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Dudeney E, Coates R, Ayers S, McCabe R. Acceptability and content validity of suicidality screening items: a qualitative study with perinatal women. Front Psychiatry 2024; 15:1359076. [PMID: 38666087 PMCID: PMC11044181 DOI: 10.3389/fpsyt.2024.1359076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 03/25/2024] [Indexed: 04/28/2024] Open
Abstract
Background Suicide is a leading cause of death for perinatal women. It is estimated that up to 50% of women with mental health issues during pregnancy and/or after birth are not identified, despite regular contact with healthcare services. Screening items are one way in which perinatal women needing support could be identified. However, research examining the content validity and acceptability of suicide-related screening items with perinatal women is limited. Aims This study sought to: (i) assess the acceptability and content validity of 16 suicide-related items that have been administered and/or validated in perinatal populations; and (ii) explore the potential barriers and facilitators that may affect how women respond to these items when administered during pregnancy and after birth. Methods Twenty-one cognitive and semi-structured interviews were conducted with pregnant and postnatal women in the UK. The sample included women who had experienced self-reported mental health problems and/or suicidality during the perinatal period, and those who had not. Interviews were transcribed verbatim, and a coding framework based on the Theoretical Framework of Acceptability was applied to explore the data using deductive and inductive approaches. Results Findings indicated that the acceptability and content validity of suicide-related items were largely unacceptable to perinatal women in their current form. Women found terms such as 'better off dead' or 'killing myself' uncomfortable. Most women preferred the phrase 'ending your life' as this felt less confronting. Comprehensibility was also problematic. Many women did not interpret 'harming myself' to include suicidality, nor did they feel that abstract language such as 'leave this world' was direct enough in relation to suicide. Stigma, fear, and shame was central to non-disclosure. Response options and recall periods further affected the content validity of items, which created additional barriers for identifying those needing support. Conclusions Existing suicide-related screening items may not be acceptable to perinatal women. Maternity practitioners and researchers should consider the phrasing, clarity, context, and framing of screening items when discussing suicidality with perinatal women to ensure potential barriers are not being reinforced. The development of specific suicidality screening measures that are acceptable, appropriate, and relevant to perinatal women are warranted.
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Affiliation(s)
- Elizabeth Dudeney
- Centre for Maternal and Child Health Research, School of Heath and Psychological Sciences, City, University of London, London, United Kingdom
| | - Rose Coates
- Centre for Maternal and Child Health Research, School of Heath and Psychological Sciences, City, University of London, London, United Kingdom
| | - Susan Ayers
- Centre for Maternal and Child Health Research, School of Heath and Psychological Sciences, City, University of London, London, United Kingdom
| | - Rose McCabe
- Centre for Mental Health Research, School of Heath and Psychological Sciences, City, University of London, London, United Kingdom
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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 2023:10731911231216961. [PMID: 38159031 DOI: 10.1177/10731911231216961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [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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Aagaard A, Ravn SL, Andersen TE, Vaegter HB. Interpretation of the Patient Health Questionnaire 9 in High-Impact Chronic Pain: Do We Measure Depressive Symptoms the Way We Think? Clin J Pain 2023; 39:501-515. [PMID: 37440339 DOI: 10.1097/ajp.0000000000001142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 05/22/2023] [Indexed: 07/15/2023]
Abstract
OBJECTIVES Depression is prevalent among patients with chronic pain and may impact pain management. An accurate assessment is, however, complicated by overlapping symptoms. This study investigated how patients with high-impact chronic pain interpreted and responded to the Patient Health Questionnaire 9 (PHQ-9) to identify problematic items and causes hereof. MATERIALS AND METHODS Cognitive interviews using the Three-Step Test-Interview procedure were conducted during the completion of the PHQ-9 in 33 patients with high-impact chronic pain referred to interdisciplinary treatment. Responses were analyzed using 4 coding categories: (1) "congruent" (response consistent with intention); (2) "incongruent" (response not consistent intention); (3) "ambiguous" (response both congruent and incongruent or insufficient to evaluate congruency); and (4) "confused" (response with confused or misunderstood statements). Next, the content of responses to problematic items was analyzed to identify causes for noncongruency, and encountered response difficulties were identified across all items. RESULTS Three items (items 2, 6, and 9) performed as intended (>97% congruent responses), while 7 items (items 1, 3, 4, 5, 7, 8, and 10) were identified as problematic (<50% congruent responses). Problematic items had 1 or more issues: Responses were based on (1) pain-related issues or (2) other (non-pain) factors unrelated to depression, or item structure caused response difficulties due to wordings, reversion, or having 2 questions in 1. DISCUSSION Problematic items limit the construct validity of the PHQ-9, leaving an increased risk of inflated depression scores in high-impact chronic pain. Identified problems should guide future revisions to enhance validity and screening accuracy for the benefit of both research and clinical practice.
