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Kristófersdóttir KH, Kristjánsdóttir H, Asgeirsdottir RL, Karlsson T, Vésteinsdóttir V, Thorsdottir F. Investigating the PHQ-9 With Mokken Scale Analysis and Cognitive Interviews. Assessment 2024; 31:1332-1355. [PMID: 38159031 DOI: 10.1177/10731911231216961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
Scores on the Patient Health Questionnaire-9 (PHQ-9) are frequently used to assess depression both in research and in clinical practice. The aim was to examine the validity of the PHQ-9 sum score by using Mokken scale analysis (Study I) and cognitive interviews (Study II) on the Icelandic version of PHQ-9. A primary care sample of 618 individuals was used in Study I. The results indicate that the PHQ-9 items are not close enough to perfectly unidimensional for their sum score to accurately order people on the depression severity dimension. In Study II, the sample consisted of 53 individuals, with 28 having a history of depression and 25 not. The findings reveal a number of issues concerning respondents' use of the PHQ-9. No systematic differences were found in the results of the two groups. The PHQ-9 sum score should thus be interpreted and used with great care. We provide scale revision recommendations to improve the quality of PHQ-9.
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Lovero KL, Stockton MA, Greene MC, Basaraba C, Khan S, Mabunda D, Mandlate F, Gouveia L, Fumo W, Wall MM, Duarte CS, Oquendo MA, Wainberg ML. Psychometric Evaluation of Screens for Common Mental Disorders, Severe Mental Disorders, Substance Use Disorders, and Suicide Risk in Mozambican Healthcare. MEDICAL RESEARCH ARCHIVES 2024; 12. [PMID: 39268201 PMCID: PMC11391859 DOI: 10.18103/mra.v12i8.5294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/15/2024]
Abstract
Globally, mental and substance use disorders are a leading cause of disease burden. In low- and middle-income countries, where there is an extreme shortage of trained mental health specialists, validated, brief screening tools for mental and substance use disorders are required for non-specialists to efficiently identify patients in need of mental health care. Mozambique, one of the poorest countries in the world, has fewer than two mental health specialists for every 100,000 people. In the present study, we evaluated a comprehensive set of seven measures for depression, anxiety, somatization, alcohol use disorder, substance use disorder, psychosis and mania, and suicide risk among N=911 Mozambican adults in general healthcare settings. All instruments demonstrated acceptable internal consistency (α > 0.75). Compared to diagnoses made by the Mini International Neuropsychiatric Interview, all measures showed good criterion validity (AUC > 0.75), except the Psychosis Screening Questionnaire, which showed low sensitivity (0.58) for psychotic disorder. No substantial differences were observed in internal consistency when stratifying by gender, age, education level, primary language, facility-type, and patient status; criterion validity showed some variability when stratified by sub-population, particularly for education, primary language, and whether the participant was seeking care that day. Exploratory factor analyses indicated that the measures best differentiate categories of diagnoses (common mental disorder, severe mental disorders, substance use disorders, and suicide risk) rather than individual diagnoses, suggesting the utility of a transdiagnostic approach. Our findings support the use of these measures in Mozambique to identify common mental disorders, substance use disorders, and suicide risk, but indicate further research is needed to develop an adequate screen for severe mental disorders. Given the limited mental health specialists in this and other LMIC settings, these brief measures can support non-specialist provision of mental health services and promote closure of the treatment gap.
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Affiliation(s)
- Kathryn L Lovero
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, USA
| | - Melissa A Stockton
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, USA
| | - M Claire Greene
- Program on Forced Migration and Health, Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, USA
| | - Cale Basaraba
- Department of Population Health, Grossman School of Medicine, New York University
| | - Saida Khan
- Department of Mental Health, Ministry of Health, Maputo, Mozambique
| | - Dirceu Mabunda
- Department of Mental Health, Ministry of Health, Maputo, Mozambique
| | - Flavio Mandlate
- Department of Mental Health, Ministry of Health, Maputo, Mozambique
| | - Lidia Gouveia
- Department of Mental Health, Ministry of Health, Maputo, Mozambique
| | - Wilza Fumo
- Department of Mental Health, Ministry of Health, Maputo, Mozambique
| | - Melanie M Wall
- Department of Psychiatry, New York State Psychiatric Institute and Columbia University Vagelos College of Physicians and Surgeons, New York, USA
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York, USA
| | - Cristiane S Duarte
- Department of Psychiatry, New York State Psychiatric Institute and Columbia University Vagelos College of Physicians and Surgeons, New York, USA
| | - Maria A Oquendo
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, USA
| | - Milton L Wainberg
- Department of Psychiatry, New York State Psychiatric Institute and Columbia University Vagelos College of Physicians and Surgeons, New York, USA
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Manafe N, Ismael-Mulungo H, Ponda F, Dos Santos PF, Mandlate F, Cumbe VFJ, Mocumbi AO, Oliveira Martins MR. Prevalence and associated factors of common mental disorders among internally displaced people by armed conflict in Cabo Delgado, Mozambique: a cross-sectional community-based study. Front Public Health 2024; 12:1371598. [PMID: 38689772 PMCID: PMC11058794 DOI: 10.3389/fpubh.2024.1371598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 03/27/2024] [Indexed: 05/02/2024] Open
