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Development and cross-cultural testing of the International Depression Symptom Scale (IDSS): a measurement instrument designed to represent global presentations of depression

  • E. E. Haroz (a1), J. Bass (a1), C. Lee (a2), S. S. Oo (a3), K. Lin (a4), B. Kohrt (a5), L. Michalopolous (a6), A. J. Nguyen (a7) and P. Bolton (a2)...

Abstract

Background

Self-report measurement instruments are commonly used to screen for mental health disorders in Low and Middle-Income Countries (LMIC). The Western origins of most depression instruments may constitute a bias when used globally. Western measures based on the DSM, do not fully capture the expression of depression globally. We developed a self-report scale design to address this limitation, the International Depression Symptom Scale-General version (IDSS-G), based on empirical evidence of the signs and symptoms of depression reported across cultures. This paper describes the rationale and process of its development and the results of an initial test among a non-Western population.

Methods

We evaluated internal consistency reliability, test–retest reliability and inter-rater reliability of the IDSS-G in a sample N = 147 male and female attendees of primary health clinics in Yangon, Myanmar. For criterion validity, IDSS-G scores were compared with diagnosis by local psychiatrists using the Structured Clinical Interview for DSM (SCID). Construct validity was evaluated by investigating associations between the IDSS-G and the Patient Health Questionnaire (PHQ), impaired function, and suicidal ideation.

Results

The IDSS-G showed high internal consistency reliability (α = 0.92), test–retest reliability (r = 0.87), and inter-rater reliability (ICC = 0.90). Strong correlations between the IDSS-G and PHQ-9, functioning, and suicidal ideation supported construct validity. Criterion validity was supported for use of the IDSS-G to identify people with a SCID diagnosed depressive disorder (major depression/dysthymia). The IDSS-G also demonstrated incremental validity by predicting functional impairment beyond that predicted by the PHQ-9. Results suggest that the IDSS-G accurately assesses depression in this population. Future testing in other populations will follow.

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Copyright

This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.

Corresponding author

*Address for correspondence: E. E. Haroz, Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205, USA. (Email: EHaroz1@jhu.edu)

