Reliability and validity of a perinatal depression screening instrument in rural Mali

BACKGROUND: In order to reduce the burden of perinatal depression in low- and middle-income countries, health systems must be able to identify and treat women suffering from depression. The objective of our study was to develop a locally valid and reliable screening instrument for use in identifying pregnant women and mothers of young children with a local depression syndrome, dusukasi, in rural Mali. METHODS: We administered a locally adapted screening instrument containing items from the Edinburgh Postpartum Depression Scale (EPDS) and Hopkins Symptom Checklist (HSCL-25) to 180 pregnant women and mothers of children under age 2 in Sélingué, Mali to assess the instrument’s psychometric properties and validity. Item Response Theory was used to develop an abbreviated version of the measure and the validity and psychometric properties of this shortened version were compared with the full-length scale. RESULTS: The full 28-item scale exhibited a single factor structure with good internal consistency (Cronbach’s alpha = 0.92). Women who self-identified as suffering from dusukasi (n = 87) in a known groups analysis to assess construct validity had significantly higher depression and anxiety symptom scores (p < 0.0001) and functional impairment scores (p < 0.0001) compared to women not reporting dusukasi (n = 93). The shortened 16-item scale performed as well as the full scale in identifying women with dusukasi. CONCLUSIONS: Construct validity of our adapted screening instrument was supported for identifying dusukasi in rural Malian women. Our methodology can be applied in other settings to develop similarly valid screening instruments for perinatal depression.