Abstract
Background Humanitarian emergencies are a major global health challenge with the potential to have a profound impact on people's mental and psychological health. Displacement is a traumatic event that disrupts families and affects physical and psychological health at all ages. A person may endure or witness a traumatic incident, such as being exposed to war, and, as a result, develop post-traumatic stress disorder (PTSD). There is a lack of information about post-traumatic stress disorder, depression, and anxiety disorder in low and middle-income countries in humanitarian emergency contexts such as Mozambique. This study aimed to assess the prevalence of PTSD, depression, and anxiety, and associated factors among armed conflict survivors in Cabo Delgado, north region of Mozambique in 2023. Methods A community-based cross-sectional study was conducted between January and April 2023 among 750 participants, who were selected by convenience. A face-to-face interview used the Primary Care Post-Traumatic Stress Disorder Checklist (PC-PTSD-5) to evaluate PTSD, the Generalized Anxiety Disorder Scale (GAD-7) to evaluate anxiety and the Patient Health Questionnaire - Mozambique (PHQ-9 MZ) to evaluate depression. The association between PTSD and demographic and psychosocial characteristics was analyzed using bivariate and multivariable binary logistic regression. We used a 5% significance level. Results The three mental disorders assessed were highly prevalent in our sample with 74.3% PTSD, 63.8% depression, and 40.0% anxiety. The chance of developing PTSD was higher in females (AOR = 2.30, 95% CI 1.50-3.51), in patients with depression symptoms (AOR = 8.27, 95% CI = 4.97-13.74) and anxiety symptoms (AOR = 1.45, 95% CI = 0.84-2.50). Conclusion This study reported that the prevalence of PTSD, depression, and anxiety were high. Patients having depressive symptoms, anxiety symptoms, and being female are more at risk of developing PTSD. There is a need to integrate screening for common mental disorders in the context of humanitarian emergencies and its adapted integration of psychosocial interventions.
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Affiliation(s)
- Naisa Manafe
- Instituto Nacional de Saúde, Maputo, Mozambique
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisbon, Portugal
| | | | - Fábio Ponda
- Instituto Nacional de Saúde, Maputo, Mozambique
| | | | - Flávio Mandlate
- Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Vasco F. J. Cumbe
- Mental Health Department, Ministry of Health, Provincial Health Directorate of Sofala, Beira, Mozambique
| | - Ana Olga Mocumbi
- Instituto Nacional de Saúde, Maputo, Mozambique
- Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Maria R. Oliveira Martins
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisbon, Portugal
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Giusto A, Romer A, Lovero K, dos Santos PF, Greene C, Gouveia L, Suleman A, Feliciano P, Oquendo MA, Mootz J, Wainberg ML. Examination of the Factor Structure of Psychopathology in a Mozambican Sample. Clin Psychol Sci 2023; 11:409-424. [PMID: 37181407 PMCID: PMC10181828 DOI: 10.1177/21677026221122773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Factor-analytic studies are needed in global samples to advance understanding of psychopathology. We aimed to examine the structure of psychopathology and a general psychopathology ('p') factor using data from a cross-sectional study of 971 adults (63% women) from Maputo City, Mozambique. We used confirmatory factor analyses of symptoms from 15 psychiatric disorders to test common models of the structure of psychopathology. Models including internalizing, substance use, and thought disorder factors as well as a general p-factor fit the data well. Measurement invariance testing revealed that factor loadings on p differed by gender. Higher levels of p, internalizing, and thought disorder factors were associated with greater suicide risk, psychiatric comorbidity, chronic medical illnesses, and poorer functioning. A general psychopathology ('p') factor and internalizing, substance use, and thought disorder factors are identifiable in this Mozambican sample. Understanding psychopathology dimensions is a step toward building more scalable mental health service approaches globally.
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Affiliation(s)
- Ali Giusto
- Department of Psychiatry, New York State Psychiatric Institute and Columbia University Vagelos College of Physicians and Surgeons, 1051 Riverside Dr. Unit #24, New York, New York, USA
| | - Adrienne Romer
- Center for Depression, Anxiety and Stress Research, McLean Hospital, Belmont, MA, USA
- Harvard Medical School, Belmont, MA, USA
| | - Kathryn Lovero
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Palmira Fortunado dos Santos
- Department of Mental Health, Ministry of Health, Av. Eduardo Mondlane/Av. Salvador Allende P.O. Box 1613, Maputo, Mozambique
| | - Claire Greene
- Program on Forced Migration and Health, Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Lidia Gouveia
- Department of Mental Health, Ministry of Health, Av. Eduardo Mondlane/Av. Salvador Allende P.O. Box 1613, Maputo, Mozambique
| | - Antonio Suleman
- Department of Mental Health, Ministry of Health, Av. Eduardo Mondlane/Av. Salvador Allende P.O. Box 1613, Maputo, Mozambique
| | - Paulino Feliciano
- Department of Mental Health, Ministry of Health, Av. Eduardo Mondlane/Av. Salvador Allende P.O. Box 1613, Maputo, Mozambique
| | - Maria A. Oquendo
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street Suite 200, Philadelphia, Pennsylvania, USA
| | - Jennifer Mootz
- Department of Psychiatry, New York State Psychiatric Institute and Columbia University Vagelos College of Physicians and Surgeons, 1051 Riverside Dr. Unit #24, New York, New York, USA