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Affiliation(s)
| | - Sophie Lykkegaard Ravn
- Departments of Psychology
- Specialized Hospital for Polio and Accident Victims, Roedovre, Denmark
| | | | - Henrik Bjarke Vaegter
- Clinical Research, Faculty of Health Sciences, University of Southern Denmark
- Pain Research Group, Pain Center, University Hospital Odense
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Concepcion T, Mogere P, Ngure K, Mwathi N, Njiru R, Kipkorir B, Kiptinness C, Maina G, Owidi E, Owens T, Kohler P, Wagenaar BH, Dorsey S, Collins PY, Velloza J. Higher rates of mental health screening of adolescents recorded after provider training using simulated patients in a Kenyan HIV clinic: results of a pilot study. Front Public Health 2023; 11:1209525. [PMID: 37808984 PMCID: PMC10556463 DOI: 10.3389/fpubh.2023.1209525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 08/31/2023] [Indexed: 10/10/2023] Open
Abstract
Background Kenyan adolescent girls and young women (AGYW) experience a dual burden of HIV and common mental disorders (CMD). HIV clinics are a key entry point for AGYW in need of integrated CMD and HIV care; however, rates of screening and referral for CMDs are low. Our objective was to test an evidence-based provider training strategy, simulated patient encounters (SPEs), on CMD service delivery for AGYW in a Kenyan HIV clinic. Methods This pilot study was conducted in a public HIV clinic in Thika, Kenya from January to November 2021. The simulated patient encounter (SPE) implementation strategy included case script development from prior qualitative work, patient actor training, and a three-day SPE training including four standardized mock clinical encounters followed by quantitative surveys assessing provider competencies for each encounter. We abstracted medical record data related to HIV and CMDs such as HIV status, reason for visit, CMD screening test performed, and counselling or referral information. We conducted an interrupted time series analysis using abstracted HIV and CMD screening rates from AGYW ages 16-25 years visiting the clinic 7 months before and 3 months after SPE training. We used generalized linear models to assess changes in CMD screening rates after training. Results A total of 10 providers participated in the training. Competency ratings improved across four mock encounters (mean score from 8.1 to 13.7) between first and fourth encounters. We abstracted all medical records (n = 1,154) including from 888 (76%) AGYW seeking HIV treatment, 243 (21%) seeking prevention services, and 34 (3%) seeking other services. CMD screening rates increased immediately following training from 8 to 21% [relative risk (RR) = 2.57, 95% confidence interval (CI) = 1.34-4.90, p < 0.01]. The 3 months following the SPE training resulted in an 11% relative increase in CMD screening proportion compared to the 7 months pre-SPE (RR: 1.11, 95% CI: 1.04-1.17, p < 0.01). Finally, 1% of all pre-SPE screens resulted in referral versus 5% of post-SPE screens (p = 0.07). Conclusion The SPE model is a promising implementation strategy for improving HIV provider competencies and CMD service delivery for adolescents in HIV clinics. Future research is needed to explore effects on adolescent clinical outcomes in larger trials.
