title: Validity of brief screening questionnaires to detect depression in primary care in Ethiopia.
abstract: BACKGROUND
  Brief depression screening questionnaires may increase detection of depression in primary care settings but there have been few validation studies carried out in typical populations in low-income countries.
  
  
  METHODS
  Cultural validation of the Patient Health Questionnaire (PHQ-9/PHQ-2), the 20-item Self-Reporting Questionnaire (SRQ-20) and the Kessler scales (K6/K10) was carried out in 306 adults consecutively attending primary care facilities in small towns in Ethiopia. To assess criterion validity, the gold standard assessment for presence of Major Depressive Disorder (MDD) was made by Ethiopian psychiatric nurses using the Mini International Neuropsychiatric Interview.
  
  
  RESULTS
  The prevalence of gold standard MDD was 5.9%, with irritability more common than depressed mood or anhedonia. The area under the receiver operating characteristic curve indicated good performance of the PHQ-9, SRQ-20, K6 and K10 (0.83-0.85) but only fair for the PHQ-2 (0.78). No cut-off score had acceptable sensitivity combined with adequate positive predictive value. All screening questionnaires were associated with disability and the PHQ-9 and SRQ-20 were associated with higher health service contacts, indicating convergent validity. Construct validity of all scales was indicated by unidimensionality on exploratory factor analysis.
  
  
  CONCLUSIONS
  Test-retest reliability was not assessed.
  
  
  CONCLUSIONS
  Brief depression screening questionnaires were found to be valid in primary care in this low-income country. However, these questionnaires do not have immediate applicability in routine clinical settings. Further studies should evaluate utility of indicated screening embedded within health system changes that support MDD detection. Investigation of irritability as a core depression symptom is warranted.
authors.affiliation: Addis Ababa University, College of Health Sciences, School of Medicine, Department of Psychiatry, Ethiopia; King's College London, Institute of Psychiatry, Psychology and Neuroscience, Health Services and Population Research Department, Centre for Global Mental Health, UK. Electronic address: charlotte.hanlon@kcl.ac.uk.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Hanlon
authors.affiliation: Addis Ababa University, Aklilu-Lemma Institute of Pathobiology, Ethiopia.
authors.forename: Girmay
authors.initials: G
authors.lastname: Medhin
authors.affiliation: Addis Ababa University, College of Health Sciences, School of Medicine, Department of Psychiatry, Ethiopia.
authors.forename: Medhin
authors.initials: M
authors.lastname: Selamu
authors.affiliation: Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, South Africa.
authors.forename: Erica
authors.initials: E
authors.lastname: Breuer
authors.affiliation: Addis Ababa University, College of Health Sciences, School of Medicine, Department of Psychiatry, Ethiopia.
authors.forename: Benyam
authors.initials: B
authors.lastname: Worku
authors.affiliation: Addis Ababa University, College of Health Sciences, School of Medicine, Department of Psychiatry, Ethiopia.
authors.forename: Maji
authors.initials: M
authors.lastname: Hailemariam
authors.affiliation: Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, South Africa.
authors.forename: Crick
authors.initials: C
authors.lastname: Lund
authors.affiliation: King's College London, Institute of Psychiatry, Psychology and Neuroscience, Health Services and Population Research Department, Centre for Global Mental Health, UK.
authors.forename: Martin
authors.initials: M
authors.lastname: Prince
authors.affiliation: Addis Ababa University, College of Health Sciences, School of Medicine, Department of Psychiatry, Ethiopia; King's College London, Centre for Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, UK.
authors.forename: Abebaw
authors.initials: A
authors.lastname: Fekadu
mesh_terms: D000328:Adult; D003863:Depression / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology; D003865:Major Depressive Disorder / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology; D005002:Ethiopia; D005163:Factor Analysis, Statistical; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods* / Q000706:statistics & numerical data; D008875:Middle Aged; D015995:Prevalence; D011320:Primary Health Care / Q000379:methods*; D011581:Psychological Tests / Q000706:statistics & numerical data*; D012372:ROC Curve; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: Depression; Developing country; Primary health care; Screening; Sub-Saharan Africa; Validation