquet K, Ustün I, T. B. Lifetime prevalence and age-of-onset distributions of mental disorders in the World Health Organization’s World Mental Health Survey Initiative. World Psychiatry. 2007;6(3):168–76.
pubmed: 18188442
pmcid: 2174588
Kohrt BA, Harper I. Navigating diagnoses: understanding mind–body relations, Mental Health, and Stigma in Nepal. Cult Med Psychiatry. 2008;32(4):462–91. https://doi.org/10.1007/s11013-008-9110-6 .
doi: 10.1007/s11013-008-9110-6
pubmed: 18784989
Kohrt BA, Kaiser BN. Measuring mental health in humanitarian crises: a practitioner’s guide to validity. Confl Health. 2021;15(1):72. https://doi.org/10.1186/s13031-021-00408-y .
doi: 10.1186/s13031-021-00408-y
pubmed: 34565416
pmcid: 8474916
Kohrt BA, Jordans MJ, Tol WA, Luitel NP, Maharjan SM, Upadhaya N. 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. 2011;11(1):127. https://doi.org/10.1186/1471-244x-11-127 .
doi: 10.1186/1471-244x-11-127
pubmed: 21816045
pmcid: 3162495
Kohrt BA, Luitel NP, Acharya P, Jordans MJD. Detection of depression in low resource settings: validation of the Patient Health Questionnaire (PHQ-9) and cultural concepts of distress in Nepal. BMC Psychiatry. 2016;16(1):58.
doi: 10.1186/s12888-016-0768-y
pubmed: 26951403
pmcid: 4782581
Levis B, Benedetti A, Thombs BD. Accuracy of Patient Health Questionnaire-9 (PHQ-9) for screening to detect major depression: individual participant data meta-analysis. BMJ. 2019;365:l1476. https://doi.org/10.1136/bmj.l1476 .
doi: 10.1136/bmj.l1476
pubmed: 30967483
pmcid: 6454318
Lovero KL, Adam SE, Bila CE, Canda ED, Fernandes ME, Rodrigues TIB, Wainberg ML. Validation of brief screening instruments for internalizing and externalizing disorders in Mozambican adolescents. BMC Psychiatry. 2022;22(1):549. https://doi.org/10.1186/s12888-022-04189-3 .
doi: 10.1186/s12888-022-04189-3
pubmed: 35962378
pmcid: 9373392
Marlow M, Skeen S, Grieve CM, Carvajal-Velez L, Åhs JW, Kohrt BA, Tomlinson M. Detecting depression and anxiety among adolescents in South Africa: validity of the isiXhosa Patient Health Questionnaire-9 and generalized anxiety Disorder-7. J Adolesc Health. 2023;72(1s):S52–60. https://doi.org/10.1016/j.jadohealth.2022.09.013 .
doi: 10.1016/j.jadohealth.2022.09.013
pubmed: 36274021
McGorry PD, Mei C. Early intervention in youth mental health: progress and future directions. Evid Based Ment Health. 2018;21(4):182–4. https://doi.org/10.1136/ebmental-2018-300060 .
doi: 10.1136/ebmental-2018-300060
pubmed: 30352884
pmcid: 10270418
Ministry of Education Science and Technology. (2020). (2020) Flash I REPORT 2077 (2020-021). Available at: https://cehrd.gov.np/file_data/mediacenter_files/media_file-17-1312592262.pdf (Accessed: 30 April 2023). Kathmandu, Nepal: Government of Nepal.
Mughal AY, Devadas J, Ardman E, Levis B, Go VF, Gaynes BN. A systematic review of validated screening tools for anxiety disorders and PTSD in low to middle income countries. BMC Psychiatry. 2020;20(1):338. https://doi.org/10.1186/s12888-020-02753-3 .
doi: 10.1186/s12888-020-02753-3
pubmed: 32605551
pmcid: 7325104
National Statistics Office. (2023). National Population and Housing Census 2021 (Acced through https: http://censusnepal.cbs.gov.np/results/ literacy on 30 April 2023). Kathmandu, Nepal: Government of Nepal, Office of the Prime Minister and Council of Ministers.
