Luitel Nagendra P, Rimal Damodar, Eleftheriou Georgia, Rose-Clarke Kelly, Nayaju Suvash, Gautam Kamal, Pant Sagun Ballav, Devkota Narmada, Rana Shruti, Chaudhary Jug Maya, Gurung Bhupendra Singh, Åhs Jill Witney, Carvajal-Velez Liliana, Kohrt Brandon A
Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
Research Department, Transcultural Psychosocial Organization (TPO) Nepal, Baluwatar, Kathmandu, Nepal.
Child Adolesc Psychiatry Ment Health. 2024 Jun 19;18(1):74. doi: 10.1186/s13034-024-00763-7.
Depression and anxiety are significant contributors to the global burden of disease among young people. Accurate data on the prevalence of these conditions are crucial for the equitable distribution of resources for planning and implementing effective programs. This study aimed to culturally adapt and validate data collection tools for measuring depression and anxiety at the population level.
The study was conducted in Kathmandu, Nepal, a diverse city with multiple ethnicities, languages, and cultures. Ten focus group discussions with 56 participants and 25 cognitive interviews were conducted to inform adaptations of the Patient Health Questionnaire adapted for Adolescents (PHQ-A) and Generalized Anxiety Disorder (GAD-7). To validate the tools, a cross-sectional survey of 413 adolescents (aged 12-19) was conducted in three municipalities of Kathmandu district. Trained clinical psychologists administered the Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS-DSM 5 version) to survey participants.
A number of cultural adaptations were required, such as changing statements into questions, using a visual scale (glass scale) to maintain uniformity in responses, and including a time frame at the beginning of each item. For younger adolescents aged 12 to 14 years, a PHQ-A cut-off of > = 13 had a sensitivity of 0.93, specificity of 0.80, positive predictive value (PPV) of 0.33, and negative predictive value (NPV) of 0.99. For older adolescents aged 15-19, a cut-off of > = 11 had a sensitivity of 0.89, specificity of 0.70, PPV of 0.32, and NPV of 0.97. For GAD-7, a cut-off of > = 8 had a sensitivity of 0.70 and specificity of 0.67 for younger adolescents and 0.71 for older adolescents, with a PPV of 0.39 and NPV of 0.89. The individual symptom means of both PHQ-A and GAD-7 items showed moderate ability to discriminate between adolescents with and without depression and anxiety.
The PHQ-A and GAD-7 demonstrate fair psychometric properties for screening depression but performed poorly for anxiety, with high rates of false positives. Even when using clinically validated cut-offs, population prevalence rates would be inflated by 2-4 fold with these tools, requiring adjustment when interpreting epidemiological findings.
抑郁和焦虑是导致全球年轻人疾病负担的重要因素。准确掌握这些疾病的患病率数据对于公平分配资源以规划和实施有效项目至关重要。本研究旨在对用于在人群层面测量抑郁和焦虑的数据收集工具进行文化调适和验证。
该研究在尼泊尔加德满都进行，这是一个拥有多种族、语言和文化的多元化城市。开展了10次焦点小组讨论（56名参与者）和25次认知访谈，以指导对青少年患者健康问卷（PHQ-A）和广泛性焦虑障碍量表（GAD-7）的调适。为验证这些工具，在加德满都区的三个市对413名青少年（12至19岁）进行了横断面调查。经过培训的临床心理学家对调查参与者实施儿童情感障碍和精神分裂症量表（K-SADS-DSM 5版）。
需要进行一些文化调适，例如将陈述改为问题，使用视觉量表（玻璃量表）以保持回答的一致性，并在每个项目开头加入时间框架。对于12至14岁的青少年，PHQ-A临界值≥13时，灵敏度为0.93，特异度为0.80，阳性预测值（PPV）为0.33，阴性预测值（NPV）为0.99。对于15至19岁的青少年，临界值≥11时，灵敏度为0.89，特异度为0.70，PPV为0.32，NPV为0.97。对于GAD-7，临界值≥8时，12至14岁青少年的灵敏度为0.70，特异度为0.67，15至19岁青少年的灵敏度为0.71，PPV为0.39，NPV为0.89。PHQ-A和GAD-7各项目的个体症状均值在区分有抑郁和焦虑与无抑郁和焦虑的青少年方面表现出中等能力。
PHQ-A和GAD-7在筛查抑郁方面显示出尚可的心理测量特性，但在筛查焦虑方面表现不佳，假阳性率较高。即使使用经过临床验证的临界值，使用这些工具得出的人群患病率也会高出2至4倍，在解释流行病学结果时需要进行调整。
