title: One size does not fit all: psychometric properties of the Shona Symptom Questionnaire (SSQ) among adolescents and young adults in Zimbabwe.
abstract: BACKGROUND
  Depression is a major contributor to the global burden of disease. Onset commonly occurs during the adolescent period. Understanding how depression tools are functioning among adolescents has been relatively overlooked.
  
  
  METHODS
  Using cross-sectional survey data among a sample of 2768 adolescents (aged 15-19) and 2027 young adults (aged 20-24) living in Zimbabwe this paper calibrated the Shona Symptom Questionnaire (SSQ) against the Self Report Questionnaire (SRQ-20) and examined the performance indices of the SSQ based on various cut points for classification. Using a multivariate logistic regression model we isolated particular characteristics to test their association with the odds of being misclassified as non-depressed by the SSQ.
  
  
  RESULTS
  A modified cut point of five or more substantially increases the depression estimates for both age groups. The prevalence of depression increased from 3.5% to 13.2% among adolescents and from 5.1% to 16.2% among young adults based on these revisions. Adolescents who were orphaned or ever had sex had significantly a greater odd of being misclassified. When retested using the modified cut point of five or greater, associations with misclassification disappeared.
  
  
  CONCLUSIONS
  Scales were not administered separately or in their entirety but rather overlapping items were only asked once, utilizing exclusively SRQ-20 phrasing rather than the culturally-emic language in the SSQ.
  
  
  CONCLUSIONS
  Not all depression scales are appropriate for use among adolescents given their unique developmental stage. An alternative cut point for depression classification could improve detection of depression among Zimbabwean adolescents.
authors.affiliation: Gillings School of Global Public Health, Department of Maternal and CHild Health, University of North Carolina at Chapel Hill, United States.
authors.forename: Erica
authors.initials: E
authors.lastname: Haney
authors.affiliation: Gillings School of Global Public Health, Department of Maternal and CHild Health, University of North Carolina at Chapel Hill, United States.
authors.forename: Kavita
authors.initials: K
authors.lastname: Singh
authors.affiliation: Gillings School of Global Public Health, Department of Maternal and CHild Health, University of North Carolina at Chapel Hill, United States.
authors.forename: Constance
authors.initials: C
authors.lastname: Nyamukapa
authors.affiliation: Gillings School of Global Public Health, Department of Maternal and CHild Health, University of North Carolina at Chapel Hill, United States.
authors.forename: Simon
authors.initials: S
authors.lastname: Gregson
authors.affiliation: Gillings School of Global Public Health, Department of Maternal and CHild Health, University of North Carolina at Chapel Hill, United States.
authors.forename: Laura
authors.initials: L
authors.lastname: Robertson
authors.affiliation: Gillings School of Global Public Health, Department of Maternal and CHild Health, University of North Carolina at Chapel Hill, United States.
authors.forename: Lorraine
authors.initials: L
authors.lastname: Sherr
authors.affiliation: Gillings School of Global Public Health, Department of Maternal and CHild Health, University of North Carolina at Chapel Hill, United States.
authors.forename: Carolyn
authors.initials: C
authors.lastname: Halpern
mesh_terms: D000293:Adolescent; D003430:Cross-Sectional Studies; D003866:Depressive Disorder / Q000175:diagnosis* / Q000453:epidemiology*; D003906:Developing Countries; D005260:Female; D006306:Health Surveys; D006801:Humans; D008297:Male; D011594:Psychometrics / Q000706:statistics & numerical data*; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires; D055815:Young Adult; D015030:Zimbabwe
keywords: Adolescent health; Depression; SRQ-20; SSQ; Scale performance; Zimbabwe