Prevalence of depression and validation of the beck depression inventory-II and the children's depression inventory-short amongst HIV-positive adolescents in Malawi

Maria H. Kim, Alick C. Mazenga, Akash Devandra, Saeed Ahmed, Peter N. Kazembe, Xiaoying Yu, Chi Nguyen, Carla Sharp

Research output: Contribution to journalArticle

29 Citations (Scopus)

Abstract

Introduction: There is a remarkable dearth of evidence on mental illness in adolescents living with HIV/AIDS, particularly in the African setting. Furthermore, there are few studies in sub-Saharan Africa validating the psychometric properties of diagnostic and screening tools for depression amongst adolescents. The primary aim of this cross-sectional study was to estimate the prevalence of depression amongst a sample of HIV-positive adolescents in Malawi. The secondary aim was to develop culturally adapted Chichewa versions of the Beck Depression Inventory-II (BDI-II) and Children's Depression Inventory-II-Short (CDI-II-S) and conduct a psychometric evaluation of these measures by evaluating their performance against a structured depression assessment using the Children's Rating Scale, Revised (CDRS-R). Study design: Cross-sectional study. Methods: We enrolled 562 adolescents, 12-18 years of age from two large public HIV clinics in central and southern Malawi. Participants completed two self-reports, the BDI-II and CDI-II-S, followed by administration of the CDRS-R by trained clinicians. Sensitivity, specificity and positive and negative predictive values for various BDI-II and CDI-II-S cut-off scores were calculated with receiver operating characteristics analysis. The area under the curve (AUC) was also calculated. Internal consistency was measured by standardized Cronbach's alpha coefficient, and correlation between self-reports and CDRS-R by Spearman's correlation. Results: Prevalence of depression as measured by the CDRS-R was 18.9%. Suicidal ideation was expressed by 7.1% (40) using the BDI-II. The AUC for the BDI-II was 0.82 (95% CI 0.78-0.89) and for the CDI-II-S was 0.75 (95% CI 0.70-0.80). A score of ≥13 in BDI-II achieved sensitivity of >80%, and a score of ≥17 had a specificity of >80%. The Cronbach's alpha was 0.80 (BDI-II) and 0.66 (CDI-II-S). The correlation between the BDI-II and CDRS-R was 0.42 (p <0.001) and between the CDI-II-S and CDRS-R was 0.37 (p<0.001). Conclusions: This study demonstrates that the BDI-II has sound psychometric properties in an outpatient setting among HIV-positive adolescents in Malawi. The high prevalence of depression amongst HIV-positive Malawian adolescents noted in this study underscores the need for the development of comprehensive services for HIV-positive adolescents.

Original languageEnglish (US)
Article number18965
JournalJournal of the International AIDS Society
Volume17
DOIs
StatePublished - 2014
Externally publishedYes

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Malawi
HIV
Depression
Equipment and Supplies
Psychometrics
Self Report
Area Under Curve
Cross-Sectional Studies

Keywords

  • Adolescents
  • BDI-II
  • CDI-II-Short
  • Depression
  • HIV
  • Prevalence

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health
  • Infectious Diseases

Cite this

Prevalence of depression and validation of the beck depression inventory-II and the children's depression inventory-short amongst HIV-positive adolescents in Malawi. / Kim, Maria H.; Mazenga, Alick C.; Devandra, Akash; Ahmed, Saeed; Kazembe, Peter N.; Yu, Xiaoying; Nguyen, Chi; Sharp, Carla.

In: Journal of the International AIDS Society, Vol. 17, 18965, 2014.

Research output: Contribution to journalArticle

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title = "Prevalence of depression and validation of the beck depression inventory-II and the children's depression inventory-short amongst HIV-positive adolescents in Malawi",
abstract = "Introduction: There is a remarkable dearth of evidence on mental illness in adolescents living with HIV/AIDS, particularly in the African setting. Furthermore, there are few studies in sub-Saharan Africa validating the psychometric properties of diagnostic and screening tools for depression amongst adolescents. The primary aim of this cross-sectional study was to estimate the prevalence of depression amongst a sample of HIV-positive adolescents in Malawi. The secondary aim was to develop culturally adapted Chichewa versions of the Beck Depression Inventory-II (BDI-II) and Children's Depression Inventory-II-Short (CDI-II-S) and conduct a psychometric evaluation of these measures by evaluating their performance against a structured depression assessment using the Children's Rating Scale, Revised (CDRS-R). Study design: Cross-sectional study. Methods: We enrolled 562 adolescents, 12-18 years of age from two large public HIV clinics in central and southern Malawi. Participants completed two self-reports, the BDI-II and CDI-II-S, followed by administration of the CDRS-R by trained clinicians. Sensitivity, specificity and positive and negative predictive values for various BDI-II and CDI-II-S cut-off scores were calculated with receiver operating characteristics analysis. The area under the curve (AUC) was also calculated. Internal consistency was measured by standardized Cronbach's alpha coefficient, and correlation between self-reports and CDRS-R by Spearman's correlation. Results: Prevalence of depression as measured by the CDRS-R was 18.9{\%}. Suicidal ideation was expressed by 7.1{\%} (40) using the BDI-II. The AUC for the BDI-II was 0.82 (95{\%} CI 0.78-0.89) and for the CDI-II-S was 0.75 (95{\%} CI 0.70-0.80). A score of ≥13 in BDI-II achieved sensitivity of >80{\%}, and a score of ≥17 had a specificity of >80{\%}. The Cronbach's alpha was 0.80 (BDI-II) and 0.66 (CDI-II-S). The correlation between the BDI-II and CDRS-R was 0.42 (p <0.001) and between the CDI-II-S and CDRS-R was 0.37 (p<0.001). Conclusions: This study demonstrates that the BDI-II has sound psychometric properties in an outpatient setting among HIV-positive adolescents in Malawi. The high prevalence of depression amongst HIV-positive Malawian adolescents noted in this study underscores the need for the development of comprehensive services for HIV-positive adolescents.",
keywords = "Adolescents, BDI-II, CDI-II-Short, Depression, HIV, Prevalence",
author = "Kim, {Maria H.} and Mazenga, {Alick C.} and Akash Devandra and Saeed Ahmed and Kazembe, {Peter N.} and Xiaoying Yu and Chi Nguyen and Carla Sharp",
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journal = "Journal of the International AIDS Society",
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T1 - Prevalence of depression and validation of the beck depression inventory-II and the children's depression inventory-short amongst HIV-positive adolescents in Malawi

AU - Kim, Maria H.

