Detecting perinatal common mental disorders in Ethiopia: validation of the self-reporting questionnaire and Edinburgh Postnatal Depression Scale
Abstract
Background The cultural validity of instruments to detect perinatal common mental disorders (CMD) in rural, community settings has been little-investigated in developing countries.Methods Semantic, content, technical, criterion and construct validity of the Edinburgh Postnatal Depression Scale (EPDS) and Self-Reporting Questionnaire (SRQ) were evaluated in perinatal women in rural Ethiopia. Gold-standard measure of CMD was psychiatric assessment using the Comprehensive Psychopathological Rating Scale (CPRS). Community-based, convenience sampling was used. An initial validation study (n=101) evaluated both EPDS and SRQ. Subsequent validation was of SRQ alone (n=119).Results EPDS exhibited poor validity; area under the receiver operating characteristic (AUROC) curve of 0.62 (95%CI 0.49 to 0.76). SRQ-20 showed better validity as a dimensional scale, with AUROC of 0.82 (95%CI 0.68 to 0.96) and 0.70 (95%CI 0.57 to 0.83) in the two studies. The utility of SRQ in detecting 'cases' of CMD was not established, with differing estimates of optimal cut-off score: three and above in Study 1 (sensitivity 85.7%, specificity 75.6%); seven and above in Study 2 (sensitivity 68.4%, specificity 62%). High convergent validity of SRQ as a dimensional measure was demonstrated in a community survey of 1065 pregnant women.Limitations Estimation of optimal cut-off scores and validity coefficients for detecting CMD was limited by sample size.Conclusions EPDS demonstrated limited clinical utility as a screen for perinatal CMD in this rural, low-income setting. The SRQ-20 was superior to EPDS across all domains for evaluating cultural equivalence and showed validity as a dimensional measure of perinatal CMD.
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Purposive sampling was conducted based on gender, age, area of residence, and level of mental distress, as indicated by scores on the culturally validated Self-Reporting Questionnaire, 20-item version.
“For this qualitative study, purposive sampling was conducted based on gender, age, area of residence, and level of mental distress, as indicated by scores on the culturally validated Self-Reporting Questionnaire, 20-item version [33–36].”
From Experience and perceptions of mental ill-health in people with epilepsy in rural Ethiopia: A qualitative study (2024) · cites this paper as [35]
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- Authors
- Hanlon, C., Medhin, G., Alem, A., Araya, M., Abdulahi, A., Hughes, M., Tesfaye, M., Wondimagegn, D., Patel, V., & Prince, M.
- Affiliations
- King's College London (GB)
- Addis Ababa University (ET)
- London School of Hygiene & Tropical Medicine (GB)
- Corresponding author
- Hanlon, Charlotte
- ORCID
- Venue
- Journal of Affective Disorders
- Publisher
- Elsevier BV
- Published
- 2008-06
- Volume
- 108
- Issue
- 3
- Pages
- 251-262
- ISSN
- 0165-0327 (ISSN-L)
- OpenAlex
- W1974901321
- Cited by
- 278
- References
- 46
- Citations by year
- 2026: 10 · 2025: 12 · 2024: 18 · 2023: 21 · 2022: 20 · 2021: 32 · 2020: 25 · 2019: 17 · 2018: 13 · 2017: 11 · 2016: 14 · 2015: 13 · 2014: 14 · 2013: 17 · 2012: 8
- FWCI
- 8.27
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Affective Disorders (publishedVersion)
- PubMed (publishedVersion)
- Research Portal (King's College London) (submittedVersion)
- Funders
- Wellcome Trust (GR071643MA)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Maternal Mental Health During Pregnancy and Postpartum
- Social Sciences › Education › Health Education and Validation
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Keywords
- Edinburgh Postnatal Depression Scale, Self-Reporting Questionnaire, SRQ-20, screening tool validation, cultural validity, rural Ethiopia, pregnant women, cut-off values, convergent validity, dimensional metrology
- MeSH terms
- Adult, Mental Disorders, Catchment Area, Health, Ethiopia, Female, Humans, Mass Screening, Perinatology, Puerperal Disorders, Surveys and Questionnaires, Reproducibility of Results, Prevalence, Depression, Postpartum
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