Detecting Depression and Anxiety Among Adolescents in South Africa: Validity of the isiXhosa Patient Health Questionnaire-9 and Generalized Anxiety Disorder-7

Authors

• Marguerite Marlow, Institute for Life Course Health Research, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa. Electronic address: marlow@sun.ac.za.
• Sarah Skeen, Institute for Life Course Health Research, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa; Amsterdam Institute for Social Science Research, University of Amsterdam, Amsterdam, Netherlands.
• Caitlin M. Grieve, Institute for Life Course Health Research, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
• Liliana Carvajal, Division of Data, Analytics, Planning and Monitoring, Data and Analytics Section, UNICEF, New York, New York; Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
• Jill W. Åhs, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Department of Health Sciences, Swedish Red Cross University College, Stockholm, Sweden.
• Brandon A. Kohrt, Department of Psychiatry, George Washington University, Washington, District of Columbia.
• Jennifer Requejo, Division of Data, Analytics, Planning and Monitoring, Data and Analytics Section, UNICEF, New York, New York.
• Jaqueline Stewart, Division of Global Surgery, University of Cape Town, Cape Town, South Africa.
• Junita Henry, Institute for Life Course Health Research, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
• Daniel Goldstone, Institute for Life Course Health Research, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
• Tashmira Kara, Institute for Life Course Health Research, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
• Mark Tomlinson, Institute for Life Course Health Research, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa; School of Nursing and Midwifery, Queens University, Belfast, United Kingdom.

Document Type

Journal Article

Publication Date

10-20-2022

Journal

The Journal of adolescent health : official publication of the Society for Adolescent Medicine

DOI

10.1016/j.jadohealth.2022.09.013

Keywords

Adolescents; Anxiety; Depression; Diagnostic assessment; GAD-7; Low- and middle-income countries; Mental health; PHQ-9; Screening; Validity

Abstract

PURPOSE: Screening tools such as the Patient Health Questionnaire-9 (PHQ-9) and the Generalized Anxiety Disorder-7 (GAD-7) could potentially be used in resource-limited settings to identify adolescents who need mental health support. We examined the criterion validity of the isiXhosa versions of the PHQ-9 and GAD-7 in detecting depression and anxiety among adolescents (10-19 years) in South Africa. METHODS: Adolescents were recruited from the general population and from nongovernmental organizations working with adolescents in need of mental health support. The PHQ-9 and GAD-7 were culturally adapted and translated into isiXhosa and administered to 302 adolescents (56.9% female). The Kiddie Schedule for Affective Disorders and Schizophrenia was administered by trained clinicians as the gold standard diagnostic measure for depression and anxiety. RESULTS: For the PHQ-9, the area under the curve was 0.88 for the full sample of adolescents (10-19 years old). A score of ≥10 had 91% sensitivity and 76% specificity for detecting adolescents with depression. For the GAD-7, the area under the curve was 0.78, and cutoff scores with an optimal sensitivity-specificity balance were low (≥6). A score of ≥6 had 67% sensitivity and 75% specificity for detecting adolescents with anxiety. DISCUSSION: The culturally adapted isiXhosa version of the PHQ-9 can be used as a valid measure for depression in adolescents. Further research on the GAD-7 for use with adolescents is recommended.

APA Citation

Marlow, Marguerite; Skeen, Sarah; Grieve, Caitlin M.; Carvajal, Liliana; Åhs, Jill W.; Kohrt, Brandon A.; Requejo, Jennifer; Stewart, Jaqueline; Henry, Junita; Goldstone, Daniel; Kara, Tashmira; and Tomlinson, Mark, "Detecting Depression and Anxiety Among Adolescents in South Africa: Validity of the isiXhosa Patient Health Questionnaire-9 and Generalized Anxiety Disorder-7" (2022). GW Authored Works. Paper 1754.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/1754

Department

Psychiatry and Behavioral Sciences