title: Measuring depression and anxiety in sub-saharan Africa.
abstract: BACKGROUND
  Despite being one of the leading causes of disability worldwide, fewer than 10% of depressed individuals in low-resource settings have access to treatment. Mounting evidence suggests that nonspecialist workers are capable of providing counseling and case management at the community level. They often use brief psychiatric screening instruments as clinical tools to identify cases and monitor symptoms over time. In order for such tools to be used in diverse settings, they must demonstrate adequate reliability and validity in addition to cross-cultural relevance. To be used to guide routine care they also need to be flexibly adapted and sensitive to change. The goal of this paper is to assess the cross-cultural validity of brief psychiatric screening instruments in sub-Saharan Africa, identify best practices, and discuss implications for clinical management and scale-up of mental health treatment in resource-poor settings.
  
  
  METHODS
  Systematic review of studies assessing the validity of screening instruments for depression, anxiety, and mental distress in sub-Saharan Africa using Medline and PsycINFO.
  
  
  RESULTS
  Sixty-five studies from 16 countries assessing the validity of brief screening instruments for depression, anxiety, and/or mental distress.
  
  
  CONCLUSIONS
  Despite evidence of underlying universality in the experience of depression and anxiety in sub-Saharan Africa, differences in the salience, manifestation, and expression of symptoms suggest the need for the local adaptation of instruments. Rapid ethnographic assessment has emerged as a promising, low-cost, and efficient strategy for doing so.
authors.affiliation: Columbia University College of Physicians and Surgeons, Department of Psychiatry.
authors.forename: Annika C
authors.initials: AC
authors.lastname: Sweetland
authors.forename: Gary S
authors.initials: GS
authors.lastname: Belkin
authors.forename: Helena
authors.initials: H
authors.lastname: Verdeli
mesh_terms: D017954:Africa South of the Sahara / Q000208:ethnology; D001008:Anxiety Disorders / Q000175:diagnosis / Q000208:ethnology; D003866:Depressive Disorder / Q000175:diagnosis / Q000208:ethnology; D006801:Humans; D008403:Mass Screening / Q000191:economics / Q000295:instrumentation / Q000592:standards; D011569:Psychiatric Status Rating Scales / Q000592:standards*; D011594:Psychometrics / Q000295:instrumentation*
keywords: anxiety; brief screening instruments; cross-cultural; depression; sub-Saharan Africa; validity