Guillemin et al (1993) [10] have suggested the following guidelines to preserve equivalence in adapting measures developed in one language and culture for use in another language and culture; 1. more than one independent translations, 2. as many back-translations as translations[11], 3. a committee approach to produce a final version in the target language, and 4. pre-testing to establish equivalence in source and target versions using either a probe technique (using qualitative methods) or bilingual method (administering both the versions to a group of bilingual lay people to assess if they respond similarly to the same question in both languages).
depression test in urdu
For cross-cultural validationwe, therefore, extracted data on process of back-translation, whether or not a committee approach had been taken, and whether the authors had done pre-testing. If a bilingual approach for pre-testing had been taken we assessed whether the authors had examined linguistic equivalence (whether the questionnaire has been translated literally), conceptual equivalence (whether the translation captures the meaning of the original), and scale equivalence (whether both the source and target language versions identify the same individuals as high scorers) [12].
For being clinically useful, besides being valid, a new test or scale must also be reliable. The reliability of a test describes the degree to which the test consistently measures a variable [13]. The higher the reliability of a test the more likely it is that the test will yield a similar result when administered; by different raters (inter-rater reliability), by the same rater after some interval of time (intra-rater reliability), or in two halves (split-half reliability), and that items measuring different dimensions of the same phenomenon will be scored similarly (internal consistency). A scale can be reliable but not valid, but if a scale is unreliable it can not be valid. We therefore extracted data on different forms of reliability whenever it was reported in a paper.
Table 1 shows the cross-cultural validation status for all the scales translated from English language. Of the thirteen translated scales six, the CIS-R, EAT, HADS, How I feel scale, SRQ AND WHO-QOL BREF were evaluated most rigorously for cross-cultural validation employing back-translation, translation committee, and pre-testing in a non-clinical sample. The GHQ-28 did not have back-translation done but had a translation committee and was also pre-tested.
The EAT, GHQ-28, HADS and WHO-QOL-BREF were pre-tested tested using the bilingual method and had their linguistic, conceptual and scale equivalence examined. The CIS-R, How I Feel scale and SRQ were pre-tested using the probe technique. The SDQ was back-translated and had a translation committee but was not pre-tested on a non-clinical sample. The EPDS, GHQ-12 and PHQ did not undergo cross-cultural validation.
Quality of included studies varied greatly. Some studies had very small sample sizes like 20 for HADS or 30 for PTSD-Q validation study making it questionable if the results could be extrapolated to the whole Pakistan population or even a sub-population. Four studies have used "Psychiatrists' Clinical Diagnoses" as gold standard [15, 17, 20, 39] rather than using a more valid gold standard like a structured or semi-structured diagnostic interview. This puts the validity of the validation itself in question. Many studies have either not mentioned Reliability at all or mentioned that they tested for Reliability but have not provided any values, as detailed in Additional file 1.
On one hand it was rather surprising and encouraging to find 19 questionnaires measuring psychiatric symptoms in Urdu which had undergone some degree of either cross-cultural or criterion validation. On the other hand most of these are screening tools for anxiety, depression or general psychiatric morbidity. The very commonly used research tools like HRSD, MADRS, BDI, PANSS etc, and the definitive diagnostic instruments like SCID have not undergone any sort of validation in Urdu.
Bhui et al. [44] have suggested that even within a broad ethnic group expressions of distress may vary between different sub-groups and may change as a result of acculturation. The GHQ-12 performed better than the ADI (Amritsar Depression Inventory, developed in the Punjab in India) in detecting depression even in the Punjabi population settled in UK. This suggests that even instruments developed in one language may not be equally valid for all sub-groups speaking that language depending on the culture they are living in. In that sense language and culture are not one and the same where validation of instruments is concerned.
