Are visual measures of mood superior to questionnaire measures in non-Western settings?
OBJECTIVE
We hypothesised that, in a non-Western setting where literacy was not universal, a visual measure (the FACES test) would be more valid than a traditional psychiatric questionnaire [the General Health Questionnaire (GHQ)] as a screening test for mood disorders.


METHODS
The study was nested within a randomised controlled trial of 450 patients with a common mental disorder (CMD). Subjects were evaluated at 2, 6 and 12 months after enrolment with the Clinical Interview Standardised-Revised (CISR) (the gold standard), the GHQ5 (the shortened version of the GHQ-12) and the FACES test.


RESULTS
Correlation coefficients and Receiver Operating Characteristic (ROC) curves show superiority of the GHQ5 in the detection of CMD based on the CISR, compared with the visual FACES test. Less-educated subjects had particular difficulty completing the FACES. The kappa coefficient of agreement between the two instruments, using the cut-off point for the GHQ5 estimated by the ROC curves, was between 0.70 and 0.75.


CONCLUSIONS
Contrary to our hypothesis, the questionnaire-based measure was significantly superior to a visual measure of mood, especially for less-educated subjects. A short five-item version of the GHQ has a good discriminatory ability for CMD and may be used as a brief alternative to standardised interviews in clinical and survey settings.
MSF-Holland, Afghanistan.
Gloria
G
Puertas
Vikram
V
Patel
Tom
T
Marshall
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001008:Anxiety Disorders / Q000175:diagnosis / Q000453:epidemiology; D003431:Cross-Cultural Comparison; D003866:Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology; D003906:Developing Countries; D004522:Educational Status; D004644:Emotions; D005149:Facial Expression; D005260:Female; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D019964:Mood Disorders / Q000175:diagnosis* / Q000453:epidemiology; D010364:Pattern Recognition, Visual; D010555:Personality Inventory / Q000706:statistics & numerical data*; D011594:Psychometrics / Q000706:statistics & numerical data; D015203:Reproducibility of Results; D012647:Self-Assessment; D011795:Surveys and Questionnaires