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Luitel NP, Rimal D, Eleftheriou G, Rose-Clarke K, Nayaju S, Gautam K, Pant SB, Devkota N, Rana S, Chaudhary JM, Gurung BS, Åhs JW, Carvajal-Velez L, Kohrt BA. Translation, cultural adaptation and validation of Patient Health Questionnaire and generalized anxiety disorder among adolescents in Nepal. Child Adolesc Psychiatry Ment Health 2024; 18:74. [PMID: 38898474 PMCID: PMC11188246 DOI: 10.1186/s13034-024-00763-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 06/06/2024] [Indexed: 06/21/2024] Open
Abstract
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 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 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 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.
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Affiliation(s)
- Nagendra P Luitel
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
- Research Department, Transcultural Psychosocial Organization (TPO) Nepal, Baluwatar, Kathmandu, Nepal.
- Center for Global Mental Health Equity, Department of Psychiatry and Behavioural Health, The George Washington University, Washington, D.C, USA.
| | - Damodar Rimal
- Research Department, Transcultural Psychosocial Organization (TPO) Nepal, Baluwatar, Kathmandu, Nepal
| | - Georgia Eleftheriou
- Center for Global Mental Health Equity, Department of Psychiatry and Behavioural Health, The George Washington University, Washington, D.C, USA
| | - Kelly Rose-Clarke
- Department of Global Health and Social Medicine, King's College London, London, UK
| | - Suvash Nayaju
- Research Department, Transcultural Psychosocial Organization (TPO) Nepal, Baluwatar, Kathmandu, Nepal
| | - Kamal Gautam
- Research Department, Transcultural Psychosocial Organization (TPO) Nepal, Baluwatar, Kathmandu, Nepal
- Center for Global Mental Health Equity, Department of Psychiatry and Behavioural Health, The George Washington University, Washington, D.C, USA
| | - Sagun Ballav Pant
- Department of Psychiatry & Mental Health, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Narmada Devkota
- Child and Adolescent Psychiatry Unit, Kanti Children's Hospital, Kathmandu, Nepal
| | - Shruti Rana
- Child and Adolescent Psychiatry Unit, Kanti Children's Hospital, Kathmandu, Nepal
| | - Jug Maya Chaudhary
- Child and Adolescent Psychiatry Unit, Kanti Children's Hospital, Kathmandu, Nepal
| | | | - Jill Witney Åhs
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Liliana Carvajal-Velez
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Division of Data, Analytics, Planning and Monitoring, Data and Analytics Section, UNICEF, New York, New York, USA
| | - Brandon A Kohrt
- Research Department, Transcultural Psychosocial Organization (TPO) Nepal, Baluwatar, Kathmandu, Nepal
- Center for Global Mental Health Equity, Department of Psychiatry and Behavioural Health, The George Washington University, Washington, D.C, USA
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Giri R, Khadka S, Chalise A, Swar K, Paudel S. Depressive symptoms and its associated factors among secondary school adolescents of Birtamod Municipality, Jhapa, Nepal. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002826. [PMID: 38241240 PMCID: PMC10798441 DOI: 10.1371/journal.pgph.0002826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 12/21/2023] [Indexed: 01/21/2024]
Abstract
Depression is a rising public health concern affecting adolescents' mental health throughout the world. This cross-sectional study aimed to assess the prevalence of depressive symptoms and its associated factors among adolescents from urban Nepal. The depressive symptoms among 271 randomly selected secondary school adolescents of Britamod Municipality were assessed using Center for Epidemiologic Studies Depression Scale (CES-D). The chi-square test and multivariable logistic regression were executed to assess the statistical relationship between potential risk factors and depressive symptoms at 5% level of significance. The prevalence of depressive symptoms was 42.8% (95% CI: 37.3-49.1%). Multiple logistic regression revealed that female adolescents (aOR: 2.309, 95% CI: 1.233-4.325), adolescents enrolled in higher grades i.e. 10th grade (aOR: 4.576, 95% CI: 1.482-9.128), studying at private school (aOR: 2.302, 95% CI: 1.184-4.476), not sharing their problems with their friends (aOR: 3.022, 95% CI: 1.477-6.186), presence of perceived academic stress (aOR: 2.388, 95% CI: 1.263-4.518), dissatisfaction with current academic performance (aOR: 2.278, 95% CI: 1.141-4.518), lower perceived family support (aOR: 3.440, 95% CI: 1.276-9.275), and lower self-esteem (aOR: 2.139, 95% CI: 1.061-8.708) had higher odds of experiencing depressive symptoms. There is a high prevalence of depression among Nepalese adolescents. The findings highlight the need for health promotion interventions focusing on mental health awareness, enhancing social support systems, and implementing stress reduction strategies within schools to mitigate the burden of depression among Nepalese adolescents.
