Abstract
Depression is a debilitating illness, and stigma associated with it often prevents people from seeking support. Easy-to-administer and culturally-specific diagnostic tools can allow for early screening for depression in primary care clinics, especially in resource-limited settings. In this pilot study, we will produce the first open-access isiXhosa-language version of the nine-item Patient Health Questionnaire (PHQ-9), a well-validated measure of depression incidence and severity, using a transcultural translation framework. We will validate this isiXhosa PHQ-9 in a small sample of adolescents living with HIV in Cape Town, South Africa who speak isiXhosa at home. Participants have previously completed the ASEBA Youth Self Report (YSR) form, and responses from the YSR will be used as a gold standard to validate the isiXhosa PHQ-9. If validated through this Registered Report, this isiXhosa PHQ-9 may be an invaluable culturally-specific tool for clinicians serving Xhosa people in identifying clinical or sub-clinical depression.
Highlights
“If I show you where I’m struggling, I feel you have been exposed to my weakness,” said Siyanda, a young Xhosa man, in relation to the cultural expectation for Xhosa men to manage mental health issues without seeking support (1, p.56)
The ongoing development and validation of the 16-item South African Depression Scale (SADS) in isiXhosa is promising, especially for Xhosa people living with HIV [19, 20]
The nine-item Patient Health Questionnaire (PHQ-9) is a useful measure for depression incidence and severity [21, 22]. It has been validated as a diagnostic tool in clinical samples [23] as well as the general population [24], where it shows a high degree of convergent validity with other depression scales such as the Beck Depression Inventory (BDI)
Summary
“If I show you where I’m struggling, I feel you have been exposed to my weakness,” said Siyanda, a young Xhosa man, in relation to the cultural expectation for Xhosa men to manage mental health issues without seeking support (1, p.56). Given this global body of evidence, the PHQ-9 represents a measure of depression that could facilitate cross-cultural comparisons of depression pathology better than population- or geographyspecific scales such as the EPDS or SADS Despite these many advantages, to the best of our knowledge, an isiXhosa-language version of the PHQ-9 has not yet been validated and made publicly available. [Baron et al [16] report findings from an isiXhosa version of the PHQ-9, but this version is not available alongside the study except by request to the authors.] Given the utility of the PHQ-9 in rapid screening of depressive symptomatology, a freely-available isiXhosa-language PHQ-9 may be an invaluable mental health triage tool for clinicians serving Xhosa people In this pilot study, we aim to produce and validate the first open-access isiXhosa-language version of the PHQ9 depression scale. This pilot study may pave the way for largerscale validation studies of this isiXhosa-language PHQ-9 and add an easy-to-administer, culturally-specific questionnaire to the local clinician’s toolbox
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