title: Validation of the Client Diagnostic Questionnaire to Assess Mental Health in South African Caregivers of Children.
abstract: BACKGROUND
  Given the high prevalence of mental health (MH) and substance abuse problems in low-to-middle income countries, the scarcity of MH professionals and the negative impact of psychiatric disorders on caregivers of young children, there is significant need for brief evidence-based screening tools for lay counselors to assist with MH assessment. This study aimed to validate a brief screening tool to assess psychiatric and substance use disorders, the Client Diagnostic Questionnaire (CDQ), in South Africa (SA).
  
  
  METHODS
  Data are from a longitudinal study of health and psychosocial needs in preschool children in SA. Participants included 322 Zulu-speaking, female caregivers. Following procedures of the US CDQ validation study, lay counselors interviewed participants using the translated Zulu CDQ. Subsequently a psychologist conducted a full psychiatric assessment guided by the CDQ questions. Analyses examined sensitivity, specificity and overall accuracy, comparing lay counselor and psychologist assessment.
  
  
  RESULTS
  Sensitivity (73%), specificity (81%) and overall accuracy (79%) were good for the variable indicating presence of 'any diagnosis.' Among those cases identified by the psychologist as having any psychiatric diagnosis, over 70% were correctly identified by lay counselors using the CDQ (i.e., positive predictive value was greater than 70%). The false positive rate was relatively low (19%). Specificity for 'any disorder' (including substance use) and 'any psychiatric disorder' were 81% and 79%.
  
  
  CONCLUSIONS
  The isiZulu CDQ is a sensitive and valid MH diagnostic screener that can be used by lay counselors with limited MH training to identify those in need of treatment and target extremely scarce MH professionals. Copyright © 2016 John Wiley & Sons, Ltd.
  
  
  CONCLUSIONS
  South Africa (SA), a country heavily impacted by poverty, HIV and the legacy of Apartheid, has a high prevalence of mental health (MH) and substance abuse problems. In SA and other low-and-middle-income-countries (LMIC) there is a dearth of MH professionals. This study examined use and validity of the Client Diagnostic Questionnaire (CDQ), a brief diagnostic MH screening tool designed for use by lay counselors in HIV-affected populations. Comparing lay counsellor diagnoses on the CDQ to clinician assessment, sensitivity, specificity and overall accuracy were good at the level of 'any diagnosis.' The CDQ can be used effectively in SA and other LMIC with limited MH services to enable appropriate and efficient referral of individuals in primary care settings, supporting caregivers and the children in their care.
authors.affiliation: HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, NY, USA.
authors.forename: Claude A
authors.initials: CA
authors.lastname: Mellins
authors.affiliation: Department of Pediatrics and Child Health, Maternal and Child Health Unit, University of KwaZulu-Natal, Durban, South Africa.
authors.forename: Shuaib
authors.initials: S
authors.lastname: Kauchali
authors.affiliation: HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, NY, USA.
authors.forename: Danielle F
authors.initials: DF
authors.lastname: Nestadt
authors.affiliation: Department of Biostatistics, Columbia University Mailman School of Public Health, New York, NY, USA.
authors.forename: Dan
authors.initials: D
authors.lastname: Bai
authors.affiliation: Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY, USA.
authors.forename: Angela
authors.initials: A
authors.lastname: Aidala
authors.affiliation: University of KwaZulu-Natal, Durban, South Africa.
authors.forename: Nonhlahla
authors.initials: N
authors.lastname: Myeza
authors.affiliation: Department of Pediatrics and Child Health, Maternal and Child Health Unit, University of KwaZulu-Natal, Durban, South Africa.
authors.forename: Murray H
authors.initials: MH
authors.lastname: Craib
authors.affiliation: Department of Public Health Medicine, University of KwaZulu-Natal, Durban, South Africa.
authors.forename: Jane
authors.initials: J
authors.lastname: Kvalsvig
authors.affiliation: HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, NY, USA.|Department of Biostatistics, Columbia University Mailman School of Public Health, New York, NY, USA.
authors.forename: Cheng-Shiun
authors.initials: CS
authors.lastname: Leu
authors.affiliation: Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA.
authors.forename: Justin
authors.initials: J
authors.lastname: Knox
authors.affiliation: Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA.|Department of Pediatrics, Columbia University Medical Center, New York, NY, USA.
authors.forename: Stephen
authors.initials: S
authors.lastname: Arpadi
authors.affiliation: Department of Pediatrics and Child Health, Maternal and Child Health Unit, University of KwaZulu-Natal, Durban, South Africa.
authors.forename: Meera
authors.initials: M
authors.lastname: Chhagan
authors.affiliation: Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA.|Department of Pediatrics, Columbia University Medical Center, New York, NY, USA.
authors.forename: Leslie L
authors.initials: LL
authors.lastname: Davidson
mesh_terms: D000328:Adult; D017028:Caregivers / Q000523:psychology*; D002654:Child Care / Q000523:psychology*; D002675:Child, Preschool; D003431:Cross-Cultural Comparison; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data*; D001523:Mental Disorders / Q000175:diagnosis* / Q000523:psychology*; D010552:Personality Assessment / Q000706:statistics & numerical data*; D011594:Psychometrics / Q000706:statistics & numerical data*; D015203:Reproducibility of Results; D013019:South Africa; D019966:Substance-Related Disorders / Q000175:diagnosis* / Q000523:psychology*; D011795:Surveys and Questionnaires; D014175:Translating
keywords: Child Caregivers; HIV/AIDS; Mental health; Psychiatric Diagnostic Screener; South Africa; Task Shifting