Ojha SP, Ma J, Chapagain M, Tulachan P. Emotional and behavioural problems among sheltered homeless children. JNMA J Nepal Med Assoc. 2013;52(191):457–61.
pubmed: 24907950
Paudel S, Gautam H, Adhikari C, Yadav DK. Depression, anxiety and stress among the undergraduate students of Pokhara Metropolitan, Nepal. J Nepal Health Res Counc. 2020;18(1):27–34. https://doi.org/10.33314/jnhrc.v18i1.2189 .
doi: 10.33314/jnhrc.v18i1.2189
pubmed: 32335589
Richardson LP, McCauley E, Grossman DC, McCarty CA, Richards J, Russo JE, Katon W. Evaluation of the Patient Health Questionnaire-9 item for detecting major depression among adolescents. Pediatrics. 2010;126(6):1117–23. https://doi.org/10.1542/peds.2010-0852 .
doi: 10.1542/peds.2010-0852
pubmed: 21041282
Rimal H, Pokharel A. Prevalence of attention deficit hyperactivity disorder among School Children and Associated Co-morbidities - A Hospital based descriptive study. Kathmandu Univ Med J (KUMJ). 2016;14(55):226–30.
pubmed: 28814683
Risal A, Sharma PP. Psychiatric illness in the paediatric population presenting to a psychiatry clinic in a tertiary care centre. Kathmandu Univ Med J (KUMJ). 2010;8(32):375–3981. https://doi.org/10.3126/kumj.v8i4.6235 .
doi: 10.3126/kumj.v8i4.6235
pubmed: 22610765
Sharma V, Levin BL, Rahill GJ, Baldwin JA, Luitel A, Marhefka SL. Post-earthquake self-reported depressive symptoms and post-traumatic stress disorder and their correlates among College-youths in Kathmandu, Nepal. Psychiatr Q. 2021;92(4):1595–609. https://doi.org/10.1007/s11126-021-09928-5 .
doi: 10.1007/s11126-021-09928-5
pubmed: 34109493
pmcid: 8189706
Silwal S, Dybdahl R, Chudal R, Sourander A, Lien L. Psychiatric symptoms experienced by adolescents in Nepal following the 2015 earthquakes. J Affect Disord. 2018;234:239–46. https://doi.org/10.1016/j.jad.2018.03.002 .
doi: 10.1016/j.jad.2018.03.002
pubmed: 29549825
Spitzer RL, Kroenke K, Williams JB, Löwe B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med. 2006;166(10):1092–7. https://doi.org/10.1001/archinte.166.10.1092 .
doi: 10.1001/archinte.166.10.1092
pubmed: 16717171
Steel Z, Chey T, Silove D, Marnane C, Bryant RA, van Ommeren M. Association of torture and other potentially traumatic events with mental health outcomes among populations exposed to mass conflict and displacement: a systematic review and meta-analysis. JAMA. 2009;302(5):537–49. https://doi.org/10.1001/jama.2009.1132 .
doi: 10.1001/jama.2009.1132
pubmed: 19654388
Tele AK, Carvajal-Velez L, Nyongesa V, Ahs JW, Mwaniga S, Kathono J, Kumar M. Validation of the English and Swahili Adaptation of the Patient Health Questionnaire-9 for Use among adolescents in Kenya. J Adolesc Health. 2023;72(1s):S61–70. https://doi.org/10.1016/j.jadohealth.2022.10.003 .
doi: 10.1016/j.jadohealth.2022.10.003
pubmed: 36376148
van Ommeren M, Sharma B, Thapa SB, Makaju R, Prasain D, Bhattarai R, de Jong J. Preparing instruments for Transcultural Research: Use of the translation monitoring form with Nepali-speaking Bhutanese refugees. Transcult Psychiatry. 1999;36(3):285–301. https://doi.org/10.1177/136346159903600304 .
doi: 10.1177/136346159903600304
World Health Organization. (2023). Suicide. Retrieved 24 December 2023, from https://www.who.int/news-room/fact-sheets/detail/suicide .