Cross-cultural adaptation and validation of the self-reporting questionnaire among HIV+ individuals in a rural ART program in southern Uganda

Abstract

Etheldreda Nakimuli-Mpungu1,3, Ramin Mojtabai1, Pierre K Alexandre1, Elly Katabira4, Seggane Musisi3, Jean B Nachega2,5, Judith K Bass11Department of Mental Health, 2Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; 3Department of Psychiatry, 4Department of Internal Medicine, Makerere University College of Health Sciences, Kampala, Uganda; 5Department of Medicine and Centre for Infectious Diseases, Stellenbosch University, Faculty of Health Sciences, Cape Town, South AfricaBackground: HIV treatment programs are in need of brief, valid instruments to identify common mental disorders such as depression.Aim: To translate and culturally adapt the Self-Reporting Questionnaire (SRQ-20) for use in Uganda and to investigate its psychometric properties in this setting.Methods: Following an initial translation of the SRQ-20 from English to Luganda, key informant interviews and focus-group discussions were used to produce a culturally adapted version of the instrument. The adapted SRQ-20 was administered to 200 HIV-positive individuals in a rural antiretroviral therapy program in southern Uganda. All study participants were also evaluated by a psychiatric clinical officer with the Mini International Neuropsychiatric Interview (MINI). Receiver-operating-characteristic analysis was used to examine the sensitivity and specificity of the SRQ-20 compared to the clinical diagnosis generated by the MINI.Results: The prevalence estimates of any depressive disorder and current depression were 24% (n = 48) and 12% (n = 24), respectively. The SRQ-20 scores discriminated well between subjects with and without current depression based on the MINI, with an area under the curve of 0.92, as well as between subjects with and without any current or past depressive disorder, with an area under the curve of 0.75. A score of 6 or more had 84% sensitivity and 93% specificity for current depression, and 75% sensitivity and 90% specificity for any depressive disorder.Conclusion: The SRQ-20 appears to be a reliable and valid screening measure for depression among rural HIV-positive individuals in southern Uganda. The use of this screening instrument can potentially improve detection and management of depression in this setting.Keywords: depression, HIV/AIDS, Self-Reporting Questionnaire, cross-cultural adaptation and validation, Uganda