| | - Milton L. Wainberg
- Department of Psychiatry, New York State Psychiatric Institute and Columbia University Vagelos College of Physicians and Surgeons, 1051 Riverside Dr. Unit #24, New York, New York, USA
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Muanido A, Cumbe V, Manaca N, Hicks L, Fabian KE, Wagenaar BH. Prevalence and associated factors of common mental disorders in primary care settings in Sofala Province, Mozambique. BJPsych Open 2023; 9:e12. [PMID: 36632814 PMCID: PMC9885355 DOI: 10.1192/bjo.2022.613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 10/21/2022] [Accepted: 11/05/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND In Mozambique, the prevalence of common mental illness in primary care is not well established. AIMS This study aimed to assess the prevalence of, and associated factors for, common mental illness in patients accessing primary care services in three Ministry of Health clinics in Mozambique. METHOD Adult patients were recruited from the waiting rooms of prenatal, postpartum and general out-patient consultations. A mental health professional administered a diagnostic interview to examine prevalence of major depressive disorder (MDD), generalised anxiety disorder (GAD), post-traumatic stress disorder (PTSD) and any substance misuse or dependence. Generalised linear mixed models were used to examine the odds of each disorder and sociodemographic associations. RESULTS Of 502 patients interviewed, 74.1% were female (n = 372) and the average age was 27.8 years (s.d. = 7.4). Of all participants, 23.9% (n = 120) met diagnostic criteria for at least one common mental disorder; 8.6% were positive for MDD (n = 43), 13.3% were positive for GAD (n = 67), 4.8% were positive for PTSD (n = 24) and 4.0% were positive for any substance misuse or dependence (n = 20). Patients attending prenatal or postpartum consultations had significantly lower odds of any common mental disorder than patients attending out-patient primary care. Age was negatively associated with MDD, but positively associated with substance misuse or dependence. CONCLUSIONS Over 20% of patients attending primary care in Mozambique may have common mental disorders. A specific focus on patients attending general out-patient visits, young people for depression, and older people and men for substance misuse/dependence would provide a targeted response to high-risk demographics.
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Affiliation(s)
| | - Vasco Cumbe
- Sofala Provincial Health Directorate, Department of Mental Health, Ministry of Health, Mozambique
| | | | - Lee Hicks
- Health Alliance International, Washington, USA
| | - Katrin E. Fabian
- Department of Global Health, University of Washington, Washington, USA
| | - Bradley H. Wagenaar
- Health Alliance International, Washington, USA; Department of Global Health, University of Washington, Washington, USA; and Department of Epidemiology, University of Washington, Washington, USA
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Rakshasa-Loots AM, Hamana T, Fanqa B, Lindani F, van Wyhe K, Kruger S, Laughton B. isiXhosa translation of the Patient Health Questionnaire (PHQ-9) shows satisfactory psychometric properties for the measurement of depressive symptoms [Stage 2]. Brain Neurosci Adv 2023; 7:23982128231194452. [PMID: 37667732 PMCID: PMC10475240 DOI: 10.1177/23982128231194452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 07/25/2023] [Indexed: 09/06/2023] Open
Abstract
Depression is a debilitating illness, and stigma associated with it often prevents people from seeking support. Easy-to-administer and culturally- inclusive tools can allow for early screening for depressive symptoms in primary care clinics, especially in resource-limited settings. In this pre-registered pilot study (Stage 1 Report available at DOI: 10.3389/fpsyt.2022.840912), we produced an open-access isiXhosa-language version of the nine-item Patient Health Questionnaire (PHQ-9), a well-validated measure of depression incidence and severity, using a transcultural translation framework. We validated this isiXhosa PHQ-9 in a sample of N = 47 adolescents living with and without HIV in Cape Town, South Africa who speak isiXhosa at home. Reliability, convergent validity, and criterion validity were assessed, with T scores on the Achenbach System of Empirically Based Assessment Youth Self Report (YSR) form completed previously as reference standard. Our isiXhosa PHQ-9 exhibited satisfactory reliability, with Cronbach's α = 0 . 866 , inter-item correlations ranging from 0.229 to 0.730, and mean item-total correlation of 0.69. PHQ-9 score and Withdrawn/Depressed component T scores on the Youth Self Report were moderately associated (Spearman's ρ = 0 . 40 , p = 0 . 011 ) , indicating acceptable convergent validity. The isiXhosa PHQ-9 showed satisfactory criterion validity (area under the receiver operating characteristic curve, AUC = 0.706), but these analyses were under-powered. Principal component analysis revealed a one-factor solution, with 45.8% of variance explained by the first principal component and all factor loadings above conventional thresholds. Our isiXhosa translation of the PHQ-9 thus exhibited satisfactory psychometric properties in this pilot validation study and performed comparably to other PHQ-9 versions validated in different languages in African and global contexts. This questionnaire may serve as an invaluable culturally-inclusive screening tool for measuring depressive symptoms among isiXhosa speakers. Caution must be exercised as screening tools including the PHQ-9 may over- or under-estimate prevalence of depression. Further validation in larger, independent cohorts may enable wider use of our isiXhosa PHQ-9 as a screening tool in clinics, research studies, and mental health non-profits who serve amaXhosa.
