Abstract
Purpose: Our study aimed to validate culturally adapted English and Swahili versions of the Patient Health Questionnaire–9 (PHQ-9) for use with adolescents in Kenya. Criterion validity was determined with clinician-administered diagnostic interviews using the Kiddie Schedule of Affective Disorders and Schizophrenia. Methods: A total of 250 adolescents comprising 148 (59.2%) females and 102 (40.8%) males aged 10–19 years (mean = 14.76; standard deviation = 2.78) were recruited. The PHQ-9 was administered to all respondents concurrently in English and Swahili. Adolescents were later interviewed by clinicians using Kiddie Schedule of Affective Disorders and Schizophrenia to determine the presence or absence of current symptoms of major depressive disorder. Sensitivity specificity, positive predictive value (PPV) and negative predictive value (NPV), and likelihood ratios for various cut-off scores for PHQ-9 were analyzed using receiver operating characteristic curves. Results: The internal consistency (Cronbach's α) for PHQ-9 was 0.862 for the English version and 0.834 for Swahili version. The area under the curve was 0.89 (95% confidence interval, 0.84–0.92) and 0.87 (95% confidence interval, 0.82–0.90) for English and Swahili version, respectively, on receiver operating characteristic analysis. A cut-off of ≥ 9 on the English-language version had a sensitivity of 95.0%, specificity of 73.0%, PPV of 0.23, and NPV of 0.99; a cut-off of ≥ 9 on the Swahili version yielded a sensitivity of 89.0%, specificity of 70.0%, PPV of 0.20, and NPV of 0.90. Discussion: Psychometric properties were comparable across both English-adapted and Swahili-adapted version of the PHQ-9, are reliable, and valid instrument to detect major depressive disorder among adolescents which can be used in resource-limited settings for early identification of adolescents in need of mental health support.
| Original language | English |
|---|---|
| Pages (from-to) | S61-S70 |
| Number of pages | 10 |
| Journal | Journal of Adolescent Health |
| Volume | 72 |
| Issue number | 1, Supplement |
| Early online date | 12 Nov 2022 |
| DOIs | |
| Publication status | Published - Jan 2023 |
Bibliographical note
Funding Information:UNICEF participation in this work was supported, in part, by the Bill & Melinda Gates Foundation [INV-001395]. Under the grant conditions of the Foundation, a Creative Commons Attribution 4.0 Generic License has already been assigned to the Author Accepted Manuscript version that might arise from this submission. MMAP validation field work in Kenya presented in this manuscript was funded by the Government of Italy, through a grant to the UNICEF Office of Research—Innocenti. Research reported in this publication was also supported by the Fogarty International Center of the National Institutes of Health under Award Number K43TW010716, which also supported the contributions of M.K. to this work. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Funding Information:
We acknowledge and thank members of the MMAP Technical Advisory Group for their contributions in shaping this work: Abiodun Adewuya, Claudia Cappa, Regina Guthold, Vikram Patel, George Patton, James Scott, Chiara Servili, and Danuta Wasserman. We are also grateful to Jill Ahs in her role as UNICEF mental health MMAP consultant for providing technical guidance and support with documentation that informed validation field work. Kasra Zarei and Georgia Eleftheriou for editing the document. We are also grateful to Priscilla Idele from the UNICEF Office of Research for her support in facilitating the Kenya field pilot work and technical guidance in the process.
Publisher Copyright:
© 2022 Society for Adolescent Health and Medicine
Funding
UNICEF participation in this work was supported, in part, by the Bill & Melinda Gates Foundation [INV-001395]. Under the grant conditions of the Foundation, a Creative Commons Attribution 4.0 Generic License has already been assigned to the Author Accepted Manuscript version that might arise from this submission. MMAP validation field work in Kenya presented in this manuscript was funded by the Government of Italy, through a grant to the UNICEF Office of Research—Innocenti. Research reported in this publication was also supported by the Fogarty International Center of the National Institutes of Health under Award Number K43TW010716, which also supported the contributions of M.K. to this work. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. We acknowledge and thank members of the MMAP Technical Advisory Group for their contributions in shaping this work: Abiodun Adewuya, Claudia Cappa, Regina Guthold, Vikram Patel, George Patton, James Scott, Chiara Servili, and Danuta Wasserman. We are also grateful to Jill Ahs in her role as UNICEF mental health MMAP consultant for providing technical guidance and support with documentation that informed validation field work. Kasra Zarei and Georgia Eleftheriou for editing the document. We are also grateful to Priscilla Idele from the UNICEF Office of Research for her support in facilitating the Kenya field pilot work and technical guidance in the process.
| Funders | Funder number |
|---|---|
| Chiara Servili | |
| Danuta Wasserman | |
| MMAP | |
| UNICEF Office of Research | |
| National Institutes of Health | K43TW010716 |
| National Institutes of Health | |
| Fogarty International Center | |
| Bill and Melinda Gates Foundation | INV-001395 |
| Bill and Melinda Gates Foundation | |
| UNICEF |
Keywords
- Children and adolescents
- Depression
- Developing countries
- Psychometrics
- Screening
- Validation