References

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Adewuya, AO, Ola, BA, Afolabi, OO (2006). Validity of the patient health questionnaire (PHQ-9) as a screening tool for depression amongst Nigerian university students. Journal of Affective Disorders 96, 8993. doi: 10.1016/j.jad.2006.05.021.
Ali, G-C, Ryan, G, De Silva, MJ, Moussavi, S, Chatterji, S, Verdes, E, Tandon, A, Patel, V, Ustun, B, Simon, G, Abas, M, Ali, G, Nakimuli-Mpungu, E, Chibanda, D, Hotopf, M, Chidgey, J, Addington-Hall, J, Ly, KL, Brown, L, Kroenke, K, Lunda, C, Breena, A, Flishera, A, Kakumab, R, Corrigalla, J, Joskaa, J, Missinne, S, Bracke, P, Lindert, J, von Ehrenstein, O, Priebe, S, Mielckd, A, Brähler, E, Bronstein, I, Montgomery, P, Vythilingum, B, Field, S, Kafaar, Z, Baron, E, Stein, D, Sanders, L, Abiodun, O, Patel, V, Kirmayer, L, Adewuya, A, Ola, B, Dada, A, Fasoto, O, Bolton, P, Bass, J, Ryder, R, Lammers, M, Mukaba, T, Bolton, P, Tsai, A, Scott, J, Hung, K, Zhu, J, Matthews, L, Psaros, C, Reuland, D, Cherrington, A, Watkins, G, Bradford, D, Blanco, R, Gaynes, B, Wu, C, Kelley, L, Akena, D, Joska, J, Obuku, E, Amos, T, Musisi, S, Stein, D, Glasa, A, Lijmerb, J, Prinsc, M, Bonseld, G, Bossuyta, P, Sheng, L, Wang, Y, Zhang, L, Chen, C, Yao, G, Mumford, D, Ayub, M, Karim, R, Izhar, N, Asif, A, Bavington, J, Rumble, S, Swartz, L, Parry, C, Zwarenstein, M, Abiodun, O, Adewuya, A, Ola, B, Afolabi, O, Zhang, Y, Liang, W, Chen, Z, Zhang, H, Zhang, J, Weng, X, Khamseh, M, Baradaran, H, Javanbakht, A, Mirghorbani, M, Yadollahi, Z, Malek, M, Gelaye, B, Williams, M, Lemma, S, Deyessa, N, Bahretibeb, Y, Shibre, T, Uwakwe, R (2016). Validated screening tools for common mental disorders in low and middle income countries: a systematic review. PLoS ONE 11, e0156939. doi: 10.1371/journal.pone.0156939.
Allen, MJ, Yen, WM (2002) Introduction to Measurement Theory. Waveland Press, Inc: Long Grove, IL.
Almeida, OP, Draper, B, Pirkis, J, Snowdon, J, Lautenschlager, NT, Byrne, G, Sim, M, Stocks, N, Kerse, N, Flicker, L, Pfaff, JJ (2012). Anxiety, depression, and comorbid anxiety and depression: risk factors and outcome over two years. International Psychogeriatrics 24, 16221632.
American Psychiatric Association (2000). Diagnostic and Statistical Manual of Mental Disorders: DSM-IV-TR.Author: Washington, DC: Washington, DC.
American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders, 5th edn. American Psychiatric Publishing.
Applied Mental Health Research Group (2013). Design, Implementation, Monitoring, and Evaluation of Mental Health and Psychosocial Assistance Programs for Trauma Survivors in low Resource Countries: a User's Manual for Researchers and Program Implementers. Johns Hopkins University: Baltimore, MD.
Bass, JK, Annan, J, McIvor Murray, S, Kaysen, D, Griffiths, S, Cetinoglu, T, Wachter, K, Murray, LK, Bolton, PA (2013). Controlled trial of psychotherapy for Congolese survivors of sexual violence. New England Journal of Medicine 368, 21822191. doi: 10.1056/NEJMoa1211853.
Bass, JK, Ryder, RW, Lammers, M-C, Mukaba, TN, Bolton, PA (2008). Post-partum depression in Kinshasa, Democratic Republic of Congo: validation of a concept using a mixed-methods cross-cultural approach. Tropical Medicine and International Health: TM & IH 13, 15341542. doi: 10.1111/j.1365-3156.2008.02160.x.
Beck, AT, Ward, CH, Mendelson, M, Mock, J, Erbaugh, J (1961). An inventory for measuring depression. Archives of General Psychiatry 4, 561571.
Bolton, P, Bass, J, Neugebauer, R, Verdeli, H, Clougherty, KF, Wickramaratne, P, Speelman, L, Ndogoni, L, Weissman, M (2003). Group interpersonal psychotherapy for depression in Rural Uganda. JAMA 289, 3117. doi: 10.1001/jama.289.23.3117.