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Affiliation(s)
- Arish Mudra Rakshasa-Loots
- Family Centre for Research with Ubuntu (FAMCRU), Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
- Edinburgh Neuroscience, School of Biomedical Sciences, College of Medicine & Veterinary Medicine, The University of Edinburgh, Edinburgh, UK
| | - Thandi Hamana
- Family Centre for Research with Ubuntu (FAMCRU), Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
- Division of Biomedical Engineering, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Busiswa Fanqa
- Family Centre for Research with Ubuntu (FAMCRU), Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | - Filicity Lindani
- Family Centre for Research with Ubuntu (FAMCRU), Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | - Kaylee van Wyhe
- Family Centre for Research with Ubuntu (FAMCRU), Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
- ACSENT Laboratory, Department of Psychology, University of Cape Town, Cape Town, South Africa
| | - Sharon Kruger
- Family Centre for Research with Ubuntu (FAMCRU), Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | - Barbara Laughton
- Family Centre for Research with Ubuntu (FAMCRU), Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
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Iheanacho T, Maciejewski KR, Ogudebe F, Chumo F, Slade T, Leff R, Ngaruiya C. Prevalence and correlates of depression and substance use disorders in emergency department populations: A cross-sectional study at East Africa's largest public hospital. Afr J Emerg Med 2022; 12:307-314. [PMID: 35892005 PMCID: PMC9307521 DOI: 10.1016/j.afjem.2022.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 04/25/2022] [Accepted: 06/21/2022] [Indexed: 11/24/2022] Open
Abstract
Introduction There are persistent gaps in screening, identification, and access to care for common mental disorders in Low- and Middle-Income Countries. An initial step towards reducing this gap is identifying the prevalence, co-morbidities, and context of these disorders in different clinical settings and exploring opportunities for intervention. This study evaluates the prevalence and correlates of depression and substance use disorders among adults presenting to the Emergency Department (ED) of a major national hospital in East Africa. Methods This study utilized the World Health Organization's STEPwise Approach to Surveillance (WHO-STEPS) tool and the Patient Health Questionnaire (PHQ-9) to conduct a cross-sectional survey capturing socio-demographic data, tobacco, and alcohol use and rates of depression in a sample of adults presenting to the ED. Bivariate and multivariate analyses were conducted for each outcome of interest and socio-demographics. Results Of 734 respondents, 298 (40.6%) had a PHQ-9 score in the "moderate" to "severe" range indicative of major depressive disorder. About 17% of respondents endorsed current tobacco use while about 30% reported being daily alcohol users. Those with high PHQ-9 score had higher odds of reporting current tobacco use ("severe range" = adjusted odds ratio (aOR) 1.85, 95% CI 1.05, 3.26). Those with a "severe" PHQ-9 scores were 9 times (aOR 2.3-35.3) more likely to be daily drinkers. Conclusions Screening and identification of people with depression and substance use disorders in the ED of a large national hospital in Kenya is feasible. This offers an opportunity for brief intervention and referral to further treatment.
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Affiliation(s)
- Theddeus Iheanacho
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- Corresponding author.
| | - Kaitlin R. Maciejewski
- Yale Center for Analytical Sciences, Yale University School of Public Health, New Haven, CT, USA
| | | | - Faith Chumo
- Department of History of Science, Medicine and Public Health, Yale College, New Haven, CT, USA
| | - Tracie Slade
- Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Rebecca Leff
- Department of Emergency Medicine, Mayo Clinic, Rochester, MN, USA
| | - Christine Ngaruiya
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT, USA
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Beswick E, Quigley S, Macdonald P, Patrick S, Colville S, Chandran S, Connick P. The Patient Health Questionnaire (PHQ-9) as a tool to screen for depression in people with multiple sclerosis: a cross-sectional validation study. BMC Psychol 2022; 10:281. [PMID: 36443880 PMCID: PMC9706934 DOI: 10.1186/s40359-022-00949-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 07/11/2022] [Accepted: 07/25/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Depression has a point prevalence of 25% and lifetime prevalence of 50% in people with multiple sclerosis (pwMS). Due to accessibility and brevity, the 9-item Patient Health Questionnaire (PHQ-9) may be a useful tool in clinical practice for screening and monitoring of depressive symptoms in people with MS (pwMS). METHODS The objective of this study was to evaluate the reliability, validity and acceptability of the PHQ-9 as a screening tool for depressive symptoms in pwMS. PwMS completed online questionnaires at 3 time-points over 4-weeks. The PHQ-9, Multiple Sclerosis Impact Scale (MSIS-29), Centre for Disease Control Health-Related Quality of Life Measure (CDC-HQOL-4) and clinical history. RESULTS 103 participants completed the PHQ-9 at three time points, 43% were categorised as depressed on at least one response. The PHQ-9 exhibited high internal reliability (Cronbach's α = 0.89), and test-re-test agreement (ICC 0.89, 95% CI 0.85-0.91). Convergent validity was indicated through positive correlation with the mental health items on the MSIS-29 (r = 0.46 and r = 0.50) and CDC-HQOL-4 (r = 0.79 and r = 0.73) at both assessment points. Positive correlations between the PHQ-9 and the MSIS-29 (r = 0.86 and r = 0.84) and CDC-HQOL-4 (r = 0.55 and r = 0.37) physical symptom sub-scores did not indicate divergent validity. 93% of ratings evaluated the PHQ-9 as "Very" or "Completely" acceptable. CONCLUSION The PHQ-9 is a reliable and valid measure of depressive symptoms in people with MS. Given its accessibility, ease of administration, and acceptability, we recommend the PHQ-9 as a tool to screen for depressive symptoms in people with MS.
