Rakshasa-Loots Arish Mudra, Hamana Thandi, Fanqa Busiswa, Lindani Filicity, van Wyhe Kaylee, Kruger Sharon, Laughton Barbara
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.
Brain Neurosci Adv. 2023 Aug 31;7:23982128231194452. doi: 10.1177/23982128231194452. eCollection 2023 Jan-Dec.
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 = 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 , 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 PHQ-9 score and Withdrawn/Depressed component T scores on the Youth Self Report were moderately associated (Spearman's , indicating acceptable convergent validity.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.
抑郁症是一种使人衰弱的疾病，与之相关的污名往往阻碍人们寻求帮助。易于使用且具有文化包容性的工具能够在基层医疗诊所对抑郁症状进行早期筛查，尤其是在资源有限的环境中。在这项预先注册的试点研究（第一阶段报告可在DOI: 10.3389/fpsyt.2022.840912获取）中，我们使用跨文化翻译框架制作了一份开放获取的科萨语版九项患者健康问卷（PHQ-9），这是一种经过充分验证的抑郁症发病率和严重程度测量工具。我们在南非开普敦47名在家说科萨语、感染和未感染艾滋病毒的青少年样本中对这份科萨语PHQ-9进行了验证。评估了其信度、收敛效度和效标效度，以先前完成的基于实证评估的阿肯巴克青少年自我报告（YSR）表格中的T分数作为参考标准。我们的科萨语PHQ-9表现出令人满意的信度，克朗巴哈系数为[具体数值未给出]，项目间相关性在0.229至0.730之间，平均项目与总分相关性为0.69。PHQ-9分数与青少年自我报告中的退缩/抑郁分量表T分数呈中度相关（斯皮尔曼相关系数为[具体数值未给出]），表明收敛效度可接受。科萨语PHQ-9显示出令人满意的效标效度（受试者工作特征曲线下面积，AUC = 0.706），但这些分析的效能不足。主成分分析揭示了一个单因素解决方案，第一个主成分解释了45.8%的方差，所有因子载荷均高于传统阈值。因此，我们的科萨语版PHQ-9在这项试点验证研究中表现出令人满意的心理测量特性，并且与在非洲和全球背景下以不同语言验证的其他PHQ-9版本表现相当。这份问卷可作为一种非常有价值的、具有文化包容性的筛查工具，用于测量说科萨语人群中的抑郁症状。必须谨慎使用，因为包括PHQ-9在内的筛查工具可能高估或低估抑郁症的患病率。在更大的独立队列中进行进一步验证，可能会使我们的科萨语PHQ-9更广泛地用作诊所、研究和为科萨人服务的心理健康非营利组织中的筛查工具。
