Background: Brief depression screening questionnaires may increase
detection of depression in primary care settings but there have been few
validation studies carried out in typical populations in low-income
Methods: Cultural validation of the Patient Health Questionnaire
(PHQ-9/PHQ-2), the 20-item Self-Reporting Questionnaire (SRQ-20) and the
Kessler scales (K6/K10) was carried out in 306 adults consecutively
attending primary care facilities in small towns in Ethiopia. To assess
criterion validity, the gold standard assessment for presence of Major
Depressive Disorder (MDD) was made by Ethiopian psychiatric nurses using
the Mini International Neuropsychiatric Interview.
Results: The prevalence of gold standard MDD was 5.9%, with irritability
more common than depressed mood or anhedonia. The area under the
receiver operating characteristic curve indicated good performance of
the PHQ-9, SRQ-20, K6 and K10 (0.83–0.85) but only fair for the PHQ-2
(0.78). No cut-off score had acceptable sensitivity combined with
adequate positive predictive value. All screening questionnaires were
associated with disability and the PHQ-9 and SRQ-20 were associated with
higher health service contacts, indicating convergent validity.
Construct validity of all scales was indicated by unidimensionality on
exploratory factor analysis.
Limitations: Test-retest reliability was not assessed.
Conclusions: Brief depression screening questionnaires were found to be
valid in primary care in this low-income country. However, these
questionnaires do not have immediate applicability in routine clinical
settings. Further studies should evaluate utility of indicated screening
embedded within health system changes that support MDD detection.
Investigation of irritability as a core depression symptom is warranted.
This research is supported by the Department for International Development’s Programme for Improving Mental Health Care (PRIME) which is led by University of Cape Town
Hanlon, C.; Medhin, G.; Selamu, M.; Breuer, E.; Worku, B.; Hailemariam, M.; Lund, C.; Prince, M.; Fekadu, A. Validity of brief screening questionnaires to detect depression in primary care in Ethiopia. Journal of Affective Disorders (2015) 186: 32-39. [DOI: 10.1016/j.jad.2015.07.015]
Validity of brief screening questionnaires to detect depression in primary care in Ethiopia