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Affiliation(s)
- Emily Beswick
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, Scotland.,Anne Rowling Regenerative Neurology Clinic, The University of Edinburgh, Edinburgh, Scotland
| | - Suzanne Quigley
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, Scotland.,Anne Rowling Regenerative Neurology Clinic, The University of Edinburgh, Edinburgh, Scotland
| | - Pamela Macdonald
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, Scotland.,Anne Rowling Regenerative Neurology Clinic, The University of Edinburgh, Edinburgh, Scotland
| | - Sarah Patrick
- The School of Medicine & Veterinary Medicine, The University of Edinburgh, Edinburgh, Scotland.,West Scotland Deanery Foundation Programme, NHS Education for Scotland Trainee, Edinburgh, Scotland
| | - Shuna Colville
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, Scotland.,Anne Rowling Regenerative Neurology Clinic, The University of Edinburgh, Edinburgh, Scotland
| | - Siddharthan Chandran
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, Scotland.,Anne Rowling Regenerative Neurology Clinic, The University of Edinburgh, Edinburgh, Scotland
| | - Peter Connick
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, Scotland. .,Anne Rowling Regenerative Neurology Clinic, The University of Edinburgh, Edinburgh, Scotland.
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Cumbe VFJ, Greene C, Fumo AMT, Fumo H, Mabunda D, Gouveia LC, Oquendo MA, Duarte CS, Sidat M, Mari JDJ. Community Health Workers' Knowledge, Attitudes, and Practices towards Epilepsy in Sofala, Central Mozambique. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15420. [PMID: 36430139 PMCID: PMC9693375 DOI: 10.3390/ijerph192215420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 07/22/2022] [Accepted: 07/26/2022] [Indexed: 05/14/2023]
Abstract
BACKGROUND Epilepsy is the most common neurological disease in the world, affecting 50 million people, with the majority living in low- and middle-income countries (LMICs). A major focus of epilepsy treatment in LMICs has been task-sharing the identification and care for epilepsy by community health workers (CHWs). The present study aimed to assess the knowledge, attitudes, and practices (KAPs) of CHWs towards epilepsy in Mozambique. METHODS One hundred and thirty-five CHWs completed a questionnaire that included socio-demographic characteristics and 44-items divided into six subscales pertaining to KAPs towards epilepsy (QKAP-EPI) across nine districts of Sofala, Mozambique. The internal consistency was examined to evaluate the reliability of the instrument (QKAP-EPI). The association between sociodemographic variables and QKAP-EPI subscales was examined using linear regression models. RESULTS The internal consistency was moderate for two subscales (causes of epilepsy, α = 0.65; medical treatment, α = 0.694), acceptable for cultural treatment (α = 0.797) and excellent for 2 subscales (safety and risks, α = 0.926; negative attitudes, α = 0.904). Overall, CHWs demonstrated accurate epilepsy knowledge (medical treatment: mean = 1.63, SD = 0.28; safety/risks: mean = 1.62, SD = 0.59). However, CHWs reported inaccurate epilepsy knowledge of the causes, negative attitudes, as well as culturally specific treatments for epilepsy, such as: "if a person with epilepsy burns when set on fire they cannot be treated". Knowledge about how to manage epileptic seizures varied across the different emergency care practices, from the accurate belief that it is not advisable to place objects in the individual's mouth during an epileptic seizure, to the wrong perception of the need to hold the person in seizures to control seizures. Heterogeneity in the level of epilepsy knowledge was observed among CHWs, when considering epilepsy according to the local names as treatable ("Dzumba") and other forms as untreatable ("Nzwiti"). CONCLUSION CHWs knowledge of medical treatment and epilepsy safety/risks were adequate. However, information on the causes of epilepsy, stigmatizing attitudes, cultural treatment, and some knowledge of epileptic seizure management were low. These areas of poor knowledge should be the focus of educating CHWs in increasing their ability to provide quality care for patients with epilepsy in Mozambique.
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Affiliation(s)
- Vasco Francisco Japissane Cumbe
- Mental Health Department, Ministry of Health, Provincial Health Directorate of Sofala, Beira 543, Mozambique
- Mental Health and Psychiatry Department, Faculty of Medicine, Eduardo Mondlane University (UEM), Maputo 257, Mozambique
- Medicine Department, Psychiatry and Mental Health Service, Beira Central Hospital, Sofala 1613, Mozambique
- Departamento de Psiquiatria, Escola Paulista de Medicina, Universidade Federal de São Paulo, UNIFESP, São Paulo 04017-030, Brazil
| | - Claire Greene
- Program on Forced Migration and Health, Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, NY 10032, USA
| | - Afonso Mazine Tiago Fumo
- Medicine Department, Psychiatry and Mental Health Service, Beira Central Hospital, Sofala 1613, Mozambique
- Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo (USP), São Paulo 05403-903, Brazil
| | - Hélder Fumo
- Mental Health Department, Ministry of Health, Provincial Health Directorate of Sofala, Beira 543, Mozambique
| | - Dirceu Mabunda
- Mental Health and Psychiatry Department, Faculty of Medicine, Eduardo Mondlane University (UEM), Maputo 257, Mozambique
- Departamento de Psiquiatria, Escola Paulista de Medicina, Universidade Federal de São Paulo, UNIFESP, São Paulo 04017-030, Brazil
- Service of Psychiatry and Mental Health, Mavalane General Hospital, Maputo 7981000, Mozambique
| | - Lídia Chaúque Gouveia
- Mental Health and Psychiatry Department, Faculty of Medicine, Eduardo Mondlane University (UEM), Maputo 257, Mozambique
- Departamento de Psiquiatria, Escola Paulista de Medicina, Universidade Federal de São Paulo, UNIFESP, São Paulo 04017-030, Brazil
- Department of Mental Health, Directorate of Public Health, Ministry of Health, Maputo 264, Mozambique
