Brandon A. Kohrt|Nagendra P. Luitel|Prakash Acharya|Mark J. D. Jordans
Detection of depression in low resource settings: validation of the Patient Health Questionnaire (PHQ-9) and cultural concepts of distress in Nepal
King's College London
despite recognition burden disease due mood disorders low middleincome countries lack consensus best practices detecting depression selfreport screening tools patient health questionnaire phq9 require modification low literacy populations assure cultural clinical validity alternative approach employ idioms distress locally salient synonymous psychiatric categories therefore objectives evaluate validity phq9 assess added value using idioms distress develop algorithm depression detection primary care conducted transcultural translation phq9 nepal using qualitative methods achieve semantic content technical criterion equivalence researchers administered nepali phq9 randomly selected patients rural primary health care center trained psychosocial counselors administered validated nepali depression module composite international diagnostic interview cidi validate nepali phq9 patients also assessed local idioms distress including heartmind problems nepali manko samasya among 125 primary care patients 17 14 positive major depressive episode prior 2 weeks based cidi administration nepali phq9 cutoff 10 sensitivity 094 specificity 080 positive predictive value ppv 042 negative predictive value npv 099 positive likelihood ratio 462 negative likelihood ratio 007 heartmind problems sensitivity 094 specificity 027 ppv 017 npv 097 algorithm comprising two screening questions 1 presence heartmind problems 2 function impairment due heartmind problems determine receive full phq9 number patients requiring administration phq9 could reduced 50 phq9 false positives would reduced 18 88 patients depression would correctly identified combining idioms distress transculturallytranslated depression screener increases efficiency maintains accuracy high levels detection algorithm reduces time needed primary healthcare staff verbally administer tool patients limited literacy burden false positives comparable rates highincome countries limitation universal primary care screening