The problem with an exclusively emic approach is that it does not allow quantitative comparison across times and between cultures. The problem with an exclusively etic approach is that manifestations and expressions of a universal phenomenon, for example depression, may be different in different cultures, and thus may be missed if concepts and measures from one culture are applied blindly to another culture [4]. The first is time, labour and expertise intensive because of the need to conceptualise a new measure and select its items, while the second is fraught with the difficulties of the relevance and validity of a measure developed in one language and culture being used in another language and culture.
In Urdu it seems like both approaches have been used, with most scales being translated from English and a few being developed indigenously from complaints of Pakistani patients later diagnosed as suffering from Depression and Anxiety. However, since even the latter were validated against etic constructs like ICD and DSM diagnoses it is difficult to say if there are any purely emic instruments in Urdu. This raises the question whether there should be a different set of criteria for diagnosing depression in Pakistan if people suffering from depression in Pakistan present with different expressions of distress compared to patients in the West? If the diagnostic criteria are different should we call this syndrome something other than depression? Questions like these would only be answered after a lot more cultre-centred research than has been carried out as yet.
Methods: After translation of the HAM-D into the Urdu language following standard guidelines, the final Urdu version (HAM-D-U) was administered to 160 depressed outpatients. Inter-item correlation was assessed by calculating Cronbach alpha. Correlation between HAM-D-U scores at baseline and after a 2-week interval was evaluated for test-retest reliability. Moreover, scores of two clinicians on HAM-D-U were compared for inter-rater reliability. For establishing concurrent validity, scores of HAM-D-U and BDI-U were compared by using Spearman correlation coefficient. The study was conducted at Mayo Hospital, Lahore, from May to December 2014.
Results: The Cronbach alpha for HAM-D-U was 0.71. Composite scores for HAM-D-U at baseline and after a 2-week interval were also highly correlated with each other (Spearman correlation coefficient 0.83, p-value
Conclusion: The HAM-D-U is a valid and reliable instrument for the assessment of Depression. It shows good inter-rater and test-retest reliability. The HAM-D-U can be a tool either for clinical management or research.
The original research of HADS tested its psychometric soundness on a group of hospitalised patients who suffered from different diseases. The scale is proven to be valid and reliable for other groups of patients as well: for oncology,21 22 HIV-infected patients,23 hospitalised elderly,24 gynaecology patients,12 14 patients with coronary artery diseases,25 patients in the emergency department26 and among patients in primary healthcare.27 In turn, our study contributes to the body of knowledge about irregularities of psychometric findings of HADS noticed in the literature28 when it is applied on patients with chronic diseases to others who suffer from physiological changes during pregnancy.
The HADS/UV of both scales is comparable to previous studies12 31 and showed satisfactory internal consistency. The Cronbach alpha of HADS scales was good (α=0.84) and above recommended value and met Klines' criteria.20 The Cronbach alpha coefficient of the HADS subscales was good for anxiety (α=0.82) but below the recommended value for depression (α=0.64). By and large, the HADS-A subscale showed better psychometric properties than the HADS-D.13 Our study has reported good reliability scores; hence, we recommend that HADS/UV should be used in the clinical setting for screening of anxiety and depression in Pakistan.
Though depression and grief share some features, depression is different from grief felt after losing a loved one or sadness felt after a traumatic life event. Depression usually involves self-loathing or a loss of self-esteem, while grief typically does not.
People experience depression in different ways. It may interfere with your daily work, resulting in lost time and lower productivity. It can also influence relationships and some chronic health conditions.
SSRIs are the most commonly prescribed antidepressant medications and tend to have few side effects. They treat depression by increasing the availability of the neurotransmitter serotonin in your brain.
Due to side effects and safety concerns, MAOIs are not the first choice for treating mental health disorders. They are typically used only if other medications are unsuccessful at treating depression.
Exposure to doses of white light can help regulate your mood and improve symptoms of depression. Light therapy is commonly used in seasonal affective disorder, which is now called major depressive disorder with seasonal pattern. 2ff7e9595c
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