| | - Maria A. Oquendo
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Cristiane S. Duarte
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
| | - Mohsin Sidat
- Department of Community Health, Faculty of Medicine, Eduardo Mondlane University (UEM), Maputo 257, Mozambique
| | - Jair de Jesus Mari
- Departamento de Psiquiatria, Escola Paulista de Medicina, Universidade Federal de São Paulo, UNIFESP, São Paulo 04017-030, Brazil
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10
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Lovero KL, Adam SE, Bila CE, Canda ED, Fernandes ME, Rodrigues TIB, Sander MCT, Mellins CA, Duarte CS, Dos Santos PF, Wainberg ML. Validation of brief screening instruments for internalizing and externalizing disorders in Mozambican adolescents. BMC Psychiatry 2022; 22:549. [PMID: 35962378 PMCID: PMC9373392 DOI: 10.1186/s12888-022-04189-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Accepted: 07/18/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Mental disorders are the leading cause of disability for youth worldwide. However, there is a dearth of validated, brief instruments to assess mental health in low- and middle-income countries (LMIC). We aimed to facilitate identification of mental disorders in LMIC contexts by adapting and validating measures of internalizing and externalizing disorders for adolescents in Mozambique, an LMIC in southeastern Africa. METHODS We selected instruments with good support for validity in high-income and other LMIC settings: the Patient Health Questionnaire Adolescent (PHQ-A), Generalized Anxiety Disorders 7 (GAD-7), and Strengths and Difficulties Questionnaire (SDQ). Instruments were adapted by local and international mental health specialists followed by cognitive interviews (n = 48) with Mozambican adolescents. We administered the instruments along with the Miniature International Neuropsychiatric Interview for Children and Adolescents (MINI-KID)to 485 adolescents aged 12-19 years attending two secondary schools in Maputo City, Mozambique. One week later, we re-administered instruments to a randomly selected sample of 49 adolescents. RESULTS Participants were 66.2% (n = 321) female and the average age was 15.9 (S.D = 1.7).Internal consistency (alpha = 0.80, PHQ-A; 0.84, GAD-7; 0.80, SDQ) and test-retest reliabilty (ICC = 0.74, PHQ-A; 0.70, GAD-7; 0.77, SDQ) were acceptabe for the PHQ-A, GAD-7, and the full SDQ. The SDQ internalizing subscale showed poor test-retest reliability (ICC = 0.63) and the SDQ externalizing subscale showed poor internal consistency (alpha = 0.65). All instruments demonstrated good sensitivity and specificity (> 0.70). Youden's index identified optimal cutoff scores of 8 for the PHQ-A, 5 for the GAD-7, 10 for the SDQ internalizing and 9 for the SDQ externalizing subscales, though a range of scores provided acceptable sensitivity and specificity. CONCLUSIONS Our data supports reliability and validity of the PHQ-A, GAD-7, and SDQ instruments for rapidly assessing mental health problems in Mozambican adolescents. Use of these tools in other contexts with limited specialists may asist with expanding mental health assessment. Specific instrument and cutoff selection should be based on screening goals, treatment resources, and program objectives.
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Affiliation(s)
- Kathryn L Lovero
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, 722 W. 168th St. 9th Floor, New York, NY, 10032, USA.
| | | | | | - Elda D Canda
- Department of Mental Health, Ministry of Health, Maputo, Mozambique
| | | | | | - Mariel C Tai Sander
- Department of Psychiatry, New York State Psychiatric Institute and Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Claude A Mellins
- Department of Psychiatry, New York State Psychiatric Institute and Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
- HIV Center for Clinical and Behavioral Health, Department of Psychiatry, New York State Psychiatric Institute and Columbia University, New York, NY, USA
| | - Cristiane S Duarte
- Department of Psychiatry, New York State Psychiatric Institute and Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | | | - Milton L Wainberg
- Department of Psychiatry, New York State Psychiatric Institute and Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
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11
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Cumbe VFJ, Manaca MN, Atkins DL, Muanido A, Hicks L, Oquendo MA, de Jesus Mari J, Wagenaar BH. Prevalence and correlates of suicidal behavior in primary care settings in Mozambique. BMC Psychiatry 2022; 22:423. [PMID: 35739519 PMCID: PMC9218046 DOI: 10.1186/s12888-022-04059-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 06/13/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND This study assessed the prevalence of suicidal behavior and associated risk factors in public primary health care in Mozambique. METHODS The Mini International Neuropsychiatric Interview was used to evaluate suicidal behavior among 502 adults attending three Primary Health Care (PHC) settings. RESULTS In the past month, 13% (n = 63) of PHC attendees expressed suicidal ideation, 8% (n = 40) had made a suicide plan, 4% (n = 20) had made a suicide attempt, and 5% (n = 25) reported a lifetime suicide attempt. Females had 2.8-fold increased odds of suicide plan (95% CI: 1.5, 5.5) and 3.3-fold increased odds of suicide attempt in the past month (95% CI: 1.2, 9.1). Each 10-year increase in age was associated with 0.61-fold the odds of suicide plan (95% CI: 0.38, 0.98) and 0.09-fold the odds of suicide attempt (95% CI: 0.01, 0.69) in the past month. People living with HIV (PLWHA) had 2.2-fold increased adjusted odds of past month suicide attempt (CI: 1.1, 4.1). CONCLUSION Suicidal behaviors are common among adults attending PHC clinics in Mozambique. Screening and linkage to effective preventive interventions are urgently needed in PHC settings. Females, younger individuals, and PLWHA are at elevated risk for suicidal behavior in PHC.