Bolton, P, Lee, C, Haroz, EE, Murray, L, Dorsey, S, Robinson, C, Ugueto, AM, Bass, J (2014). A transdiagnostic community-based mental health treatment for comorbid disorders: development and outcomes of a randomized controlled trial among burmese refugees in Thailand. PLoS Medicine 11, e1001757. doi: 10.1371/journal.pmed.1001757.
Bromet, E, Andrade, LH, Hwang, I, Sampson, NA, Alonso, J, de Girolamo, G, de Graaf, R, Demyttenaere, K, Hu, C, Iwata, N, Karam, AN, Kaur, J, Kostyuchenko, S, Lépine, J-P, Levinson, D, Matschinger, H, Mora, MEM, Browne, MO, Posada-Villa, J, Viana, MC, Williams, DR, Kessler, RC (2011). Cross-national epidemiology of DSM-IV major depressive episode. BMC Medicine 9, 90. doi: 10.1186/1741-7015-9-90.
Cohen, J (1988). Statistical Power Analysis for the Behavioral Sciences. Lawrence Erlbaum Associates: Mahwah, NJ.
Craney, TA, Surles, JG (2002). Model-dependent variance inflation factor cutoff values. Quality Engineering 14, 391403.
Cronbach, LJ (1951). Coefficient alpha and the internal structure of tests. Psychometrika 16, 297334.
Ferrari, AJ, Charlson, FJ, Norman, RE, Patten, SB, Freedman, G, Murray, CJL, Vos, T, Whiteford, HA, Ferrari, A, Somerville, A, Baxter, A, Norman, R, Patten, S, Ferrari, A, Charlson, F, Norman, R, Flaxman, A, Patten, S, Charlson, F, Ferrari, A, Somerville, A, Norman, R, Patten, S, Ustun, T, Ayuso-Mateos, J, Chatterji, S, Mathers, C, Murray, C, Prince, M, Patel, V, Saxena, S, Maj, M, Maselko, J, Murray, C, Ezzati, M, Flaxman, A, Lim, S, Lozano, R, Murray, C, Vos, T, Lozano, R, Naghavi, M, Flaxman, A, Lim, S, Vos, T, Flaxman, A, Danaei, G, Shibuya, K, Lozano, R, Naghavi, M, Foreman, K, Lim, S, Shibuya, K, Salomon, J, Vos, T, Hogan, D, Gagnon, M, Naghavi, M, Vos, T, Flaxman, A, Naghavi, M, Lozano, R, Michaud, C, Whiteford, H, Degenhardt, L, Rehm, J, Baxter, A, Ferrari, A, Moher, D, Liberati, A, Tetzlaff, J, Altman, D, The, P, Kruijshaar, M, Barendregt, J, Vos, T, de Graaf, R, Spijker, J, Moffitt, T, Caspi, A, Taylor, A, Kokaua, J, Milne, B, Simon, G, VonKorff, M, Susser, E, Shrout, P, Baxter, A, Page, A, Whiteford, H, Vos, T, Haby, M, Barendregt, J, Kruijshaar, M, Corry, J, Barendregt, J, Van Oortmarssen, G, Vos, T, Murray, C, Baxter, A, Charlson, F, Somerville, A, Whiteford, H, Charlson, F, Stapelberg, N, Baxter, A, Whiteford, H, Li, Z, Page, A, Martin, G, Taylor, R, Eaton, W, Kalaydjian, A, Scharfstein, D, Mezuk, B, Ding, Y, Fu, T, Lee, C, Gunnell, D, Lee, W, Cheng, A, Charlson, F, Steel, Z, Degenhardt, L, Chey, T, Silove, D, Jessop, E, Murray, C, Richards, M, Newton, J, Fenton, L, McKnight, P, Kashdan, T, Sheehan, K, Sheehan, D, Sheehan, D, Harnett-Sheehan, K, Raj, B, Kessler, R, Berglund, P, Demler, O, Jin, R, Koretz, D (2013). Burden of depressive disorders by country, sex, age, and year: findings from the global burden of disease study 2010. PLoS Medicine 10, e1001547. doi: 10.1371/journal.pmed.1001547.
Fischer, JE, Bachmann, LM, Jaeschke, R (2003). A readers' guide to the interpretation of diagnostic test properties: clinical example of sepsis. Intensive Care Medicine 29, 10431051.
Fleiss, J (1986). The Design and Analysis of Clinical Experiments. John Wiley & Sons, Ltd: New York, NY.
Ghimire, DJ, Chardoul, S, Kessler, RC, Axinn, WG and Adhikari, BP (2013). Modifying and validating the Composite International Diagnostic Interview (CIDI) for use in Nepal. International Journal of Methods in Psychiatric Research 22, 7181. doi: 10.1002/mpr.1375.
Hamilton, M (1960). A rating scale for depression. Journal of Neurology, Neurosurgery, and Psychiatry 23, 5662.
Haroz, EE, Bass, JK, Lee, C, Murray, LK, Robinson, C, Bolton, P (2014). Adaptation and testing of psychosocial assessment instruments for cross-cultural use: an example from the Thailand Burma border. BMC Psychology 2, 31. doi: 10.1186/s40359-014-0031-6.
Haroz, EE, Bolton, P, Gross, A, Chan, KS, Michalopoulos, L, Bass, J (2016). Depression symptoms across cultures: an IRT analysis of standard depression symptoms using data from eight countries. Social Psychiatry and Psychiatric Epidemiology 51, 981991. doi: 10.1007/s00127-016-1218-3.