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Affiliation(s)
- Tessa Concepcion
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Peter Mogere
- Partners in Health and Research Development, Thika, Kenya
| | - Kenneth Ngure
- School of Public Health, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
| | - Njoroge Mwathi
- Partners in Health and Research Development, Thika, Kenya
| | - Roy Njiru
- Partners in Health and Research Development, Thika, Kenya
| | - Boaz Kipkorir
- Partners in Health and Research Development, Thika, Kenya
| | | | - Gakuo Maina
- Partners in Health and Research Development, Thika, Kenya
| | - Emmah Owidi
- Partners in Health and Research Development, Thika, Kenya
| | - Tamara Owens
- Simulation and Clinical Skills Center, Howard University, Washington, DC, United States
| | - Pamela Kohler
- Department of Global Health, University of Washington, Seattle, WA, United States
- Department of Child, Family, and Population Health Nursing, Seattle, WA, United States
| | - Bradley H Wagenaar
- Department of Global Health, University of Washington, Seattle, WA, United States
- Department of Epidemiology, University of Washington, Seattle, WA, United States
| | - Shannon Dorsey
- Department of Psychology, University of Washington, Seattle, WA, United States
| | - Pamela Y Collins
- Department of Global Health, University of Washington, Seattle, WA, United States
- Department of Psychiatry, University of Washington, Seattle, WA, United States
| | - Jennifer Velloza
- Department of Global Health, University of Washington, Seattle, WA, United States
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, United States
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Ahmed MS, Ahmed N. A Fast and Minimal System to Identify Depression Using Smartphones: Explainable Machine Learning-Based Approach. JMIR Form Res 2023; 7:e28848. [PMID: 37561568 PMCID: PMC10450542 DOI: 10.2196/28848] [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: 12/26/2022] [Revised: 03/17/2023] [Accepted: 03/19/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND Existing robust, pervasive device-based systems developed in recent years to detect depression require data collected over a long period and may not be effective in cases where early detection is crucial. Additionally, due to the requirement of running systems in the background for prolonged periods, existing systems can be resource inefficient. As a result, these systems can be infeasible in low-resource settings. OBJECTIVE Our main objective was to develop a minimalistic system to identify depression using data retrieved in the fastest possible time. Another objective was to explain the machine learning (ML) models that were best for identifying depression. METHODS We developed a fast tool that retrieves the past 7 days' app usage data in 1 second (mean 0.31, SD 1.10 seconds). A total of 100 students from Bangladesh participated in our study, and our tool collected their app usage data and responses to the Patient Health Questionnaire-9. To identify depressed and nondepressed students, we developed a diverse set of ML models: linear, tree-based, and neural network-based models. We selected important features using the stable approach, along with 3 main types of feature selection (FS) approaches: filter, wrapper, and embedded methods. We developed and validated the models using the nested cross-validation method. Additionally, we explained the best ML models through the Shapley additive explanations (SHAP) method. RESULTS Leveraging only the app usage data retrieved in 1 second, our light gradient boosting machine model used the important features selected by the stable FS approach and correctly identified 82.4% (n=42) of depressed students (precision=75%, F1-score=78.5%). Moreover, after comprehensive exploration, we presented a parsimonious stacking model where around 5 features selected by the all-relevant FS approach Boruta were used in each iteration of validation and showed a maximum precision of 77.4% (balanced accuracy=77.9%). Feature importance analysis suggested app usage behavioral markers containing diurnal usage patterns as being more important than aggregated data-based markers. In addition, a SHAP analysis of our best models presented behavioral markers that were related to depression. For instance, students who were not depressed spent more time on education apps on weekdays, whereas those who were depressed used a higher number of photo and video apps and also had a higher deviation in using photo and video apps over the morning, afternoon, evening, and night time periods of the weekend. CONCLUSIONS Due to our system's fast and minimalistic nature, it may make a worthwhile contribution to identifying depression in underdeveloped and developing regions. In addition, our detailed discussion about the implication of our findings can facilitate the development of less resource-intensive systems to better understand students who are depressed and take steps for intervention.
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Affiliation(s)
- Md Sabbir Ahmed
- Design Inclusion and Access Lab, North South University, Dhaka, Bangladesh
| | - Nova Ahmed
- Design Inclusion and Access Lab, North South University, Dhaka, Bangladesh
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Dudeney E, Coates R, Ayers S, McCabe R. Measures of suicidality in perinatal women: A systematic review. J Affect Disord 2023; 324:210-231. [PMID: 36584713 DOI: 10.1016/j.jad.2022.12.091] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 12/20/2022] [Accepted: 12/22/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND Suicide is a leading cause of death for perinatal women. Identifying women at risk of suicide is critical. Research on the validity and/or reliability of measures assessing suicidality in perinatal women is limited. This review sought to: (1) identify; and (2) evaluate the psychometric properties of suicidality measures validated in perinatal populations. METHODS Nine electronic databases were systematically searched from inception to January 2022. Additional articles were identified through citation tracking. Study quality was assessed using an adapted tool, and the psychometric properties of measures were reviewed and presented using a narrative synthesis. RESULTS A total of 208 studies were included. Thirty-five studies reported psychometric data on ten suicidality measures. Fifteen studies reported both validity and reliability data, 12 reported more than one type of validity, seven validated more than one measure and four only reported reliability. Nearly all measures primarily screened for depression, with an item or subscale assessing suicidal ideation and/or behaviours. Three measures were specifically developed for perinatal women, but only two were validated in more than one study. The Postpartum Depression Screening Scale (PDSS), suicidal thoughts subscale, was validated most frequently. LIMITATIONS Methodological differences and variability between the measures (e.g., suicidality construct assessed, number of items and administration) precluded direct comparisons. CONCLUSION Further validation of suicidality measures is needed in perinatal women. Screening for perinatal suicidality often occurs in the context of depression. The development of a standalone measure specifically assessing suicidality in perinatal women may be warranted, particularly for use in maternity care settings.
