Validation of cross-cultural child mental health and psychosocial research instruments: adapting the Depression Self-Rating Scale and Child PTSD Symptom Scale in NepalReport as inadecuate

Validation of cross-cultural child mental health and psychosocial research instruments: adapting the Depression Self-Rating Scale and Child PTSD Symptom Scale in Nepal - Download this document for free, or read online. Document in PDF available to download.

BMC Psychiatry

, 11:127

First Online: 04 August 2011Received: 19 March 2011Accepted: 04 August 2011


BackgroundThe lack of culturally adapted and validated instruments for child mental health and psychosocial support in low and middle-income countries is a barrier to assessing prevalence of mental health problems, evaluating interventions, and determining program cost-effectiveness. Alternative procedures are needed to validate instruments in these settings.

MethodsSix criteria are proposed to evaluate cross-cultural validity of child mental health instruments: i purpose of instrument, ii construct measured, iii contents of construct, iv local idioms employed, v structure of response sets, and vi comparison with other measurable phenomena. These criteria are applied to transcultural translation and alternative validation for the Depression Self-Rating Scale DSRS and Child PTSD Symptom Scale CPSS in Nepal, which recently suffered a decade of war including conscription of child soldiers and widespread displacement of youth. Transcultural translation was conducted with Nepali mental health professionals and six focus groups with children n = 64 aged 11-15 years old. Because of the lack of child mental health professionals in Nepal, a psychosocial counselor performed an alternative validation procedure using psychosocial functioning as a criterion for intervention. The validation sample was 162 children 11-14 years old. The Kiddie-Schedule for Affective Disorders and Schizophrenia K-SADS and Global Assessment of Psychosocial Disability GAPD were used to derive indication for treatment as the external criterion.

ResultsThe instruments displayed moderate to good psychometric properties: DSRS area under the curve AUC = 0.82, sensitivity = 0.71, specificity = 0.81, cutoff score ≥ 14; CPSS AUC = 0.77, sensitivity = 0.68, specificity = 0.73, cutoff score ≥ 20. The DSRS items with significant discriminant validity were -having energy to complete daily activities- DSRS.7 -feeling that life is not worth living- DSRS.10, and -feeling lonely- DSRS.15. The CPSS items with significant discriminant validity were nightmares CPSS.2, flashbacks CPSS.3, traumatic amnesia CPSS.8, feelings of a foreshortened future CPSS.12, and easily irritated at small matters CPSS.14.

ConclusionsTranscultural translation and alternative validation feasibly can be performed in low clinical resource settings through task-shifting the validation process to trained mental health paraprofessionals using structured interviews. This process is helpful to evaluate cost-effectiveness of psychosocial interventions.

Electronic supplementary materialThe online version of this article doi:10.1186-1471-244X-11-127 contains supplementary material, which is available to authorized users.

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Author: Brandon A Kohrt - Mark JD Jordans - Wietse A Tol - Nagendra P Luitel - Sujen M Maharjan - Nawaraj Upadhaya



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