Haroz, EE, Ritchey, M, Bass, JK, Kohrt, BA, Augustinavicius, J, Michalopoulos, L, Burkey, MD, Bolton, P (2017). How is depression experienced around the world? A systematic review of qualitative literature. Social Science and Medicine 183, 151162. doi: 10.1016/j.socscimed.2016.12.030.
Hollifield, M (2002). Accurate measurement in cultural psychiatry: will we pay the costs? Transcultural Psychiatry 39, 419421. doi: 10.1177/136346150203900401.
Jayawickreme, N, Jayawickreme, E, Atanasov, P, Goonasekera, MA, Foa, EB (2012). Are culturally specific measures of trauma-related anxiety and depression needed? The case of Sri Lanka. Psychological Assessment 24, 791800. doi: 10.1037/a0027564.
Jorm, AF (2000). Does old age reduce the risk of anxiety and depression? A review of epidemiological studies across the adult life span. Psychological Medicine 30, 1122.
Kessler, RC, Berglund, P, Demler, O, Jin, R, Koretz, D, Merikangas, KR, Rush, AJ, Walters, EE, Wang, PS (2003). The epidemiology of major depressive disorder. JAMA 289, 3095. doi: 10.1001/jama.289.23.3095.
Kessler, RC, Bromet, EJ (2013). The epidemiology of depression across cultures. Annual Review of Public Health 34, 119138. doi: 10.1146/annurev-publhealth-031912-114409.
Keys, HM, Kaiser, BN, Kohrt, BA, Khoury, NM, Brewster, A-RT (2012). Idioms of distress, ethnopsychology, and the clinical encounter in Haiti's Central Plateau. Social Science and Medicine 75, 555564. doi: 10.1016/j.socscimed.2012.03.040.
Kohrt, BA, Rasmussen, A, Kaiser, BN, Haroz, EE, Maharjan, SM, Mutamba, BB, de Jong, JT, Hinton, DE (2014). Cultural concepts of distress and psychiatric disorders: literature review and research recommendations for global mental health epidemiology. International Journal of Epidemiology 43, 365406. doi: 10.1093/ije/dyt227.
Kroenke, K, Spitzer, RL, Williams, JB (2001). The PHQ-9: validity of a brief depression severity measure. Journal of General Internal Medicine 16, 606613. doi: 10.1046/j.1525-1497.2001.016009606.x.
Liu, X (2012). Classification accuracy and cut pointselection. Statistics in Medicine 31, 26762686. doi: 10.1002/sim.4509.
Lotrakul, M, Sumrithe, S, Saipanish, R (2008). Reliability and validity of the thai version of the PHQ-9. BMC Psychiatry 8, 4653.
Marc, LG, Henderson, WR, Desrosiers, A, Testa, MA, Jean, SE, Akom, EE (2014). Reliability and validity of the haitian creole PHQ-9. Journal of General Internal Medicine 29, 16791686.
Miller, KE, Omidian, P, Quraishy, AS, Quraishy, N, Nasiry, MN, Nasiry, S, Karyar, NM, Yaqubi, AA (2006). The Afghan Symptom Checklist: a culturally grounded approach to mental health assessment in a conflict zone. American Journal of Orthopsychiatry 76, 423433. doi: 10.1037/0002-9432.76.4.423.
Mulrow, CD, Williams, JW, Gerety, MB, Ramirez, G, Montiel, OM, Kerber, C (1995). Case-finding instruments for depression in primary care settings. Annals of Internal Medicine 122, 913921.
Muthén, LK, Muthén, BO (1998–2012). Mplus User’ s Guide, 7th edn. Muthen & Muthen: Los Angeles, CA.
Nichter, M (2010). Idioms of distress revisited. Culture, Medicine, and Psychiatry 34, 401416. doi: 10.1007/s11013-010-9179-6.
Nock, MK, Borges, G, Bromet, EJ, Alonso, J, Angermeyer, M, Beautrais, A, Bruffaerts, R, Chiu, WT, de Girolamo, G, Gluzman, S, de Graaf, R, Gureje, O, Haro, JM, Huang, Y, Karam, E, Kessler, RC, Lepine, JP, Levinson, D, Medina-Mora, ME, Ono, Y, Posada-Villa, J, Williams, D (2008). Cross-national prevalence and risk factors for suicidal ideation, plans and attempts. British Journal of Psychiatry 192, 98105. doi: 10.1192/bjp.bp.107.040113.
Nolen-Hoeksema, S, Larson, J, Grayson, C (1999). Explaining the gender difference in depressive symptoms. Journal of Personality and Social Psychology 77, 10611072.
