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Social Psychiatry and Psychiatric Epidemiology

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01-05-2015 | Original Paper

Making assessment locally relevant: measuring functioning for maternal depression in Khayelitsha, Cape Town

Authors: Marguerite Schneider, Emily Baron, Thandi Davies, Judith Bass, Crick Lund

Published in: Social Psychiatry and Psychiatric Epidemiology | Issue 5/2015

Abstract

Purpose

We developed a locally relevant functioning assessment instrument (FAI) for pregnant women and mothers of young babies to complement a widely validated instrument—the World Health Organization’s Disability Assessment Schedule (WHODAS) 12-item version. The FAI is an outcome measure in a randomised controlled trial on the effectiveness of a lay counsellor administered intervention for distressed pregnant women in Khayelitsha, Cape Town.

Methods

Nine items most commonly reported by 40 pregnant women or mothers with young babies in qualitative interviews were selected for the instrument, with a 10th item ‘Other’. The FAI was validated with 142 pregnant women and mothers in Khayelitsha. Analysis was conducted to assess internal reliability, exploratory factor analysis and convergent validity.

Results

The FAI had good internal reliability (Cronbach’s alpha = 0.77) and the explanatory factor analysis showed a clear 3-factor solution, relating to domestic, childcare and social activities. The FAI scores showed floor effects, but were positively correlated with the two measures of functioning (WHODAS 2.0 and Washington Group Short Set). The FAI scores also correlated with the measure of depression (Edinburgh Postnatal Depression Scale—EPDS), reflecting increased functional limitations associated with increased depressive symptoms.

Conclusion

The results show that the FAI has good internal reliability, and good convergent and construct validity as a measure of functioning for this context. This paper reports on the process of developing an instrument and highlights the importance of using instruments that are locally relevant to ensure accurate measurement of functional status.

If depression symptoms do not affect a person’s functioning, they may have a less severe episode compared with a person who does experience functional limitations.

‘Tasks’ and ‘activities’ are both included as the former refers more to specific work tasks requiring to be done, while ‘activities’ refer to broader events or happenings. These terms are commonly used in combination, for example in the ICF [6].

See Washington Group website http://www.cdc.gov/nchs/washington_group.htm and Miller, Mont, Maitland, Altman, & Madans [35] and UNESCAP [37].

Cohen ME, Marino RJ (2000) The tools of disability outcomes research functional status measures. Arch Phys Med Rehabil 81:S21–S29. doi:10.1053/apmr.2000.20620 CrossRefPubMed

Üstün TB, Kostanjsek N, Chatterji S, Rehm J (2010) Measuring health and disability manual for WHO disability assessment schedule

Kulnik ST, Nikoletou D (2013) WHODAS 2.0 in community rehabilitation: a qualitative investigation into the validity of a generic patient-reported measure of disability. Disabil Rehabil 36:146–154. doi:10.3109/09638288.2013.782360 CrossRefPubMed

Federici S, Meloni F (2010) International encyclopedia of rehabilitation WHODAS II : Disability self-evaluation in the ICF conceptual frame. Int Encycl, Rehabil

Bolton P, Tang AM (2002) An alternative approach to cross-cultural function assessment, pp 537–543. doi: 10.1007/s00127-002-0580-5

WHO (2001) International classification of functioning, disability and health (ICF). World Health Organization, Geneva

Langlieb A, Guico-Pabia C (2010) Beyond symptomatic improvement: assessing real-world outcomes in patients with major depressive disorder. Prim Care Companion J Clin Psychiatry 12:e1–e14

Cabello M, Mellor-Marsá B, Sabariego C et al (2012) Psychosocial features of depression: a systematic literature review. J Affect Disord 141:22–33. doi:10.1016/j.jad.2011.12.009 CrossRefPubMed

Sheehan D, Lecrubier Y, Harnett Sheehan K et al (1998) The mini-international neuropsychiatric interview (M.I.N.I): The development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry 59:22–33PubMed

10.

Bolton P, Bass J, Verdeli H et al (2003) Group interpersonal psychotherapy for depression in rural Uganda: a randomised controlled trial. JAMA 289:3117–3124CrossRefPubMed

11.

Bender A (2011) Restoring function in MDD: Balancing Efficacy and Tolerability to optimally manage major depressive disorder. Can J Diagnosis 28:13–21

12.

Ustün B, Kennedy C (2009) What is “functional impairment”? Disentangling disability from clinical significance. World Psychiatry 8:82–85PubMedCentralPubMed

13.

Lund C, Breen A, Flisher AJ et al (2010) Poverty and common mental disorders in low and middle income countries: A systematic review. Soc Sci Med 71:517–528. doi:10.1016/j.socscimed.2010.04.027 CrossRefPubMed

14.

Fisher J, de Mello MC, Patel V et al (2012) Prevalence and determinants of common perinatal mental disorders in women in low- and lower-middle-income countries: a systematic review. Bull World Health Organ 90(2):139–149H. doi:10.2471/BLT.11.091850 CrossRefPubMedCentral

15.

Senturk V, Hanlon C, Medhin G et al (2012) Impact of perinatal somatic and common mental disorder symptoms on functioning in Ethiopian women: the P-MaMiE population-based cohort study. J Affect Disord 136:340–349. doi:10.1016/j.jad.2011.11.028 CrossRefPubMedCentralPubMed

16.

Hartley M, Tomlinson M, Greco E et al (2011) Depressed mood in pregnancy: prevalence and correlates in two Cape Town peri-urban settlements. Reprod Health 8:9. doi:10.1186/1742-4755-8-9 CrossRefPubMedCentralPubMed

17.

