Kaiser Bonnie N, Ticao Cynthia, Anoje Chukwuemeka, Boglosa Jeremy, Gafaar Temitope, Minto John, Kohrt Brandon A
University of California San Diego, United States.
Duke Global Health Institute, United States.
SSM Ment Health. 2022 Dec;2. doi: 10.1016/j.ssmmh.2022.100168. Epub 2022 Oct 17.
With growing global recognition of the need to address mental health, a key challenge is determining who needs mental health services. Most self-report screening tools were developed in English-speaking high-income settings, and this cultural milieu influences the types and content of items, the manner in which items are asked, and the options for responding to items. Approaches have been developed for transcultural translation and validation. However, these approaches are typically applied in one language at a time, which is of limited utility in linguistically diverse settings.
To address challenges in cross-cultural validation, we undertook a unique process of simultaneously validating tools in two languages in Nigeria. Through this dual-language validation, we explored how cultural and contextual differences may influence what is considered valid for a mental health tool. We validated the Depression Self Rating Scale, Child PTSD Symptom Scale (CPSS), and Disruptive Behavior Disorders Rating Scale with a community sample of 330 adolescents aged 12-17. Validity was assessed in Hausa and Pidgin, two languages commonly spoken in Nigeria. Clinical psychologists used the Kiddie-Schedule for Affective Disorders and Schizophrenia to establish caseness.
Most items had good discriminant validity, except on the CPSS, on which only 8 of 17 items discriminated by caseness. Findings indicate the influence of culture (e.g., linguistic differences in translatability of items) and context (e.g., items that reflect experiences of hunger or foodborne illness; different PTSD caseness by language might reflect differential trauma exposure between populations). We also identified items that operated differently between languages.
We identified shortcomings in cross-cultural validation procedures with regard to determining whether language, context, or or other differences influence performance of items. For future validation efforts, we recommend systematically collecting information on context and stressful/traumatic exposures as a way to contextualize interpretation of the validity findings.
Depression Self Rating Scale (DSRS), Child PTSD Symptom Scale (CPSS), Disruptive Behavior Disorders Rating Scale (DBDRS), Oppositional Defiant Disorder (ODD), Conduct Disorder (CD), Area Under the Curve (AUC), Diagnostic Odds Ratio (DOR), Low- and Middle-Income Countries (LMICs), Posttraumatic Stress Disorder (PTSD).
随着全球对心理健康问题关注度的不断提高，一个关键挑战是确定谁需要心理健康服务。大多数自我报告筛查工具是在英语国家的高收入环境中开发的，这种文化背景影响了条目的类型和内容、提问方式以及回答选项。已经开发了跨文化翻译和验证的方法。然而，这些方法通常一次只应用于一种语言，在语言多样化的环境中效用有限。
为应对跨文化验证中的挑战，我们在尼日利亚开展了一个独特的过程，同时对两种语言的工具进行验证。通过这种双语验证，我们探讨了文化和背景差异如何影响心理健康工具有效性的判定。我们用一个由330名12至17岁青少年组成的社区样本对抑郁自评量表、儿童创伤后应激障碍症状量表（CPSS）和破坏性行为障碍评定量表进行了验证。在豪萨语和皮钦语这两种尼日利亚常用语言中评估有效性。临床心理学家使用儿童情感障碍和精神分裂症检查表来确定病例。
大多数条目具有良好的区分效度，但CPSS除外，该量表的17个条目中只有8个能区分病例。研究结果表明了文化（如条目的可翻译性方面的语言差异）和背景（如反映饥饿或食源性疾病经历的条目；不同语言的创伤后应激障碍病例情况可能反映了不同人群之间不同的创伤暴露）的影响。我们还确定了在不同语言中表现不同的条目。
我们发现了跨文化验证程序在确定语言、背景或其他差异是否会影响条目的表现方面存在的不足。对于未来的验证工作，我们建议系统地收集有关背景以及压力/创伤暴露的信息，以此作为对有效性研究结果进行背景化解释的一种方式。
抑郁自评量表（DSRS）、儿童创伤后应激障碍症状量表（CPSS）、破坏性行为障碍评定量表（DBDRS）、对立违抗障碍（ODD）、品行障碍（CD）、曲线下面积（AUC）、诊断比值比（DOR）、低收入和中等收入国家（LMICs）、创伤后应激障碍（PTSD）