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Affiliation(s)
- Elizabeth Dudeney
- Centre for Maternal and Child Health Research, School of Health and Psychological Sciences, City, University of London, London, UK.
| | - Rose Coates
- Centre for Maternal and Child Health Research, School of Health and Psychological Sciences, City, University of London, London, UK
| | - Susan Ayers
- Centre for Maternal and Child Health Research, School of Health and Psychological Sciences, City, University of London, London, UK
| | - Rose McCabe
- Centre for Mental Health Research, School of Health and Psychological Sciences, University of London, UK
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Srisurapanont M, Oon-arom A, Suradom C, Luewan S, Kawilapat S. Convergent Validity of the Edinburgh Postnatal Depression Scale and the Patient Health Questionnaire (PHQ-9) in Pregnant and Postpartum Women: Their Construct Correlations with Functional Disability. Healthcare (Basel) 2023; 11:healthcare11050699. [PMID: 36900704 PMCID: PMC10000426 DOI: 10.3390/healthcare11050699] [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: 02/09/2023] [Revised: 02/21/2023] [Accepted: 02/24/2023] [Indexed: 03/02/2023] Open
Abstract
This study aimed to evaluate the convergent validity of the Edinburgh Postnatal Depression Scale (EPDS) and the Patient Health Questionnaire (PHQ-9) in Thai pregnant and postpartum women, using the 12-item WHO Disability Assessment Schedule (WHODAS) as the reference standard. Participants completed the EPDS, PHQ-9, and WHODAS during the third trimester of pregnancy (over 28 weeks in gestational age) and six weeks postpartum. The sample included 186 and 136 participants for the antenatal and postpartum data analyses, respectively. The antenatal and postpartum data showed moderate correlations between both the EPDS and the PHQ-9 scores and the WHODAS scores (Spearman's correlation coefficients = 0.53-0.66, p < 0.001). The EPDS and PHQ-9 were moderately accurate in distinguishing disability (WHODAS score ≥ 10) from non-disability (WHODAS score < 10) in pregnant and postpartum participants, but the area under the curve of the PHQ-9 receiver operating characteristic curves in postpartum participants was significantly larger than that of the EPDS, with a difference (95% CI; p-value) of 0.08 (0.16, 0.01; p = 0.044). In conclusion, the EPDS and PHQ-9 are valid for assessing PND-related disability in pregnant and postpartum women. The PHQ-9 may perform better than the EPDS in distinguishing disability from non-disability in postpartum women.
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Affiliation(s)
- Manit Srisurapanont
- Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
- Correspondence: ; Tel.: +66-53-945422; Fax: +66-53-945426
| | - Awirut Oon-arom
- Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Chawisa Suradom
- Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Suchaya Luewan
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Suttipong Kawilapat
- Research Administration Section, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
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Rosario-Hernández E, Rovira-Millán LV, Merino-Soto C, Angulo-Ramos M. Review of the psychometric properties of the Patient Health Questionnaire-9 (PHQ-9) Spanish version in a sample of Puerto Rican workers. Front Psychiatry 2023; 14:1024676. [PMID: 36865076 PMCID: PMC9971011 DOI: 10.3389/fpsyt.2023.1024676] [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: 08/22/2022] [Accepted: 01/03/2023] [Indexed: 02/16/2023] Open
Abstract
Background This study aimed to examine the internal structure and assess the psychometric properties of the Patient Health Questionnaire (PHQ-9) in a Puerto Rican sample of workers. This instrument is a nine-item questionnaire, which was conceptualized as a unidimensional structure; however, there are mixed results regarding this internal structure. This measure is used in the occupational health psychology context in organizations in Puerto Rico; nevertheless, there is little evidence of its psychometric properties with samples of workers. Materials and methods A total of 955 samples from two different study samples were used in this cross-sectional study design in which the PHQ-9 was used. We conducted confirmatory factor analysis, bifactor analysis, and random intercept item factor analysis to examine the internal structure of the PHQ-9. Moreover, a two-factor model was examined by randomly assigning items to the two factors. Measurement invariance across sex and the relationship with other constructs were examined. Results The best-fitted model was the bifactor model followed by the random intercept item factor. The five sets of two-factor models with items randomly assigned obtained acceptable and similar fit indices regardless of the items. Conclusion The results suggest that the PHQ-9 appears to be a reliable and valid instrument to measure depression. The more parsimonious interpretation of its scores, for now, is a unidimensional structure. Comparison across sex appears to be useful in occupational health psychology research settings since the results suggest that the PHQ-9 is invariant regarding this variable.