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Affiliation(s)
- Rachana Giri
- Department of Public Health, CiST College, Pokhara University, Kathmandu, Nepal
| | - Santosh Khadka
- Department of Public Health, CiST College, Pokhara University, Kathmandu, Nepal
| | - Anisha Chalise
- Center for Research on Environment, Health and Population Activities (CREHPA), Lalitpur, Nepal
| | | | - Shishir Paudel
- Department of Public Health, CiST College, Pokhara University, Kathmandu, Nepal
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Partap U, Nyundo A, Manu A, Regan M, Ismail A, Chukwu A, Dessie Y, Njau T, Kaaya SF, Fawzi WW. Depressive symptoms among adolescents in six sub-Saharan African countries: A pooled analysis of associated factors. Prev Med Rep 2023; 36:102499. [PMID: 38116275 PMCID: PMC10728441 DOI: 10.1016/j.pmedr.2023.102499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 09/23/2023] [Accepted: 11/05/2023] [Indexed: 12/21/2023] Open
Abstract
There is a need to identify risk factors, including nutrition-related factors, for depressive disorders among sub-Saharan African (SSA) adolescents. We examined the association of multiple measures with depressive symptoms among adolescents living across six SSA countries. Building on previous analyses, we used data from a cross-sectional study conducted from 2015 to 2017 among adolescents aged 10-19 years in six SSA countries (N = 7512). Depressive symptoms were defined as highest tertile of the 6-item Kutcher Adolescent Depression Scale score. Using mixed-effects Poisson regression models, we pooled data across sites and examined the association of sociodemographic, nutrition, and other indices with depressive symptoms. We additionally assessed effect modification by sex, age, and school-going status. We observed higher risk of depressive symptoms among girls (adjusted risk ratio [RR]: 1.29, 95 % confidence interval [95 % CI]: 1.05-1.58, P = 0.016), older adolescents (RR for 18-19 years: 1.59, 95 % CI: 1.44-1.76, P < 0.001), and adolescents experiencing bullying (RR: 1.43, 95 % CI: 1.26-1.62, P < 0.001) or violence (RR: 1.34, 95 % CI: 1.24-1.45, P < 0.001). Adolescents experiencing food insecurity also had a higher risk of depressive symptoms (RR: 1.90, 95 % CI: 1.64-2.19, P < 0.001) along with those consuming ≥ 5 servings of fruit and vegetables per day (RR: 1.18, 95 % CI: 1.03-1.34, P = 0.015); conversely, those who consumed grains, roots and tubers in the past day were at decreased risk (RR: 0.73, 95 % CI: 0.69-0.77, P < 0.001). There was no strong evidence of effect modification of associations. This study reinforces the potential role of multiple sociodemographic and nutrition-related measures on risk of depressive symptoms in these populations.
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Affiliation(s)
- Uttara Partap
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Azan Nyundo
- Department of Psychiatry and Mental Health, School of Medicine, University of Dodoma, Dodoma, Tanzania
| | - Adom Manu
- Department of Population, Family and Reproductive Health, School of Public Health, University of Ghana, Accra, Ghana
| | - Mathilda Regan
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Abbas Ismail
- Department of Mathematics and Statistics, University of Dodoma, Dodoma, Tanzania
| | - Angela Chukwu
- Department of Statistics, University of Ibadan, Ibadan, Nigeria
| | - Yadeta Dessie
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Dire Dawa, Ethiopia
| | - Tasiana Njau
- Department of Psychiatry and Mental Health, College of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Sylvia F. Kaaya
- Department of Psychiatry and Mental Health, College of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Wafaie W. Fawzi
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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The prevalence and factors associated with depressive symptoms among tertiary level students in Bangladesh: A survey in Rajshahi district. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2022. [DOI: 10.1016/j.jadr.2022.100445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Hassan E, BK P, Magar J, Luitel N, Kohrt BA, Jordans M, Rose-Clarke K. Community perspectives on the implementation of a group psychological intervention for adolescents with depression: A qualitative study in rural Nepal. Front Psychiatry 2022; 13:949251. [PMID: 36339866 PMCID: PMC9634215 DOI: 10.3389/fpsyt.2022.949251] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 08/05/2022] [Indexed: 11/25/2022] Open
Abstract
Group-based psychological interventions could help to close the treatment gap for depression in low-resource settings, but implementation barriers exist. In Nepal we sought community members' perspectives on how to implement group interpersonal therapy for adolescents. We conducted qualitative interviews with 25 adolescents with depression (aged 13-18) and seven health and non-governmental organization workers, and four focus groups with non-depressed adolescents, four with parents/guardians, and two with teachers (126 participants total). Data were analyzed using the Framework Method. Participants recommended same-sex groups. School was the preferred location because it is accessible for adolescents and acceptable to parents. Adolescents wanted facilitators from their own community with good communication skills. They did not want parents or teachers to participate in groups but emphasized the need to inform parents and obtain their permission. Community members supported group psychological intervention. School-based psychological interventions facilitated by local people could be an acceptable option in rural Nepal.
