Thompson Ashland C, Stockton Melissa A, Mphonda Steven, Nyirenda Jerome, Matewere Maureen, Udedi Michael, Kulisewa Kazione, Gaynes Bradley N, Bhushan Nivedita L
University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
University of Pennsylvania, Philadelphia, PA, USA.
J Affect Disord. 2025 Jul 12;390:119863. doi: 10.1016/j.jad.2025.119863.
Depression significantly affects adolescents in low- and middle-income countries (LMICs), particularly adolescents living with HIV (ALWH). In sub-Saharan Africa (SSA), where depression prevalence among ALWH ranges from 26 to 29 %, it is essential to screen for depressive symptoms despite the challenges of limited resources. The Patient Health Questionnaire-Adolescent (PHQ-A) is a widely used tool for depression screening, but its effectiveness for adolescents in Malawi has not been thoroughly explored. This study cognitive interview tested the PHQ-A for adolescents in Malawi with the goal of ensuring cultural appropriateness and improving the tool's sensitivity and specificity for the entire adolescent population.
The study conducted cognitive interviews to explore conceptualizations of depression among both ALWH (n = 10) and adolescents without HIV (n = 10) in Malawi, assess the acceptability and comprehension of PHQ-A items, and adapt the PHQ-A for local use. The study involved adolescents (age 13-19 years), half of whom were living with HIV, who were recruited from two public health centers in Lilongwe.
Findings showed that participants were able to answer all PHQ-A items, but faced challenges comprehending questions 2 and 5, using Likert scales, the response period, and truthfully answering questions about suicidality. Additionally, Malawian adolescents perceive depression through cultural expressions involving heart issues, excessive thinking, and a focus on family and friends. ALWH interpreted some symptoms of the PHQ-A differently, yet they generally understood and responded to the questions similarly to adolescents without HIV.
While the PHQ-A is a widely used tool, its application among adolescents in Malawi requires further exploration and adaptation to ensure cultural relevance and accuracy in depression screening. This study underscores the importance of culturally sensitive mental health assessments to accurately screen adolescents and connect them with appropriate mental health services.
抑郁症对低收入和中等收入国家（LMICs）的青少年有显著影响，尤其是感染艾滋病毒的青少年（ALWH）。在撒哈拉以南非洲（SSA），ALWH中抑郁症患病率在26%至29%之间，尽管资源有限面临挑战，但筛查抑郁症状至关重要。患者健康问卷 - 青少年版（PHQ - A）是一种广泛用于抑郁症筛查的工具，但尚未对其在马拉维青少年中的有效性进行深入研究。本研究通过认知访谈对马拉维青少年的PHQ - A进行测试，目的是确保其文化适宜性，并提高该工具对全体青少年人群的敏感性和特异性。
该研究进行了认知访谈，以探讨马拉维ALWH（n = 10）和未感染艾滋病毒的青少年（n = 10）对抑郁症的概念理解，评估PHQ - A项目的可接受性和理解程度，并对PHQ - A进行本地化改编。该研究纳入了年龄在13 - 19岁的青少年，其中一半感染艾滋病毒，他们是从利隆圭的两个公共卫生中心招募的。
研究结果表明，参与者能够回答所有PHQ - A项目，但在理解问题2和5、使用李克特量表、回答期限以及如实回答有关自杀倾向的问题时面临挑战。此外，马拉维青少年通过涉及心脏问题、过度思考以及关注家人和朋友的文化表达方式来感知抑郁症。ALWH对PHQ - A的某些症状有不同的解读，但他们总体上对问题的理解和回答与未感染艾滋病毒的青少年相似。
虽然PHQ - A是一种广泛使用的工具，但在马拉维青少年中的应用需要进一步探索和调整，以确保在抑郁症筛查中具有文化相关性和准确性。本研究强调了文化敏感的心理健康评估对于准确筛查青少年并为他们提供适当心理健康服务的重要性。
