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Validation of the Patient Health Questionnaire (PHQ-9) as a screening tool for depression in pregnant women: Afaan Oromo version

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  • Yitbarek Kidane Woldetensay
  • Tefera Belachew
  • Markos Tesfaye
  • Kathryn Spielman
  • Hans Konrad Biesalski
  • Eva Johanna Kantelhardt
  • Veronika Scherbaum

Abstract

Background: Semantic, technical, content, criterion and conceptual equivalence must be examined in order to validate a psychological rating scale in a new cultural setting. Few validation studies have been conducted in sub-Saharan Africa for scales seeking to detect depression in pregnant women. The aim of this study is to validate the 9-item Patient Health Questionnaire (PHQ-9) as a screening instrument for depression among Afaan Oromo speaking pregnant Ethiopian women. Methods: A random sample of 246 pregnant women were recruited in Seka Chekorsa District, Ethiopia during their first, second or third trimester. One week later, 29 participants were selected to answer the questionnaire for a second time to evaluate test retest reliability. The Mini International Neuropsychiatric Interview (MINI-Plus) scale was used as a gold standard to evaluate validity. PHQ-9 was compared with MINI-Plus and sensitivity, specificity, accuracy, positive likelihood ratio, negative likelihood ratio and Receiver Operating Characteristic Curves (ROC) for PHQ-9 were calculated. Rasch analysis was also carried out using Winsteps version 3.81.0. Results: The reliability coefficient, Cronbach's alpha, for the PHQ-9 total score was 0.84. Both the agreement and consistency Intra-class Correlation coefficients (ICC) for the one-week test-retest reliability were 0.98. The cut-off point of a summed score of eight resulted in a sensitivity of 80.8% and a specificity of 79.5%. The calculated area under the curve (AUC) for the PHQ-9 score versus the MINI-Plus was excellent, 0.88 (SE = 0.04; CI = 0.81–0.95). The PHQ-9 meets the criteria established by Linacre for rating scale effectiveness. Conclusions: The PHQ-9 proved to be a reliable and valid instrument that may be used to screen major depressive disorders among Afaan Oromo speaking Ethiopian pregnant women.

Suggested Citation

  • Yitbarek Kidane Woldetensay & Tefera Belachew & Markos Tesfaye & Kathryn Spielman & Hans Konrad Biesalski & Eva Johanna Kantelhardt & Veronika Scherbaum, 2018. "Validation of the Patient Health Questionnaire (PHQ-9) as a screening tool for depression in pregnant women: Afaan Oromo version," PLOS ONE, Public Library of Science, vol. 13(2), pages 1-15, February.
    • Handle: RePEc:plo:pone00:0191782
    DOI: 10.1371/journal.pone.0191782
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    References listed on IDEAS

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    1. Vikram Patel & Gregory Simon & Neerja Chowdhary & Sylvia Kaaya & Ricardo Araya, 2009. "Packages of Care for Depression in Low- and Middle-Income Countries," PLOS Medicine, Public Library of Science, vol. 6(10), pages 1-7, October.
    2. David Andrich, 1978. "A rating formulation for ordered response categories," Psychometrika, Springer;The Psychometric Society, vol. 43(4), pages 561-573, December.
    3. Jacov Lerner & Pinchas Noy, 1968. "Somatic Complaints in Psychiatric Disorders: Social and Cultural Factors," International Journal of Social Psychiatry, , vol. 14(2), pages 145-150, April.
    4. Gemma-Claire Ali & Grace Ryan & Mary J De Silva, 2016. "Validated Screening Tools for Common Mental Disorders in Low and Middle Income Countries: A Systematic Review," PLOS ONE, Public Library of Science, vol. 11(6), pages 1-14, June.
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    1. Fidèle Sebera & Joao Ricardo Nickenig Vissoci & Josiane Umwiringirwa & Dirk E Teuwen & Paul E Boon & Peter Dedeken, 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, Public Library of Science, vol. 15(6), pages 1-16, June.

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