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Affiliation(s)
- Ernesto Rosario-Hernández
- Clinical Psychology Programs, School of Behavioral and Brain Sciences, Ponce Health Sciences University, Ponce, Puerto Rico
- Ponce Research Institute, Ponce Health Sciences University, Ponce, Puerto Rico
| | | | - César Merino-Soto
- Instituto de Investigación de Psicología, Universidad de San Martín de Porres, Lima, Peru
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Winter S, Musyimi C, Mutiso V, Ndetei D. Depressive symptoms and associated social and environmental factors among women living in informal settlements in Nairobi, Kenya. Glob Public Health 2023; 18:2200499. [PMID: 37054444 DOI: 10.1080/17441692.2023.2200499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/15/2023]
Abstract
Approximately 280 million people around the world suffer from depression, and the rates are higher among women than men. For women living in informal settlements in lower - and middle-income countries (LMICs) the prevalence and associated burden of depressive symptoms may be particularly high. The purpose of this paper was to explore factors associated with possible major depressive disorder (MDD) in a probability sample of women living in Mathare informal settlement in Nairobi, Kenya and to identify potential points for intervention and/or support. Quantitative surveys were conducted with 552 women aged 18-75. Possible MDD was measured using the Patient Health Questionnaire and regressed on individual, household/familial-, and community/interpersonal-level factors. Findings highlight the potential importance of factors such as physical health, economic stress, access to water and sanitation, household and family dynamics, and neighbourhood/village differences in possible MDD among women living in informal settlements. We identify potential points for research, intervention and policy including: providing appropriate tangible assistance or interventions to reduce economic stress/strain; expanding access to water and sanitation and, in doing so, reducing potential burdens to physical health; providing and expanding healthcare to include mental healthcare; and investigating family dynamics and bolstering support for families, particularly for those experiencing conflict.
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Affiliation(s)
- Samantha Winter
- School of Social Work, Columbia University, New York, NY, USA
| | - Christine Musyimi
- African Mental Health Research and Training Foundation, Nairobi, Kenya
| | - Victoria Mutiso
- African Mental Health Research and Training Foundation, Nairobi, Kenya
| | - David Ndetei
- African Mental Health Research and Training Foundation, Nairobi, Kenya
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Nyongesa V, Kathono J, Mwaniga S, Yator O, Madeghe B, Kanana S, Amugune B, Anyango N, Nyamai D, Wambua GN, Chorpita B, Kohrt BA, Ahs JW, Idele P, Carvajal L, Kumar M. Cultural and contextual adaptation of mental health measures in Kenya: An adolescent-centered transcultural adaptation of measures study. PLoS One 2022; 17:e0277619. [PMID: 36520943 PMCID: PMC9754261 DOI: 10.1371/journal.pone.0277619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 10/31/2022] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION There is paucity of culturally adapted tools for assessing depression and anxiety in children and adolescents in low-and middle-income countries. This hinders early detection, provision of appropriate and culturally acceptable interventions. In a partnership with the University of Nairobi, Nairobi County, Kenyatta National Hospital, and UNICEF, a rapid cultural adaptation of three adolescent mental health scales was done, i.e., Revised Children's Anxiety and Depression Scale, Patient Health Questionnaire-9 and additional scales in the UNICEF mental health module for adolescents. MATERIALS AND METHODS Using a qualitative approach, we explored adolescent participants' views on cultural acceptability, comprehensibility, relevance, and completeness of specific items in these tools through an adolescent-centered approach to understand their psychosocial needs, focusing on gender and age-differentiated nuances around expression of distress. Forty-two adolescents and 20 caregivers participated in the study carried out in two primary care centers where we conducted cognitive interviews and focused group discussions assessing mental health knowledge, literacy, access to services, community, and family-level stigma. RESULTS We reflect on process and findings of adaptations of the tools, including systematic identification of words adolescents did not understand in English and Kiswahili translations of these scales. Some translated words could not be understood and were not used in routine conversations. Response options were changed to increase comprehensibility; some statements were qualified by adding extra words to avoid ambiguity. Participants suggested alternative words that replaced difficult ones and arrived at culturally adapted tools. DISCUSSION Study noted difficult words, phrases, dynamics in understanding words translated from one language to another, and differences in comprehension in adolescents ages 10-19 years. There is a critical need to consider cultural adaptation of depression and anxiety tools for adolescents. CONCLUSION Results informed a set of culturally adapted scales. The process was community-driven and adhered to the principles of cultural adaptation for assessment tools.
