IDEAS home Printed from https://ideas.repec.org/a/plo/pone00/0234095.html
   My bibliography  Save this article

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
    as

    Download full text from publisher

    File URL: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0234095
    Download Restriction: no
    File URL: https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0234095&type=printable
    Download Restriction: no
    File URL: https://libkey.io/10.1371/journal.pone.0234095?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    References listed on IDEAS

    as
    1. Jiahua Chen & Zehua Chen, 2008. "Extended Bayesian information criteria for model selection with large model spaces," Biometrika, Biometrika Trust, vol. 95(3), pages 759-771.
    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).
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Md. Mominur Rahman & Bilkis Akhter, 2021. "The impact of investment in human capital on bank performance: evidence from Bangladesh," Future Business Journal, Springer, vol. 7(1), pages 1-13, December.
    2. César Merino-Soto & Gina Chávez-Ventura & Verónica López-Fernández & Guillermo M. Chans & Filiberto Toledano-Toledano, 2022. "Learning Self-Regulation Questionnaire (SRQ-L): Psychometric and Measurement Invariance Evidence in Peruvian Undergraduate Students," Sustainability, MDPI, vol. 14(18), pages 1-17, September.
    3. Nathaniel Oliver Iotti & Damiano Menin & Tomas Jungert, 2022. "Early Adolescents’ Motivations to Defend Victims of Cyberbullying," IJERPH, MDPI, vol. 19(14), pages 1-9, July.
    4. Frommlet, Florian & Ruhaltinger, Felix & Twaróg, Piotr & Bogdan, Małgorzata, 2012. "Modified versions of Bayesian Information Criterion for genome-wide association studies," Computational Statistics & Data Analysis, Elsevier, vol. 56(5), pages 1038-1051.
    5. Christoph Dworschak, 2024. "Bias mitigation in empirical peace and conflict studies: A short primer on posttreatment variables," Journal of Peace Research, Peace Research Institute Oslo, vol. 61(3), pages 462-476, May.
    6. Andreea-Ionela Puiu & Anca Monica Ardeleanu & Camelia Cojocaru & Anca Bratu, 2021. "Exploring the Effect of Status Quo, Innovativeness, and Involvement Tendencies on Luxury Fashion Innovations: The Mediation Role of Status Consumption," Mathematics, MDPI, vol. 9(9), pages 1-18, May.
    7. Slupphaug, KJell & Mehmetoglu, Mehmet & Mittner, Matthias, 2024. "modsem: An R package for estimating latent interactions and quadratic effects," OSF Preprints h3rpw, Center for Open Science.
    8. Zak-Szatkowska, Malgorzata & Bogdan, Malgorzata, 2011. "Modified versions of the Bayesian Information Criterion for sparse Generalized Linear Models," Computational Statistics & Data Analysis, Elsevier, vol. 55(11), pages 2908-2924, November.
    9. Allen, Jaime & Muñoz, Juan Carlos & Ortúzar, Juan de Dios, 2019. "On evasion behaviour in public transport: Dissatisfaction or contagion?," Transportation Research Part A: Policy and Practice, Elsevier, vol. 130(C), pages 626-651.
    10. Merkle, Edgar C. & Steyvers, Mark & Mellers, Barbara & Tetlock, Philip E., 2017. "A neglected dimension of good forecasting judgment: The questions we choose also matter," International Journal of Forecasting, Elsevier, vol. 33(4), pages 817-832.
    11. Sai-fu Fung & Esther Oi-wah Chow & Chau-kiu Cheung, 2020. "Development and Evaluation of the Psychometric Properties of a Brief Wisdom Development Scale," IJERPH, MDPI, vol. 17(8), pages 1-14, April.
    12. Goran Calic & Moren Lévesque & Anton Shevchenko, 2024. "On why women-owned businesses take more time to secure microloans," Small Business Economics, Springer, vol. 63(3), pages 917-938, October.
    13. Dang Vu, Hoai Nam & Nielsen, Martin Reinhardt, 2022. "Understanding determinants of the intention to buy rhino horn in Vietnam through the Theory of Planned Behaviour and the Theory of Interpersonal Behaviour," Ecological Economics, Elsevier, vol. 195(C).
    14. Wenigmann, Marc & Weiß, Julia & Heidelberg, Rahel, 2024. "Holding anti-feminist gender role beliefs mediate the relationship between family-related adverse childhood experiences and different forms of intimate partner violence perpetration in adulthood," Journal of Criminal Justice, Elsevier, vol. 93(C).
    15. Evans O. Mudibo & Jasper Bogaert & Caroline Tigoi & Moses M. Ngari & Benson O. Singa & Christina L. Lancioni & Abdoulaye Hama Diallo & Emmie Mbale & Ezekiel Mupere & John Mukisa & Johnstone Thitiri & , 2024. "Systemic biological mechanisms underpin poor post-discharge growth among severely wasted children with HIV," Nature Communications, Nature, vol. 15(1), pages 1-17, December.
    16. Georges Steffgen & Philipp E. Sischka & Martha Fernandez de Henestrosa, 2020. "The Quality of Work Index and the Quality of Employment Index: A Multidimensional Approach of Job Quality and Its Links to Well-Being at Work," IJERPH, MDPI, vol. 17(21), pages 1-31, October.
    17. Zaitun Mohd Saman & Ab Hamid Siti-Azrin & Azizah Othman & Yee Cheng Kueh, 2021. "The Validity and Reliability of the Malay Version of the Cyberbullying Scale among Secondary School Adolescents in Malaysia," IJERPH, MDPI, vol. 18(21), pages 1-12, November.
    18. Dennis Cook, R. & Forzani, Liliana, 2023. "On the role of partial least squares in path analysis for the social sciences," Journal of Business Research, Elsevier, vol. 167(C).
    19. Castaldo, Sandro & Ciacci, Andrea & Penco, Lara, 2023. "Perceived corporate social responsibility and job satisfaction in grocery retail: A comparison between low- and high-productivity stores," Journal of Retailing and Consumer Services, Elsevier, vol. 74(C).
    20. Xiaotong Shen & Wei Pan & Yunzhang Zhu & Hui Zhou, 2013. "On constrained and regularized high-dimensional regression," Annals of the Institute of Statistical Mathematics, Springer;The Institute of Statistical Mathematics, vol. 65(5), pages 807-832, October.

    More about this item

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:plo:pone00:0234095. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: plosone (email available below). General contact details of provider: https://journals.plos.org/plosone/ .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.