Properties of the Hopkins Symptom Checklist-25 (HSCL-25) and the Self-Reporting Questionnaire (SRQ-20) as screening instruments used in primary care in Afghanistan

Soc Psychiatry Psychiatr Epidemiol (2007) 42:328335 DOI 10.1007/s00127-007-0161-8

ORIGINAL PAPER

Peter Ventevogel Gieljan De Vries Willem F. Scholte Nasratullah Rasa Shinwari Hazullah Faiz Ruhullah Nassery Wim van den Brink Miranda Olff

Properties of the Hopkins Symptom Checklist-25 (HSCL-25) and the Self-Reporting Questionnaire (SRQ-20) as screening instruments used in primary care in Afghanistan

Accepted: 9 January 2007 / Published online: 13 February 2007

Conclusions This study underlines the necessity of validating instruments along with cultural context and gender. Earlier studies in Afghanistan may have overestimated the prevalence of mental disorders among women and underestimated the prevalence in men.

j Key words screening questionnaire common mental disorders primary care gender differences Afghanistan

j Abstract Background Recent epidemiological studies in Afghanistan using mental health questionnaires yielded high prevalence rates for anxiety and depression. Objectives To explore the validity in the Afghan cultural context of two mental health questionnaires, the Hopkins Symptom Checklist-25 (HSCL-25) and the Self-Reporting Questionnaire-20 (SRQ-20). Methods The two mental health questionnaires were compared against a gold standard semi-structured psychiatric interview, the Psychiatric Assessment Schedule (PAS). All instruments were administered to a sample of 116 Pashto-speaking patients (53 men, 63 women) attending primary health care facilities in Eastern Afghanistan. Results Both HSCL-25 and SRQ-20 had modest properties to correctly identify mental disorders, with an AUC (area under the curve) of 0.73 and 0.72 respectively. The optimal cut-off points for this population are different from those often used in transcultural research. For women the optimal cut-off points are higher than usual (2.25 for the HSCL-25 and 17 for the SRQ-20). For men the cut-off point for the HSCL-25 is lower than usual (1.50) and for the SRQ-20 it was 10).

P. Ventevogel N.R. Shinwari H. Faiz HealthNet TPO, Mental Health Programme Jalalabad, Afghanistan

P. Ventevogel G. De Vries W.F. Scholte W. van den BrinkM. OlffAcademic Medical Centre, Dept. of Psychiatry Centre for Psychological Trauma University of AmsterdamAmsterdam, The Netherlands

P. Ventevogel (&)

HealthNet TPO Burundi 1110 Bujumbura, BurundiFax: [phone]E-Mail: [email protected]

R. Nassery Directorate Mental Health Ministry of Public Health Kabul, Afghanistan

Introduction

Several recent studies in Afghanistan have demonstrated very high levels of depressive and anxiety symptoms among the general population, especially in women [1, 22, 36]. These studies, as do many others in the aftermath of...