Betancourt Theresa S, Bass Judith, Borisova Ivelina, Neugebauer Richard, Speelman Liesbeth, Onyango Grace, Bolton Paul
Dept. of Population and International Health, François-Xavier Bagnoud Center for Health and Human Rights, Harvard School of Public Health, Boston, MA 02115, USA.
Soc Psychiatry Psychiatr Epidemiol. 2009 Aug;44(8):685-92. doi: 10.1007/s00127-008-0475-1. Epub 2009 Jan 22.
This paper presents an approach for evaluating the reliability and validity of mental health measures in non-Western field settings. We describe this approach using the example of our development of the Acholi psychosocial assessment instrument (APAI), which is designed to assess depression-like (two tam, par and kumu), anxiety-like (ma lwor) and conduct problems (kwo maraco) among war-affected adolescents in northern Uganda. To examine the criterion validity of this measure in the absence of a traditional gold standard, we derived local syndrome terms from qualitative data and used self reports of these syndromes by indigenous people as a reference point for determining caseness. Reliability was examined using standard test-retest and inter-rater methods. Each of the subscale scores for the depression-like syndromes exhibited strong internal reliability ranging from alpha = 0.84-0.87. Internal reliability was good for anxiety (0.70), conduct problems (0.83), and the pro-social attitudes and behaviors (0.70) subscales. Combined inter-rater reliability and test-retest reliability were good for most subscales except for the conduct problem scale and prosocial scales. The pattern of significant mean differences in the corresponding APAI problem scale score between self-reported cases vs. noncases on local syndrome terms was confirmed in the data for all of the three depression-like syndromes, but not for the anxiety-like syndrome ma lwor or the conduct problem kwo maraco.
本文提出了一种在非西方实地环境中评估心理健康测量工具的信度和效度的方法。我们以阿乔利心理社会评估工具（APAI）的开发为例来描述这种方法，该工具旨在评估乌干达北部受战争影响青少年中的抑郁样症状（two tam、par和kumu）、焦虑样症状（ma lwor）和行为问题（kwo maraco）。为了在缺乏传统金标准的情况下检验该测量工具的效标效度，我们从定性数据中得出了当地综合征术语，并将当地人对这些综合征的自我报告作为确定病例的参考点。使用标准的重测法和评分者间方法检验信度。抑郁样综合征的每个分量表得分都表现出很强的内部信度，范围从α = 0.84 - 0.87。焦虑（0.70）、行为问题（0.83）以及亲社会态度和行为（0.70）分量表的内部信度良好。除行为问题量表和亲社会量表外，大多数分量表的评分者间信度和重测信度的综合表现良好。在所有三种抑郁样综合征的数据中，自我报告的病例与非病例在当地综合征术语上对应的APAI问题量表得分存在显著平均差异的模式得到了证实，但焦虑样综合征ma lwor或行为问题kwo maraco的数据则未证实这一模式。
