title: Prevalence of depression and validation of the Beck Depression Inventory-II and the Children's Depression Inventory-Short amongst HIV-positive adolescents in Malawi.
abstract: BACKGROUND
  There is a remarkable dearth of evidence on mental illness in adolescents living with HIV/AIDS, particularly in the African setting. Furthermore, there are few studies in sub-Saharan Africa validating the psychometric properties of diagnostic and screening tools for depression amongst adolescents. The primary aim of this cross-sectional study was to estimate the prevalence of depression amongst a sample of HIV-positive adolescents in Malawi. The secondary aim was to develop culturally adapted Chichewa versions of the Beck Depression Inventory-II (BDI-II) and Children's Depression Inventory-II-Short (CDI-II-S) and conduct a psychometric evaluation of these measures by evaluating their performance against a structured depression assessment using the Children's Rating Scale, Revised (CDRS-R).
  
  
  METHODS
  Cross-sectional study.
  
  
  METHODS
  We enrolled 562 adolescents, 12-18 years of age from two large public HIV clinics in central and southern Malawi. Participants completed two self-reports, the BDI-II and CDI-II-S, followed by administration of the CDRS-R by trained clinicians. Sensitivity, specificity and positive and negative predictive values for various BDI-II and CDI-II-S cut-off scores were calculated with receiver operating characteristics analysis. The area under the curve (AUC) was also calculated. Internal consistency was measured by standardized Cronbach's alpha coefficient, and correlation between self-reports and CDRS-R by Spearman's correlation.
  
  
  RESULTS
  Prevalence of depression as measured by the CDRS-R was 18.9%. Suicidal ideation was expressed by 7.1% (40) using the BDI-II. The AUC for the BDI-II was 0.82 (95% CI 0.78-0.89) and for the CDI-II-S was 0.75 (95% CI 0.70-0.80). A score of ≥13 in BDI-II achieved sensitivity of >80%, and a score of ≥17 had a specificity of >80%. The Cronbach's alpha was 0.80 (BDI-II) and 0.66 (CDI-II-S). The correlation between the BDI-II and CDRS-R was 0.42 (p<0.001) and between the CDI-II-S and CDRS-R was 0.37 (p<0.001).
  
  
  CONCLUSIONS
  This study demonstrates that the BDI-II has sound psychometric properties in an outpatient setting among HIV-positive adolescents in Malawi. The high prevalence of depression amongst HIV-positive Malawian adolescents noted in this study underscores the need for the development of comprehensive services for HIV-positive adolescents.
authors.affiliation: Baylor College of Medicine International Paediatric AIDS Initiative, Texas Children's Hospital, Houston, TX, USA; Baylor College of Medicine-Abbott Fund Children's Clinical Centre of Excellence, Lilongwe, Malawi; mhkim@bcm.edu.
authors.forename: Maria H
authors.initials: MH
authors.lastname: Kim
authors.affiliation: Baylor College of Medicine-Abbott Fund Children's Clinical Centre of Excellence, Lilongwe, Malawi.
authors.forename: Alick C
authors.initials: AC
authors.lastname: Mazenga
authors.affiliation: Baylor College of Medicine International Paediatric AIDS Initiative, Texas Children's Hospital, Houston, TX, USA.
authors.forename: Akash
authors.initials: A
authors.lastname: Devandra
authors.affiliation: Baylor College of Medicine International Paediatric AIDS Initiative, Texas Children's Hospital, Houston, TX, USA.
authors.forename: Saeed
authors.initials: S
authors.lastname: Ahmed
authors.affiliation: Baylor College of Medicine-Abbott Fund Children's Clinical Centre of Excellence, Lilongwe, Malawi.
authors.forename: Peter N
authors.initials: PN
authors.lastname: Kazembe
authors.affiliation: Department of Paediatrics, Epidemiology Center, Baylor College of Medicine, Houston, TX, USA.
authors.forename: Xiaoying
authors.initials: X
authors.lastname: Yu
authors.affiliation: Department of Paediatrics, Epidemiology Center, Baylor College of Medicine, Houston, TX, USA.
authors.forename: Chi
authors.initials: C
authors.lastname: Nguyen
authors.affiliation: Department of Psychology, University of Houston, Houston, TX, USA.
authors.forename: Carla
authors.initials: C
authors.lastname: Sharp
mesh_terms: D000293:Adolescent; D002648:Child; D003430:Cross-Sectional Studies; D003863:Depression / Q000175:diagnosis / Q000453:epidemiology*; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D008295:Malawi / Q000453:epidemiology; D008297:Male; D010045:Outpatients; D011237:Predictive Value of Tests; D015995:Prevalence; D011594:Psychometrics / Q000379:methods*; D012372:ROC Curve; D012680:Sensitivity and Specificity
keywords: BDI-II; CDI-II-Short; HIV; adolescents; depression; prevalence
references.citation: Ment Illn. 2012 May 08;4(1):e7
references.pmid: 25478109
references.citation: AIDS Care. 2012;24(7):836-42
references.pmid: 22292795
references.citation: J Gen Intern Med. 2009 Feb;24(2):189-97
references.pmid: 19031037
references.citation: J Clin Exp Neuropsychol. 2003 Aug;25(5):654-70
references.pmid: 12815503
references.citation: J Affect Disord. 2009 Jan;112(1-3):126-34
references.pmid: 18504058
references.citation: PLoS One. 2010 Dec 08;5(12):e14252
references.pmid: 21170384
references.citation: J Can Acad Child Adolesc Psychiatry. 2012 Feb;21(1):5-8
references.pmid: 22299009
references.citation: J Child Adolesc Psychopharmacol. 2010 Dec;20(6):513-6
references.pmid: 21186970
references.citation: JAMA. 2001 Dec 12;286(22):2857-64
references.pmid: 11735762
references.citation: Eur Child Adolesc Psychiatry. 2007 Aug;16(5):287-92
references.pmid: 17473949
references.citation: AIDS Patient Care STDS. 1999 Mar;13(3):185-97
references.pmid: 10375267
references.citation: Indian J Med Sci. 2010 Feb;64(2):72-80
references.pmid: 22466496
references.citation: J Acquir Immune Defic Syndr. 2011 Oct 1;58(2):181-7
references.pmid: 21857529
references.citation: Vulnerable Child Youth Stud. 2010 Jun;5(2):174-187
references.pmid: 20808733
references.citation: West Indian Med J. 2008 Sep;57(4):352-9
references.pmid: 19566015
references.citation: BMC Psychiatry. 2010 Jun 10;10:44
references.pmid: 20537129
references.citation: Curr Opin HIV AIDS. 2009 Jul;4(4):288-93
references.pmid: 19532066
references.citation: CNS Spectr. 2003 Jan;8(1):52-8
references.pmid: 12627049
references.citation: J Pediatr Adolesc Gynecol. 2009 Oct;22(5):306-12
references.pmid: 19592279
references.citation: Psychopharmacol Bull. 1985;21(4):995-8
references.pmid: 4089116
references.citation: JAMA. 1996 Jul 24-31;276(4):293-9
references.pmid: 8656541
references.citation: PLoS One. 2011 Jan 25;6(1):e16049
references.pmid: 21283565
references.citation: Lancet. 2007 Sep 15;370(9591):918-9
references.pmid: 17869621
references.citation: Int J Adolesc Med Health. 2005 Jul-Sep;17(3):255-7
references.pmid: 16231477
references.citation: Biometrics. 1988 Sep;44(3):837-45
references.pmid: 3203132
references.citation: J Int AIDS Soc. 2010 Nov 15;13:44
references.pmid: 21078150