Scale properties of the Kreyòl Distress Idioms (KDI) screener: association of an ethnographically-developed instrument with depression, anxiety, and sociocultural risk factors in rural Haiti

Document Type

Journal Article

Publication Date



International Journal of Culture and Mental Health








anxiety; depression; Haiti; idioms of distress; principal component analysis


© 2015 Taylor & Francis. Psychiatric instruments have limitations cross-culturally due to variations in conceptualizations and communication of mental distress. We evaluated a locally-developed screening tool for measuring mental distress in rural Haiti. We employed mixed methods to develop the Kreyòl Distress Idioms (KDI) screening tool. We piloted the KDI in an epidemiologic survey (n = 408) and assessed it using principal component analysis and comparison with the Beck Depression Inventory and Beck Anxiety Inventory (BDI, BAI). Linear regression was used to identify risk factors. Principal component analysis extracted four components: (1) lack of control over thoughts and behaviors, (2) worry and rumination, (3) somatic indicators of anxiety, and (4) fatigue and foreshortened future. The KDI correlated with the BAI (r = 0.67) and BDI (r = 0.52). Factors associated with KDI score included female gender, older age, alcohol consumption, traumatic exposures, and having a household member with mental distress. Belief that disasters cause distress was associated with higher KDI scores, whereas belief that interpersonal relationships cause distress was associated with lower scores. Associations with BDI and BAI scores and established predictors of mental distress support convergent and external validity of the KDI. The KDI provides a more ethnographically-valid measure for mental distress in Haiti than culturally-adapted psychiatric instruments.

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