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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

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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).

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.

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Acknowledgments

The authors would like to thank the interviewers, the management of HealthNet TPO in Jalalabad and the staff of the health care facilities where the study was based. We gratefully acknowledge the support of Prof. Saeed Farooq (Lady Reading Hospital, Postgraduate Medical Institute in Peshawar) and Dr. Khalid Saeed and Prof. Fareed Minhas (Institute of Psychiatry in Rawalpindi) for their help in the training and testing of the Psychiatric Assessment Schedule. Special thanks go to Drs. Shajaat Ali Khan and Mian Mokhtar ul-Haq, two Pakistani psychiatrists who were courageous enough to visit us in Afghanistan to conduct clinical interviews in the rural areas of Nangarhar Province. The Centers for Disease Control and Prevention (CDC; Atlanta, USA) provided funding to undertake this study.

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Correspondence to Peter Ventevogel.

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Ventevogel, P., De Vries, G., Scholte, W.F. et al. 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 Psychiat Epidemiol 42, 328–335 (2007). https://doi.org/10.1007/s00127-007-0161-8

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