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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

Author

Listed:
  • Fidèle Sebera
  • Joao Ricardo Nickenig Vissoci
  • Josiane Umwiringirwa
  • Dirk E Teuwen
  • Paul E Boon
  • Peter Dedeken

Abstract

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.

Suggested Citation

  • 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.
    • Handle: RePEc:plo:pone00:0234095
    DOI: 10.1371/journal.pone.0234095
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    References listed on IDEAS

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    2. Getenet Dessie & Henok Mulugeta & Cheru Tesema Leshargie & Fasil Wagnew & Sahai Burrowes, 2019. "Depression among epileptic patients and its association with drug therapy in sub-Saharan Africa: A systematic review and meta-analysis," PLOS ONE, Public Library of Science, vol. 14(3), pages 1-16, March.
    3. 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.
    4. Rosseel, Yves, 2012. "lavaan: An R Package for Structural Equation Modeling," Journal of Statistical Software, Foundation for Open Access Statistics, vol. 48(i02).
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