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Affiliation(s)
| | - Joseph Kathono
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya
- Nairobi Metropolitan Services, Nairobi, Kenya
| | - Shillah Mwaniga
- Nairobi Metropolitan Services, Nairobi, Kenya
- Vrije University, Amsterdam, Netherlands
| | - Obadia Yator
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya
| | - Beatrice Madeghe
- Department of Food and Nutrition Sciences, University of Nairobi, Nairobi, Kenya
| | | | | | - Naomi Anyango
- Department of Mental Health, Ministry of Health, Kenya
| | | | - Grace Nduku Wambua
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Bruce Chorpita
- University of California, Los Angeles, United States of America
| | - Brandon A. Kohrt
- Division of Global Mental Health, Department of Psychiatry and Behavioral Science, The George Washington University, Washington, District of Columbia, United States of America
| | - Jill W. Ahs
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna, Sweden
- Department of Health Care Sciences, Swedish Red Cross University College, Huddinge, Sweden
| | - Priscilla Idele
- UN Secretariat, New York, New York, United States of America
| | - Liliana Carvajal
- Division of Data, Analytics, Planning and Monitoring, Data and Analytics Section, UNICEF, New York, New York, United States of America
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Manasi Kumar
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya
- Brain and Mind Institute, Aga Khan University, Nairobi, Kenyau
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Lasater ME, Beebe M, Warren NE, Winch PJ, Soucko F, Keita M, Doumbia S, Murray SM. Reliability and validity of a perinatal depression screening instrument in rural Mali. SSM - MENTAL HEALTH 2022; 2:100059. [PMID: 36644110 PMCID: PMC9835090 DOI: 10.1016/j.ssmmh.2021.100059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Background In order to reduce the burden of perinatal depression in low- and middle-income countries, health systems must be able to identify and treat women suffering from depression. The objective of our study was to develop a locally valid and reliable screening instrument for use in identifying pregnant women and mothers of young children with a local depression syndrome, dusukasi, in rural Mali. Methods We administered a locally adapted screening instrument containing items from the Edinburgh Postpartum Depression Scale (EPDS) and Hopkins Symptom Checklist (HSCL-25) to 180 pregnant women and mothers of children under age 2 in Sélingué, Mali to assess the instrument's psychometric properties and validity. Item Response Theory was used to develop an abbreviated version of the measure and the validity and psychometric properties of this shortened version were compared with the full-length scale. Results The full 28-item scale exhibited a single factor structure with good internal consistency (Cronbach's alpha = 0.92). Women who self-identified as suffering from dusukasi (n = 87) in a known groups analysis to assess construct validity had significantly higher depression and anxiety symptom scores (p < 0.0001) and functional impairment scores (p < 0.0001) compared to women not reporting dusukasi (n = 93). The shortened 16-item scale performed as well as the full scale in identifying women with dusukasi. Conclusions Construct validity of our adapted screening instrument was supported for identifying dusukasi in rural Malian women. Our methodology can be applied in other settings to develop similarly valid screening instruments for perinatal depression.
