Abstract
BackgroundMany of the assessment tools used to study depression among older people are adaptations of instruments developed in other cultural setting. There is a need to validate those instruments in low and middle income countries (LMIC).MethodsA one-phase cross-sectional survey of people aged [greater than or equal to] 65 years from LMIC. EURO-D was checked for psychometric properties. Calibration with clinical diagnosis was made using ICD-10. Optimal cutpoint was determined. Concurrent validity was assessed measuring correlations with WHODAS 2.0.Results17,852 interviews were completed in 13 sites from nine countries. EURO-D constituted a hierarchical scale in most sites. The most commonly endorsed symptom in Latin American sites was depression; in China was sleep disturbance and tearfulness; in India, irritability and fatigue and in Nigeria loss of enjoyment. Two factor structure (affective and motivation) were demonstrated. Measurement invariance was demonstrated among Latin American and Indian sites being less evident in China and Nigeria. At the 4/5 cutpoint, sensitivity for ICD-10 depressive episode was 86% or higher in all sites and specificity exceeded 84% in all Latin America and Chinese sites. Concurrent validity was supported, at least for Latin American and Indian sites.ConclusionsThere is evidence for the cross-cultural validity of the EURO-D scale at Latin American and Indian settings and its potential applicability in comparative epidemiological studies.
Highlights
Many of the assessment tools used to study depression among older people are adaptations of instruments developed in other cultural setting
Educational levels varied widely between sites, the proportion not completing primary education was higher in sites in India, China and Nigeria in comparison to those in Latin America, and was generally higher in rural than urban sites
EURO-D scores were inversely associated with happiness in all sites (−0.17 to −0.49, p < 0.001) other than China urban (−0.05, p = 0.12) and rural (−0.01, p = 0.70), and Nigeria (+0.01, p = 0.68). The results of these analyses extend the evidence for the cross-cultural validity of the EURO-D scale, at least to Hispanic Latin American and Indian settings
Summary
Many of the assessment tools used to study depression among older people are adaptations of instruments developed in other cultural setting. Clinical diagnostic criteria for depression including DSM-5 [4] and ICD-10 [5] are applied to adults of all ages. These may, miss clinically significant episodes among older people who do not meet these specific criteria. Only the Geriatric Depression Scale [10,11] and the EURO-D [12] were developed for use in older people, and evidence for their validity comes mainly from high income countries [16,17,18,19,20,21] [12,22]
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