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Affiliation(s)
- Eliz Hassan
- Department of Global Health and Social Medicine, King's College London, London, United Kingdom
| | - Prakash BK
- Transcultural Psychosocial Organization Nepal, Kathmandu, Nepal
| | - Jananee Magar
- Transcultural Psychosocial Organization Nepal, Kathmandu, Nepal
| | - Nagendra Luitel
- Transcultural Psychosocial Organization Nepal, Kathmandu, Nepal
| | - Brandon A. Kohrt
- Duke Global Health Institute, Duke University, Durham, NC, United States
| | - Mark Jordans
- Department of Global Health and Social Medicine, King's College London, London, United Kingdom
| | - Kelly Rose-Clarke
- Department of Global Health and Social Medicine, King's College London, London, United Kingdom
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Sleep Quality and Its Correlates among Adolescents of Western Nepal: A Population-Based Study. SLEEP DISORDERS 2021; 2021:5590715. [PMID: 34055416 PMCID: PMC8143896 DOI: 10.1155/2021/5590715] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 04/20/2021] [Accepted: 05/04/2021] [Indexed: 11/18/2022]
Abstract
Sleep quality has a long-term impact on health leading to depression among adolescent students. We conducted a cross-sectional study to assess the prevalence of sleep quality and its associated factors among adolescents of western, Nepal. 514 adolescents from different schools were selected by the probability proportionate to size (PPS) method. The Pittsburgh Sleep Quality Index (PSQI) was used to assess the sleep quality among adolescents. The collected data were entered in EpiData 3.2 version, then extracted to excel 2019 and was analyzed with the help of RStudio (version 1.2.5033). Frequency distribution and percentage were identified as descriptive analysis whereas chi-square test was done. Variables that were found statistically significant (P < 0.05) were further analyzed using the logistic regression model. The prevalence of sleep quality in this study was 39.1%. In a bivariate analysis, ethnicity, religion, place of residence, drinking status of father, reason for selecting the currently studying faculty, satisfaction with academic performance, use of tobacco, relationship with friends or classmates, more use of internet per day, and use of internet before falling asleep were found to be statistically significant with sleep quality. Those students who left their home without informing their parents were more than three times at the risk of sleep quality than those students who never ran away from their home without informing their parents (AOR = 3.435, CI: 1.237-9.540). The overall prevalence of sleep quality among school going adolescent students was 39.1 percent which was comparatively high.
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Linkage of Depression with Elder Abuse among Institutionalized Older Persons in Kathmandu Valley, Nepal. PSYCHIATRY JOURNAL 2021; 2021:5546623. [PMID: 34007844 PMCID: PMC8102113 DOI: 10.1155/2021/5546623] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 04/19/2021] [Accepted: 04/21/2021] [Indexed: 11/18/2022]
Abstract
Background To identify the association between elderly abuse and depression among elderly living in old age homes of Kathmandu Valley, Nepal. Materials and Methods A cross-sectional study was carried out in 5 old age homes of Kathmandu Valley, Nepal. The Geriatric Mistreatment Scale and the Geriatric Depression Scale were used to collect information from 220 elderly aged 65 or above, and face-to-face interviews were conducted. Bivariate and multivariate logistic regression analyses were carried out to identify the association between elderly abuse and geriatric depression. Results Among the different types of abuse analyzed, the multivariate analysis showed that neglect (AOR = 2.995; CI: 1.249-7.181) and economical abuse (AOR = 4.728, CI: 1.836-12.173) were significantly associated with increased risk of geriatric depression. Furthermore, the study identified that future saving and absence of chronic disease significantly reduced the risk of psychological abuse, neglect, and geriatric depression. Conclusions Neglect and economical abuse are a predictor of geriatric depression. Efforts should be directed to increase awareness about the different forms of abuse among the primary caregivers of the elderly. Counseling services and support programs should be introduced in old age homes to address the high burden of geriatric depression.
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