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Affiliation(s)
- Molly E. Lasater
- Social and Behavioral Interventions Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA,Corresponding author. 615 N. Wolfe St, Baltimore, MD, USA, 21205. (M.E. Lasater)
| | - Madeleine Beebe
- Social and Behavioral Interventions Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA
| | - Nicole E. Warren
- School of Nursing, Johns Hopkins University, 525 N Wolfe St, Baltimore, MD, 21205, USA
| | - Peter J. Winch
- Social and Behavioral Interventions Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA
| | - Fatoumata Soucko
- Department of Public Health, Faculty of Medicine and Odontostomatology, University of Sciences, Techniques and Technology of Bamako, Mali
| | - Mariam Keita
- Department of Public Health, Faculty of Medicine and Odontostomatology, University of Sciences, Techniques and Technology of Bamako, Mali
| | - Seydou Doumbia
- Department of Public Health, Faculty of Medicine and Odontostomatology, University of Sciences, Techniques and Technology of Bamako, Mali
| | - Sarah M. Murray
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, Baltimore, MD, 21205, USA
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12
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Tapsoba JDD, Cover J, Obong’o C, Brady M, Cressey TR, Mori K, Okomo G, Kariithi E, Obanda R, Oluoch-Madiang D, Chen YQ, Drain P, Duerr A. Continued attendance in a PrEP program despite low adherence and non-protective drug levels among adolescent girls and young women in Kenya: Results from a prospective cohort study. PLoS Med 2022; 19:e1004097. [PMID: 36095005 PMCID: PMC9521917 DOI: 10.1371/journal.pmed.1004097] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 09/29/2022] [Accepted: 08/19/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND In sub-Saharan Africa (SSA), adolescent girls and young women (AGYW) ages 15 to 24 years represent <10% of the population yet account for 1 in 5 new HIV infections. Although oral pre-exposure prophylaxis (PrEP) with tenofovir disoproxil fumarate/emtricitabine (TDF/FTC) can be highly effective, low persistence in PrEP programs and poor adherence have limited its ability to reduce HIV incidence among women. METHODS AND FINDINGS A total of 336 AGYW participating in the PEPFAR-funded DREAMS PrEP program in western Kenya were enrolled into a study of PrEP use conducted between 6/2019 to 1/2020. AGYW, who used daily oral TDF/FTC, completed interviews and provided dried blood spots (DBS) for measurement of tenofovir-diphosphate (TFV-DP) concentrations at enrollment and 3 months later, and 176/302 (58.3%, 95% confidence interval [95% CI 52.3 to 63.8]) met our definition of PrEP persistence: having expressed intention to use PrEP and attended both the second interview and an interim refill visit. Among AGYW with DBS taken at the second interview, only 9/197 (4.6%, [95% CI 1.6 to 7.5]) had protective TFV-DP levels (≥700 fmol/punch) and 163/197 (82.7%, [95% CI 77.5 to 88]) had levels consistent with no recent PrEP use (<10 fmol/punch). Perception of being at moderate-to-high risk for HIV if not taking PrEP was associated with persistence (adjusted odds ratio, 10.17 [95% CI 5.14 to 20.13], p < 0.001) in a model accounting for county of residence and variables that had p-value <0.1 in unadjusted analysis (age, being in school, initiated PrEP 2 to 3 months before the first interview, still active in DREAMS, having children, having multiple sex partners, partner aware of PrEP use, partner very supportive of PrEP use, partner has other partners, AGYW believes that a partner puts her at risk, male condom use, injectable contraceptive use, and implant contraceptive use). Among AGYW who reported continuing PrEP, >90% indicated they were using PrEP to prevent HIV, although almost all had non-protective TFV-DP levels. Limitations included short study duration and inclusion of only DREAMS participants. CONCLUSIONS Many AGYW persisted in the PrEP program without taking PrEP frequently enough to receive benefit. Notably, AGYW who persisted had a higher self-perceived risk of HIV infection. These AGYW may be optimal candidates for long-acting PrEP.
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Affiliation(s)
- Jean de Dieu Tapsoba
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America
| | - Jane Cover
- PATH, Seattle, Washington, United States of America
| | | | - Martha Brady
- PATH, Seattle, Washington, United States of America
| | | | - Kira Mori
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America
| | | | | | | | | | - Ying Qing Chen
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America
| | - Paul Drain
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
| | - Ann Duerr
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America
- * E-mail:
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13
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Menold N, Raykov T. On the Relationship Between Item Stem Formulation and Criterion Validity of Multiple-Component Measuring Instruments. EDUCATIONAL AND PSYCHOLOGICAL MEASUREMENT 2022; 82:356-375. [PMID: 35185163 PMCID: PMC8850765 DOI: 10.1177/0013164420988169] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
The possible dependency of criterion validity on item formulation in a multicomponent measuring instrument is examined. The discussion is concerned with evaluation of the differences in criterion validity between two or more groups (populations/subpopulations) that have been administered instruments with items having differently formulated item stems. The case of complex item stems involving two stimuli description sentences (double-barreled questions) is thereby compared with the setting where items contained a single sentence. Using empirical data, the latent criterion validity differences are evaluated across three groups that are randomly assigned to conditions characterized by item stems with differing number of stimuli. The results indicate that validity of an instrument can be influenced by the specific way item stem is formulated. Implications for empirical educational, behavioral, and social science research are discussed.
