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Validity, reliability and cut-offs of the Patient Health Questionnaire-9 as a screening tool for depression among patients living with epilepsy in Rwanda.

Publication ,  Journal Article
Sebera, F; Vissoci, JRN; Umwiringirwa, J; Teuwen, DE; Boon, PE; Dedeken, P
Published in: PLoS One
2020

BACKGROUND: Patients with epilepsy (PwE) have an increased risk of active and lifetime depression. Two in 10 patients experience depression. Lack of trained psychiatric staff in low- and middle-income countries (LMIC) creates a need for screening tools that enable detection of depression in PwE. We describe the translation, validity and reliability assessment of the Patient Health Questionnaire-9 (PHQ-9) as a screening tool for depression among PwE in Rwanda. METHOD: PHQ-9 was translated to Kinyarwanda using translation-back translation and validated by a discussion group. For validation, PwE of ≥15 years of age were administered the PHQ-9 and Hamilton Depression Rating Scale (HDRS) by trained psychiatry staff at Visit 1. A random sample of 20% repeated PHQ-9 and HDRS after 14 days to assess temporal stability and intra-rater reliability. Internal structure, reliability and external validity were assessed using confirmatory factor analysis, reliability coefficients and HDRS-correlation, respectively. Maximal Youden's index was considered for cut-offs. RESULTS: Four hundred and thirty-four PwE, mean age 30.5 years (SD ±13.3), were included of whom 33.6%, 37.9%, 13.4%, and 15.1% had no, mild, moderate and severe depression, respectively. PHQ-9 performed well on a one-factor model (unidimensional model), with factor loadings of 0.63-0.86. Reliability coefficients above 0.80 indicated strong internal consistency. Good temporal stability was observed (0.79 [95% CI: 0.68-0.87]). A strong correlation (R = 0.66, p = 0.01) between PHQ-9 and HDRS summed scores demonstrated robust external validity. The optimal cut-off for the PHQ-9 was similar (≥5) for mild and moderate depression and ≥7 for severe depression. CONCLUSION: PHQ-9 validation in Kinyarwanda creates the capacity to screen PwE in Rwanda at scores of ≥5 for mild or moderate and ≥7 for severe depression. The availability of validated tools for screening and diagnosis for depression is a forward step for holistic care in a resource-limited environment.

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Published In

PLoS One

DOI

EISSN

1932-6203

Publication Date

2020

Volume

15

Issue

6

Start / End Page

e0234095

Location

United States

Related Subject Headings

  • Young Adult
  • Translating
  • Severity of Illness Index
  • Rwanda
  • Reproducibility of Results
  • ROC Curve
  • Psychometrics
  • Patient Health Questionnaire
  • Male
  • Humans
 

Citation

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Sebera, F., Vissoci, J. R. N., Umwiringirwa, J., Teuwen, D. E., Boon, P. E., & Dedeken, P. (2020). Validity, reliability and cut-offs of the Patient Health Questionnaire-9 as a screening tool for depression among patients living with epilepsy in Rwanda. PLoS One, 15(6), e0234095. https://doi.org/10.1371/journal.pone.0234095
Sebera, Fidèle, Joao Ricardo Nickenig Vissoci, Josiane Umwiringirwa, Dirk E. Teuwen, Paul E. Boon, and Peter Dedeken. “Validity, reliability and cut-offs of the Patient Health Questionnaire-9 as a screening tool for depression among patients living with epilepsy in Rwanda.PLoS One 15, no. 6 (2020): e0234095. https://doi.org/10.1371/journal.pone.0234095.
Sebera, Fidèle, et al. “Validity, reliability and cut-offs of the Patient Health Questionnaire-9 as a screening tool for depression among patients living with epilepsy in Rwanda.PLoS One, vol. 15, no. 6, 2020, p. e0234095. Pubmed, doi:10.1371/journal.pone.0234095.

Published In

PLoS One

DOI

EISSN

1932-6203

Publication Date

2020

Volume

15

Issue

6

Start / End Page

e0234095

Location

United States

Related Subject Headings

  • Young Adult
  • Translating
  • Severity of Illness Index
  • Rwanda
  • Reproducibility of Results
  • ROC Curve
  • Psychometrics
  • Patient Health Questionnaire
  • Male
  • Humans