AU - Mazenga, Alick C.

AU - Devandra, Akash

AU - Ahmed, Saeed

AU - Kazembe, Peter N.

AU - Yu, Xiaoying

AU - Nguyen, Chi

AU - Sharp, Carla

PY - 2014

Y1 - 2014

N2 - Introduction: There is a remarkable dearth of evidence on mental illness in adolescents living with HIV/AIDS, particularly in the African setting. Furthermore, there are few studies in sub-Saharan Africa validating the psychometric properties of diagnostic and screening tools for depression amongst adolescents. The primary aim of this cross-sectional study was to estimate the prevalence of depression amongst a sample of HIV-positive adolescents in Malawi. The secondary aim was to develop culturally adapted Chichewa versions of the Beck Depression Inventory-II (BDI-II) and Children's Depression Inventory-II-Short (CDI-II-S) and conduct a psychometric evaluation of these measures by evaluating their performance against a structured depression assessment using the Children's Rating Scale, Revised (CDRS-R). Study design: Cross-sectional study. Methods: We enrolled 562 adolescents, 12-18 years of age from two large public HIV clinics in central and southern Malawi. Participants completed two self-reports, the BDI-II and CDI-II-S, followed by administration of the CDRS-R by trained clinicians. Sensitivity, specificity and positive and negative predictive values for various BDI-II and CDI-II-S cut-off scores were calculated with receiver operating characteristics analysis. The area under the curve (AUC) was also calculated. Internal consistency was measured by standardized Cronbach's alpha coefficient, and correlation between self-reports and CDRS-R by Spearman's correlation. Results: Prevalence of depression as measured by the CDRS-R was 18.9%. Suicidal ideation was expressed by 7.1% (40) using the BDI-II. The AUC for the BDI-II was 0.82 (95% CI 0.78-0.89) and for the CDI-II-S was 0.75 (95% CI 0.70-0.80). A score of ≥13 in BDI-II achieved sensitivity of >80%, and a score of ≥17 had a specificity of >80%. The Cronbach's alpha was 0.80 (BDI-II) and 0.66 (CDI-II-S). The correlation between the BDI-II and CDRS-R was 0.42 (p <0.001) and between the CDI-II-S and CDRS-R was 0.37 (p<0.001). Conclusions: This study demonstrates that the BDI-II has sound psychometric properties in an outpatient setting among HIV-positive adolescents in Malawi. The high prevalence of depression amongst HIV-positive Malawian adolescents noted in this study underscores the need for the development of comprehensive services for HIV-positive adolescents.

AB - Introduction: There is a remarkable dearth of evidence on mental illness in adolescents living with HIV/AIDS, particularly in the African setting. Furthermore, there are few studies in sub-Saharan Africa validating the psychometric properties of diagnostic and screening tools for depression amongst adolescents. The primary aim of this cross-sectional study was to estimate the prevalence of depression amongst a sample of HIV-positive adolescents in Malawi. The secondary aim was to develop culturally adapted Chichewa versions of the Beck Depression Inventory-II (BDI-II) and Children's Depression Inventory-II-Short (CDI-II-S) and conduct a psychometric evaluation of these measures by evaluating their performance against a structured depression assessment using the Children's Rating Scale, Revised (CDRS-R). Study design: Cross-sectional study. Methods: We enrolled 562 adolescents, 12-18 years of age from two large public HIV clinics in central and southern Malawi. Participants completed two self-reports, the BDI-II and CDI-II-S, followed by administration of the CDRS-R by trained clinicians. Sensitivity, specificity and positive and negative predictive values for various BDI-II and CDI-II-S cut-off scores were calculated with receiver operating characteristics analysis. The area under the curve (AUC) was also calculated. Internal consistency was measured by standardized Cronbach's alpha coefficient, and correlation between self-reports and CDRS-R by Spearman's correlation. Results: Prevalence of depression as measured by the CDRS-R was 18.9%. Suicidal ideation was expressed by 7.1% (40) using the BDI-II. The AUC for the BDI-II was 0.82 (95% CI 0.78-0.89) and for the CDI-II-S was 0.75 (95% CI 0.70-0.80). A score of ≥13 in BDI-II achieved sensitivity of >80%, and a score of ≥17 had a specificity of >80%. The Cronbach's alpha was 0.80 (BDI-II) and 0.66 (CDI-II-S). The correlation between the BDI-II and CDRS-R was 0.42 (p <0.001) and between the CDI-II-S and CDRS-R was 0.37 (p<0.001). Conclusions: This study demonstrates that the BDI-II has sound psychometric properties in an outpatient setting among HIV-positive adolescents in Malawi. The high prevalence of depression amongst HIV-positive Malawian adolescents noted in this study underscores the need for the development of comprehensive services for HIV-positive adolescents.

KW - Adolescents

KW - BDI-II

KW - CDI-II-Short

KW - Depression

KW - HIV

KW - Prevalence

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