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Affiliation(s)
| | - Tenko Raykov
- Michigan State University, East Lansing, MI, USA
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14
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Is there an optimal screening tool for identifying perinatal depression within clinical settings of sub-Saharan Africa? SSM - MENTAL HEALTH 2021. [DOI: 10.1016/j.ssmmh.2021.100015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
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15
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Silva MMDJ, Clapis MJ. Depression During Pregnancy Risk Scale: elaboration of a theoretical model. Rev Esc Enferm USP 2021; 55:e03780. [PMID: 34287488 DOI: 10.1590/s1980-220x2020027503780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 02/24/2021] [Indexed: 11/21/2022] Open
Abstract
This study aim is to propose a theoretical model on the construct risk of depression during pregnancy as an initial part of the process of building and validating the Depression during Pregnancy Risk Scale. This is a theoretical study based on the methodology recommended by Pasquali, which establishes four steps for the elaboration of the theoretical model: psychological system, property of the psychological system, dimensionality, definition of the construct. In the first step, the psychological object was defined as "risk of depression during pregnancy". Thereafter, "depression during pregnancy" was defined as the property of the psychological system. In the third step, dimensionality was established through the antecedents and consequences of depression during pregnancy, understood as its risk factors and consequences, respectively. In the fourth step, the constitutive and operational definition of the construct risk of depression during pregnancy was established. The elaboration of the theoretical model advanced when it addressed the risk of depression during pregnancy as a process that articulates several concepts in which antecedents and consequences promoting repercussions on the health of the pregnant woman are inserted; and it contributed to the development of an original scale.
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Affiliation(s)
- Mônica Maria de Jesus Silva
- Departamento de Enfermagem Materno-Infantil e Saúde Pública, Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - Maria José Clapis
- Departamento de Enfermagem Materno-Infantil e Saúde Pública, Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
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16
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Anderson JL, Li P, Bukusi EA, Darbes LA, Hatcher AM, Helova A, Kwena ZA, Musoke PL, Owino G, Oyaro P, Rogers AJG, Turan JM. Effects of a Home-Based Intervention on HIV Prevention Health Behaviors in Pregnant/Postpartum Kenyan Women: Estimating Moderating Effects of Depressive Symptoms. AIDS Behav 2021; 25:1026-1036. [PMID: 33057976 DOI: 10.1007/s10461-020-03046-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2020] [Indexed: 01/05/2023]
Abstract
We estimated effects of maternal depressive symptoms, utilizing the Patient Health Questionnaire-8 (PHQ-8), on women's HIV prevention behaviors in Migori County, Kenya. Pregnant women ≥ 18 years old, with gestational age of < 37 weeks, were randomized into standard care or three home visits (2 during pregnancy, 1 postpartum) promoting couple HIV testing and counseling (CHTC) and HIV prevention. Of 105 female participants, 37 (35.24%) reported depressive symptoms and 50 (47.62%) were HIV-positive. Three Poisson regressions with robust variance (univariable, multivariable, and multivariable with depressive symptoms/study arm interaction) were modeled for three outcomes: CHTC, infant HIV testing, health-seeking postpartum. In multivariable analysis with interaction, a moderating trend for the interaction between depressive symptoms and individual health-seeking was observed (p-value = 0.067). Women scoring ≤ 9 (n = 68) on the PHQ-8 and participating in home visits were 1.76 times more likely to participate in individual health-seeking compared to participants in standard care (ARR 1.76, 95% CI 1.17-2.66).
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Affiliation(s)
- Jami L Anderson
- Department of Health Services Administration, School of Health Professions, University of Alabama at Birmingham, SHPB 553, 1716 9th Ave South, Birmingham, AL, 35294, USA.
| | - Peng Li
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Elizabeth A Bukusi
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Lynae A Darbes
- Center for Sexuality and Health Disparities, Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, Ann Arbor, MI, USA
| | - Abigail M Hatcher
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Anna Helova
- Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
- Sparkman Center for Global Health, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Zachary A Kwena
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Pamela L Musoke
- Center for Social and Behavioral Research, University of Northern Iowa, Cedar Falls, IA, USA
| | - George Owino
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Patrick Oyaro
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Anna Joy G Rogers
- Department of Obstetrics and Gynecology, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Janet M Turan
- Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
- Sparkman Center for Global Health, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
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