Show simple item record

Detection of depression in low resource settings: validation of the Patient Health Questionnaire (PHQ-9) and cultural concepts of distress in Nepal.

dc.contributor.author Kohrt, Brandon A
dc.contributor.author Luitel, Nagendra P
dc.contributor.author Acharya, Prakash
dc.contributor.author Jordans, Mark JD
dc.coverage.spatial England
dc.date.accessioned 2016-06-01T19:35:43Z
dc.date.issued 2016-03-08
dc.identifier http://www.ncbi.nlm.nih.gov/pubmed/26951403
dc.identifier 10.1186/s12888-016-0768-y
dc.identifier.uri https://hdl.handle.net/10161/12069
dc.description.abstract BACKGROUND: Despite recognition of the burden of disease due to mood disorders in low- and middle-income countries, there is a lack of consensus on best practices for detecting depression. Self-report screening tools, such as the Patient Health Questionnaire (PHQ-9), require modification for low literacy populations and to assure cultural and clinical validity. An alternative approach is to employ idioms of distress that are locally salient, but these are not synonymous with psychiatric categories. Therefore, our objectives were to evaluate the validity of the PHQ-9, assess the added value of using idioms of distress, and develop an algorithm for depression detection in primary care. METHODS: We conducted a transcultural translation of the PHQ-9 in Nepal using qualitative methods to achieve semantic, content, technical, and criterion equivalence. Researchers administered the Nepali PHQ-9 to randomly selected patients in a rural primary health care center. Trained psychosocial counselors administered a validated Nepali depression module of the Composite International Diagnostic Interview (CIDI) to validate the Nepali PHQ-9. Patients were also assessed for local idioms of distress including heart-mind problems (Nepali, manko samasya). RESULTS: Among 125 primary care patients, 17 (14 %) were positive for a major depressive episode in the prior 2 weeks based on CIDI administration. With a Nepali PHQ-9 cutoff ≥ 10: sensitivity = 0.94, specificity = 0.80, positive predictive value (PPV) =0.42, negative predictive value (NPV) =0.99, positive likelihood ratio = 4.62, and negative likelihood ratio = 0.07. For heart-mind problems: sensitivity = 0.94, specificity = 0.27, PPV = 0.17, NPV = 0.97. With an algorithm comprising two screening questions (1. presence of heart-mind problems and 2. function impairment due to heart-mind problems) to determine who should receive the full PHQ-9, the number of patients requiring administration of the PHQ-9 could be reduced by 50 %, PHQ-9 false positives would be reduced by 18 %, and 88 % of patients with depression would be correctly identified. CONCLUSION: Combining idioms of distress with a transculturally-translated depression screener increases efficiency and maintains accuracy for high levels of detection. The algorithm reduces the time needed for primary healthcare staff to verbally administer the tool for patients with limited literacy. The burden of false positives is comparable to rates in high-income countries and is a limitation for universal primary care screening.
dc.language eng
dc.publisher Springer Science and Business Media LLC
dc.relation.ispartof BMC Psychiatry
dc.relation.isversionof 10.1186/s12888-016-0768-y
dc.subject Adult
dc.subject Culture
dc.subject Depressive Disorder, Major
dc.subject Female
dc.subject Humans
dc.subject Male
dc.subject Mass Screening
dc.subject Nepal
dc.subject Poverty
dc.subject Primary Health Care
dc.subject Reproducibility of Results
dc.subject Self Report
dc.subject Sensitivity and Specificity
dc.subject Surveys and Questionnaires
dc.subject Translating
dc.title Detection of depression in low resource settings: validation of the Patient Health Questionnaire (PHQ-9) and cultural concepts of distress in Nepal.
dc.type Journal article
duke.contributor.id Kohrt, Brandon A|0598618
pubs.author-url http://www.ncbi.nlm.nih.gov/pubmed/26951403
pubs.begin-page 58
pubs.organisational-group Clinical Science Departments
pubs.organisational-group Cultural Anthropology
pubs.organisational-group Duke
pubs.organisational-group Global Health Institute
pubs.organisational-group Institutes and Provost's Academic Units
pubs.organisational-group Psychiatry & Behavioral Sciences
pubs.organisational-group Psychiatry & Behavioral Sciences, Social and Community Psychiatry
pubs.organisational-group School of Medicine
pubs.organisational-group Trinity College of Arts & Sciences
pubs.organisational-group University Institutes and Centers
pubs.publication-status Published online
pubs.volume 16
dc.identifier.eissn 1471-244X


Files in this item

Thumbnail

This item appears in the following Collection(s)

Show simple item record