Citation

Velloza J, Njoroge J, Ngure K, Thuo N, Kiptinness C, Momanyi R, Ayub S, Gakuo S, Mugo N, Simoni J, Heffron R. BMC Psychiatry 2020; 20(1): e31.

Copyright

(Copyright © 2020, Holtzbrinck Springer Nature Publishing Group - BMC)

DOI

10.1186/s12888-020-2435-6

PMID

31996166

PMCID

PMC6990517

Abstract

BACKGROUND: African women face high rates of depression, particularly during pregnancy or postpartum or after a recent HIV diagnosis. The Patient Health Questionnaire-9 (PHQ-9) depression screening tool has been quantitatively validated and extensively used to identify depression and link individuals to care. However, qualitative work is necessary to identify important opportunities to improve PHQ-9 question comprehension and performance among Kenyan women.
METHODS: We administered the Kiswahili or English PHQ-9 (based on preference) to 29 pregnant and postpartum women in Thika, Kenya. Following administration, we conducted cognitive interviews with a purposive sample of 20 women. We used analytic memos and data matrices to identify themes around scale acceptability, comprehension, and decision and response processes.
RESULTS: Most participants preferred to answer the PHQ-9 in Kiswahili (N = 15; 52%). Among the 20 interview participants, 12 (60%) had scores ≥5, indicating depressive symptoms. Overall, participants found the scale acceptable as an interviewer-administered tool. Participants reported few problems related to comprehension but had difficulty answering items not relevant to their lives (e.g., "watching television") and double-barreled items (e.g., "poor appetite or overeating"). They were hesitant to endorse items related to "duties as a wife and mother" and suicidal ideation. Most participants had difficulty distinguishing between response options of "several days" and "more than half the days".
CONCLUSIONS: We detected several problems related to PHQ-9 comprehension, decision processes, and response processes. We provide recommended changes to instructions and item wording to improve PHQ-9 validity among Kenyan women.

Language: en

Keywords

Humans; Adult; Female; Women; Depression; Young Adult; Pregnancy; Pilot Projects; Suicidal Ideation; Patient Health Questionnaire; Mass Screening; Postpartum Period; Reproducibility of Results; Mothers; Kenya; HIV Infections; Depression, Postpartum; Pregnancy Complications; PHQ-9; Mental Status and Dementia Tests