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Affiliation(s)
- Vasco F. J. Cumbe
- grid.415752.00000 0004 0457 1249Mental Health Department, Ministry of Health, Provincial Health Directorate of Sofala, Beira, Mozambique ,grid.8295.60000 0001 0943 5818Mental Health and Psychiatry Department, Faculty of Medicine, Eduardo Mondlane University (UEM), Maputo, Mozambique ,Medicine Department, Psychiatry and Mental Health Service, Beira Central Hospital, Sofala, Beira, Mozambique ,grid.411249.b0000 0001 0514 7202Departamento de Psiquiatria, Escola Paulista de Medicina, Universidade Federal de São Paulo, UNIFESP, São Paulo, Brazil
| | | | - Dana L. Atkins
- grid.34477.330000000122986657Department of Global Health, University of Washington, Seattle, WA USA
| | | | | | - Maria A. Oquendo
- grid.25879.310000 0004 1936 8972Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA USA
| | - Jair de Jesus Mari
- grid.411249.b0000 0001 0514 7202Departamento de Psiquiatria, Escola Paulista de Medicina, Universidade Federal de São Paulo, UNIFESP, São Paulo, Brazil
| | - Bradley H. Wagenaar
- grid.34477.330000000122986657Department of Global Health, University of Washington, Seattle, WA USA ,grid.429096.0Health Alliance International, Seattle, WA USA ,grid.34477.330000000122986657Department of Epidemiology, University of Washington, Seattle, WA USA
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12
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Lovero KL, dos Santos PF, Adam S, Bila C, Fernandes ME, Kann B, Rodrigues T, Jumbe AM, Duarte CS, Beidas RS, Wainberg ML. Leveraging Stakeholder Engagement and Virtual Environments to Develop a Strategy for Implementation of Adolescent Depression Services Integrated Within Primary Care Clinics of Mozambique. Front Public Health 2022; 10:876062. [PMID: 35692315 PMCID: PMC9178075 DOI: 10.3389/fpubh.2022.876062] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 04/27/2022] [Indexed: 11/13/2022] Open
Abstract
Psychiatric disorders are the number one cause of disability in adolescents worldwide. Yet, in low- and middle-income countries (LMIC), where 90% of adolescents reside, mental health services are extremely limited, and the majority do not have access to treatment. Integration of mental health services within primary care of LMICs has been proposed as an efficient and sustainable way to close the adolescent mental health treatment gap. However, there is limited research on how to effectively implement integrated mental health care in LMIC. In the present study, we employed Implementation Mapping to develop a multilevel strategy for integrating adolescent depression services within primary care clinics of Maputo, Mozambique. Both in-person and virtual approaches for Implementation Mapping activities were used to support an international implementation planning partnership and promote the engagement of multilevel stakeholders. We identified determinants to implementation of mental health services for adolescents in LMIC across all levels of the Consolidated Framework for Implementation Research, of which of 25% were unique to adolescent-specific services. Through a series of stakeholder workshops focused on implementation strategy selection, prioritization, and specification, we then developed an implementation plan comprising 33 unique strategies that target determinants at the intervention, patient, provider, policy, and community levels. The implementation plan developed in this study will be evaluated for delivering adolescent depression services in Mozambican primary care and may serve as a model for other low-resource settings.
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Affiliation(s)
- Kathryn L. Lovero
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY, United States
| | | | - Salma Adam
- Department of Mental Health, Ministry of Health, Maputo, Mozambique
| | - Carolina Bila
- Department of Mental Health, Ministry of Health, Maputo, Mozambique
| | | | - Bianca Kann
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States
| | - Teresa Rodrigues
- Department of Mental Health, Ministry of Health, Maputo, Mozambique
| | - Ana Maria Jumbe
- Department of Mental Health, Ministry of Health, Maputo, Mozambique
| | - Cristiane S. Duarte
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States
| | - Rinad S. Beidas
- Departments of Psychiatry, Medical Ethics and Health Policy, Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PN, United States
- Penn Medicine Nudge Unit, University of Pennsylvania Health System, Philadelphia, PN, United States
- Penn Implementation Science Center at the Leonard Davis Institute (PISCE@LDI), University of Pennsylvania, Philadelphia, PN, United States
- Center for Health Incentives and Behavioral Economics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PN, United States
| | - Milton L. Wainberg
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States
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13
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Moshomo T, Rivera YP, Boshe J, Rwegerera GM. The prevalence of depression and its associated factors among patients with diabetes mellitus attending a tertiary clinic in Gaborone, Botswana. S Afr J Psychiatr 2022; 28:1647. [PMID: 35281957 PMCID: PMC8905448 DOI: 10.4102/sajpsychiatry.v28i0.1647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 07/16/2021] [Indexed: 11/16/2022] Open
Abstract
Background Depression is one of the commonest co-existing medical conditions among patients with diabetes mellitus (DM). A bidirectional relationship between depression and DM exists, complicating glycaemic control leading to an increase in diabetic complications. There is a dearth of information regarding the prevalence of depression and associated factors among patients with DM in Botswana. Aim This study aimed to determine the prevalence of depression and associated factors among patients with DM. The study also assessed the association between depression and glycaemic control. Setting A tertiary diabetic referral clinic in Gaborone, Botswana. Method A sample of 260 randomly selected patients with DM was recruited in this cross-sectional study. Socio-demographic and clinical characteristics of the patients were collected using a case report form. Depression was evaluated using the Patient Health Questionnaire (PHQ)-9 scale. Multivariate regression analysis was used to determine factors significantly associated with depression. Results The mean age (standard deviation [s.d.]) of study participants was 58.4 (11.8) years, and the majority, 160/260 (61.5%), were females. The prevalence of depression was 30.4% and significantly associated with female sex (adjusted odds ratio [AOR] = 5.529, p-value = 0.004), three or more diabetes-related hospitalisations (AOR = 3.886, p-value = 0.049) and inversely associated with systolic blood pressure (SBP) ≥ 140 mmHg (AOR = 0.11, p-value = 0.001). Conclusion Depression is a common problem among patients with DM in our setting. Routine screening of depression in diabetic patients to enable early detection and treatment is recommended.