Ormel, J, Petukhova, M, Chatterji, S, Aguilar-Gaxiola, S, Alonso, J, Angermeyer, MC, Bromet, EJ, Burger, H, Demyttenaere, K, de Girolamo, G, Haro, JM, Hwang, I, Karam, E, Kawakami, N, Lepine, JP, Medina-Mora, ME, Posada-Villa, J, Sampson, N, Scott, K, Ustun, TB, Von Korff, M, Williams, DR, Zhang, M, Kessler, RC (2008). Disability and treatment of specific mental and physical disorders across the world. British Journal of Psychiatry 192, 368375. doi: 10.1192/bjp.bp.107.039107.
Patel, V, Araya, R, Chowdhary, N, King, M, Kirkwood, B, Nayak, S, Simon, G, Weiss, HA (2008). Detecting common mental disorders in primary care in India: a comparison of five screening questionnaires. Psychological Medicine 38, 221228. doi: 10.1017/S0033291707002334.
Patel, V, Simon, G, Chowdhary, N, Kaaya, S, Araya, R (2009). Packages of care for depression in low- and middle-income countries. PLoS Medicine 6, e1000159. doi: 10.1371/journal.pmed.1000159.
Patel, V, Simunyu, E, Gwanzura, F, Lewis, G, Mann, A (1997). The shona symptom questionnaire: the development of an indigenous measure of common mental disorders in Harare. Acta Psychiatrica Scandinavica 95, 469475.
Phan, T, Steel, Z, Silove, D (2004). An ethnographically derived measure of anxiety, depression and somatization: the Phan Vietnamese Psychiatric Scale. Transcultural Psychiatry 41, 200232. doi: 10.1177/1363461504043565.
Radloff, LS (1977). The CES-D scale: a self-report depression scale for research in the general population. Applied Psychological Measurement 1, 385401. doi: 10.1177/014662167700100306.
Rasmussen, A, Keatley, E, Joscelyne, A (2014). Posttraumatic stress in emergency settings outside North America and Europe: a review of the emic literature. Social Science and Medicine (1982) 109, 4454. doi: 10.1016/j.socscimed.2014.03.015.
Sackett, PR, Lievens, F (2008). Personnel selection. Annual Review of Psychology. 59, 419450. doi: 10.1146/annurev.psych.59.103006.093716.
Spitzer, RL, Williams, JB, Gibbon, M, First, MB (1995). Structured Clinical Interview for DSM-IV (SCID). Biometrics Research: New York.
StataCorp (2013). Stata Statistical Software: Release 13. StataCorp LP: College Station, TX.
Van de Velde, S, Bracke, P, Levecque, K (2010). Gender differences in depression in 23 European countries. Cross-national variation in the gender gap in depression. Social Science and Medicine 71, 305313. doi: 10.1016/j.socscimed.2010.03.035.
van Ginneken, N, Tharyan, P, Lewin, S, Rao, GN, Meera, SM, Pian, J, Chandrashekar, S, Patel, V (2013). Non-specialist health worker interventions for the care of mental, neurological and substance-abuse disorders in low- and middle-income countries. Cochrane Database of Systematic Reviews 11, CD009149. doi: 10.1002/14651858.CD009149.pub2.
Viera, AJ, Garrett, JM (2005). Understanding interobserver agreement: the kappa statistic. Family Medicine 37, 360363.
Zhong, Q, Gelaye, B, Fann, JR, Sanchez, SE, Williams, MA (2014). Cross-cultural validity of the spanish version of PHQ-9 among pregnant peruvian women: A rasch item response theory analysis. Journal of Affective Disorders 158, 148153.
Zung, WWK, Grinker, RR Sr., Overall, JE, Friedman, AS, Zunf, WWK, Wessman, AE, Hildreth, HM, Hathaway, S, McKinley, C, Hutchinson, JT, Smedberg, D, Beck, AT, Fleminger, JJ, Groden, B, Wechsler, H (1965). A self-rating depression scale. Archives of General Psychiatry 12, 63. doi: 10.1001/archpsyc.1965.01720310065008.

Keywords

Development and cross-cultural testing of the International Depression Symptom Scale (IDSS): a measurement instrument designed to represent global presentations of depression

  • E. E. Haroz (a1), J. Bass (a1), C. Lee (a2), S. S. Oo (a3), K. Lin (a4), B. Kohrt (a5), L. Michalopolous (a6), A. J. Nguyen (a7) and P. Bolton (a2)...

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