Cognitive interviewing of the PHQ-A for depression screening among adolescents living with and without HIV in Malawi.

BACKGROUND

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.

METHOD

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.

RESULTS

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.

CONCLUSION

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.