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Affiliation(s)
- Thato Moshomo
- Department of Internal Medicine, Faculty of Medicine, University of Botswana, Gaborone, Botswana
| | | | - Judith Boshe
- Department of Psychiatry, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Godfrey M Rwegerera
- Department of Internal Medicine, Faculty of Medicine, University of Botswana, Gaborone, Botswana
- Department of Medicine, Princess Marina Hospital, Gaborone, Botswana
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14
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Pranckeviciene A, Saudargiene A, Gecaite-Stonciene J, Liaugaudaite V, Griskova-Bulanova I, Simkute D, Naginiene R, Dainauskas LL, Ceidaite G, Burkauskas J. Validation of the patient health questionnaire-9 and the generalized anxiety disorder-7 in Lithuanian student sample. PLoS One 2022; 17:e0263027. [PMID: 35085349 PMCID: PMC8794093 DOI: 10.1371/journal.pone.0263027] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 01/10/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The Patient Health Questionnaire-9 (PHQ-9) and the Generalized Anxiety Disorder Questionnaire- 7 (GAD-7) are short screening instruments used for detection of depression and anxiety symptoms in various settings, including general and mental health care as well as the general population. The aim of this study is to evaluate psychometric properties and factorial structure of the PHQ-9 and the GAD-7 in a sample of Lithuanian university students. METHODS 1368 students (mean age 22.5±4.8) completed the PHQ-9 and the GAD-7 questionnaires online; after the completion of the survey, students were asked to provide phone contact for an additional interview. Eligible students were approached later by trained interviewers and completed The Clinical Interview Schedule-Revised for assessment of depressive and anxiety disorders. RESULTS Results showed that the PHQ-9 and the GAD-7 are reliable screening tools for depression and anxiety (Cronbach alpha 0.86 and 0.91, respectively). The one-factor structure of the PHQ-9 and the GAD-7 was confirmed by the Confirmatory Factor Analysis. A cut-off of ≥10 for the PHQ-9 resulted in 71% sensitivity and 66% specificity recognizing students with increased risk for mood or anxiety disorder. For the GAD-7, a cut-off ≥9 resulted in 73% sensitivity and 70% specificity recognizing students at risk. The PHQ-9 was sensitive but not specific in recognizing students with depressive disorders. The sensitivity and specificity of the GAD-7 in differentiating students with generalized anxiety disorders were low. CONCLUSIONS The PHQ-9 and the GAD-7 have sufficient formal psychometric properties, but their clinical utility as diagnostic tools for recognition of depressive and anxiety disorders in students is limited. Due to low specificity and high false positive rates, both scales are recommended only as an initial screening tool for recognition of subjects with increased risk of mental disorders, however positive cases should be later assessed using more comprehensive instruments.
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Affiliation(s)
- Aiste Pranckeviciene
- Laboratory of Behavioral Medicine, Neuroscience Institute, Lithuanian University of Health Sciences, Palanga - Kaunas, Lithuania
| | - Ausra Saudargiene
- Laboratory of Biophysics and Bioinformatics, Neuroscience Institute, Lithuanian University of Health Sciences, Kaunas, Lithuania
- Department of Informatics, Vytautas Magnus University, Kaunas, Lithuania
| | - Julija Gecaite-Stonciene
- Laboratory of Behavioral Medicine, Neuroscience Institute, Lithuanian University of Health Sciences, Palanga - Kaunas, Lithuania
| | - Vilma Liaugaudaite
- Laboratory of Behavioral Medicine, Neuroscience Institute, Lithuanian University of Health Sciences, Palanga - Kaunas, Lithuania
| | - Inga Griskova-Bulanova
- Department of Neurobiology and Biophysics, Institute of Biosciences, Vilnius University, Vilnius, Lithuania
| | - Dovile Simkute
- Department of Neurobiology and Biophysics, Institute of Biosciences, Vilnius University, Vilnius, Lithuania
| | - Rima Naginiene
- Laboratory of Toxicology, Neuroscience Institute, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Laurynas Linas Dainauskas
- Laboratory of Biophysics and Bioinformatics, Neuroscience Institute, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Gintare Ceidaite
- Department of Informatics, Vytautas Magnus University, Kaunas, Lithuania
| | - Julius Burkauskas
- Laboratory of Behavioral Medicine, Neuroscience Institute, Lithuanian University of Health Sciences, Palanga - Kaunas, Lithuania
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