Bass JK, Ryder RW, Lammers M et al (2008) Post-partum depression in Kinshasa. Democratic Republic of Congo : Validation of a concept using a mixed-methods cross-cultural approach. 13:1534–1542. doi:10.1111/j.1365-3156.2008.02160.x

18.

Rahman A, Malik A, Sikander S et al (2008) Cognitive behaviour therapy-based intervention by community health workers for mothers with depression and their infants in rural Pakistan: a cluster-randomised controlled trial. Lancet 372:902–909. doi:10.1016/S0140-6736(08)61400-2 CrossRefPubMedCentralPubMed

19.

Betancourt TS, Bass J, Borisova I et al (2009) Assessing local instrument reliability and validity: a field-based example from northern Uganda. Soc Psychiatry Psychiatr Epidemiol 44:685–692. doi:10.1007/s00127-008-0475-1 CrossRefPubMedCentralPubMed

20.

Cooper PJ, Tomlinson M, Swartz L et al (2009) Improving quality of mother-infant relationships and infant attachment in socioeconomically deprived community in South Africa: randomised controlled trial. BMJ 338:1–8. doi:10.1136/bmj.b974 CrossRef

21.

Tomlinson M (2009) Setting priorities for global mental health research. Bull World Health Organ 87:438–446. doi:10.2471/BLT.08.054353 CrossRefPubMedCentralPubMed

22.

Cooper PJ, Tomlinson M, Swartz L et al (1999) Post-partum depression and the mother-infant relationship in a South African peri-urban settlement. Br J Psychiatry 175:554–558. doi:10.1192/bjp.175.6.554 CrossRefPubMed

23.

De Bruin GP, De Swartz L, Tomlinson M et al (2006) The factor structure of the Edinburgh Postnatal Depression scale in a South African peri- urban settlement. South African J Psychol 34:113–121CrossRef

24.

Gibson J, McKenzie-McHarg K, Shakespeare J et al (2009) A systematic review of studies validating the Edinburgh Postnatal Depression Scale in antepartum and postpartum women. Acta Psychiatr Scand 119:350–364. doi:10.1111/j.1600-0447.2009.01363.x CrossRefPubMed

25.

Peltzer K, Phaswana-Mafuya N (2010) Levels of ability and functioning of persons living with HIV and AIDS using the WHO DAS II in a South African context. J Soc Dev Afr 23:33–54. doi:10.4314/jsda.v23i2.54256

26.

Schneider M (2009) The difference a word makes: responding to questions on “disability” and “difficulty” in South Africa. Disabil Rehabil 31:42–50. doi:10.1080/09638280802280338 CrossRefPubMed

27.

Schneider M, Dasappa P, Khan N, Khan A (2009) Measuring disability in censuses: The case of South Africa. ALTER Eur J Disabil Res/Rev Eur Rech sur le Handicap 3:245–265. doi:10.1016/j.alter.2009.04.002 CrossRef

28.

Lawrie TA, Hofmeyer GJ, de Jager M, Berk M (1998) Validation of the Edinburgh Postnatal depression scale on a cohort of South African Women. SAMJ 88:1340–1344PubMed

29.

Myer L, Smit J, Le Roux L et al (2008) Common mental disorders among HIV-infected individuals in South Africa: Prevalence, predictors and validation of brief psychiatric rating scales. AIDS patient care STDstient 22:147–158. doi:10.1089/apc.2007.0102 CrossRef

30.

Olley BO, Seedat S, Nei DG, Stein DJ (2004) Predictors of major depression in recently diagnosed patients with HIV/AIDS in South Africa. AIDS Patient Care STDS 18:481–487. doi:10.1089/1087291041703700 CrossRefPubMed

31.

Willis GB (2005) Cognitive interviewing: A tool for improving questionnaire design. SAGE, Thousand Oaks

32.

IBM Corp. (2012) IBM SPSS statistics for windows, version 21.0

33.

Rochat TJ, Tomlinson M, Newell M-L, Stein A (2013) Detection of antenatal depression in rural HIV-affected populations with short and ultrashort versions of the Edinburgh Postnatal depression scale (EPDS). Arch Womens Ment Health. doi:10.1007/s00737-013-0353-z PubMedCentralPubMed

34.

Kolen MJ, Lee W-C (2011) Psychometric properties of raw and scale scores on mixed-format tests. Educ Meas Issues Pract 30:15–24. doi:10.1111/j.1745-3992.2011.00201.x CrossRef

35.

Miller K, Mont D, Maitland A et al (2010) Results of a cross-national structured cognitive interviewing protocol to test measures of disability. Qual Quant 45:801–815. doi:10.1007/s11135-010-9370-4 CrossRef

36.

Luciano JV, Ayuso-Mateos JL, Fernández A et al (2010) Psychometric properties of the twelve item World Health Organization disability assessment schedule II (WHO-DAS II) in Spanish primary care patients with a first major depressive episode. J Affect Disord 121:52–58CrossRefPubMed

37.

UNESCAP (2010) Results of the testing of the ESCAP/WG extended question set on disability. Bangkok

Title: Making assessment locally relevant: measuring functioning for maternal depression in Khayelitsha, Cape Town
Authors: Marguerite Schneider
Emily Baron
Thandi Davies
Judith Bass
Crick Lund
Publication date: 01-05-2015
Publisher: Springer Berlin Heidelberg
Published in: Social Psychiatry and Psychiatric Epidemiology / Issue 5/2015
Print ISSN: 0933-7954
Electronic ISSN: 1433-9285
DOI: https://doi.org/10.1007/s00127-014-1003-0

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Making assessment locally relevant: measuring functioning for maternal depression in Khayelitsha, Cape Town

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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