Urdu translation and validation of PHQ-9, a reliable identification, severity and treatment outcome tool for depression.

OBJECTIVE: To translate and validate the self-report brief version of Patient Health Questtionaire-9 in Urdu. METHODS: The descriptive study was carried out at the Combined Military Hospitals in Gilgit and Lahore, and Pakistan Naval Ship Shifa Hospital in Karachi, from February to May 2016, and comprised of patients recruited from primary healthcare centres of the three cities Standardised procedures including forward-translation, back-translation, expert panel discussion, face validation, pilot testing, and target population validation were done. SPSS 21 was used for statistical analysis. RESULTS: Of the 293 patients, 164(56%) were males and 129(44%) were females. Exploratory factor analysis revealed a single factor solution with minimum factor loading being 0.63. Cronbach's alpha for the scale was 0.91 and split-half reliability was 0.77. Females were more likely to have depressive symptoms compared to male participants (p<0.01). Participants' area of dwelling also influenced their reported symptoms (p<0.01). CONCLUSIONS: Patient Health Questtionaire-9 Urdu scale was found to be a valid and reliable tool to screen, rate and monitor outcomes of depressive illness in primary healthcare settings in Pakistan.

Urdu translation and validation of GAD-7: A screening and rating tool for anxiety symptoms in primary health care.

OBJECTIVE: To translate and validate Generalized Anxiety Disorder -7scale in Urdu, for use in Pakistan in the primary healthcare setups. METHODS: The validation study was conducted at the Combined Military Hospital, Gilgit, Pakistan, from February to May 2016.We followed a systematic six-step process to validate the Generalized Anxiety Disorder-7 scale in the target population. The instrument was translated independently and then fused together. Back-translation was followed by recommendations by an expert committee, and face validity improvement by a language expert. A pilot study was done to get user's feedback on the construct. Volunteers were administered the questionnaire for validation procedure, along with a well-being scale, at three different cities representing volunteers from four different administrative regions of Pakistan. RESULTS: There were 285 volunteers in the study. Principal component exploratory factor analysis supported unidimensional structure of the scale with an eigenvalue of 5.18 and it explained 64.8% of the total variance. Total score on the scale was negatively correlated with positive effect (r = -0.44, p<0.001) and life satisfaction (r = -0.49, p<0.001) subscales of a the well-being scale, while it was positively correlated with the negative affect (r = 0.63, p<0.001) subscale of the same, indicating a good level of convergent and discriminate validity. Cronbach's alpha for the scale was 0.92 and split-half reliability was 0.82, revealing a good level of reliability. CONCLUSIONS: The Generalized Anxiety Disorder -7 scale was found to be a validated, brief, self-administered Urdu tool to screen, rate, and monitor outcome of anxiety disorders in primary healthcare setups.

Prevalence of anxiety and depression among doctors; the unscreened and undiagnosed clientele in Lahore, Pakistan.

OBJECTIVES: To analyze prevalence of anxiety and depression among doctors serving in a tertiary care hospital in Lahore, with a study of impact of relevant demographic features. METHODS: A cross sectional study was conducted at Combined Military Hospital, Lahore, from February 2014 to Jan 2015. Participants were doctors serving in subject hospital for at least six months duration. Standardized Hospital Anxiety Depression Score (HADS) inventory was selected as inventory. Formal approval from hospital ethical committee and written informed consent from participants were obtained. Demographic characteristics of participants were recorded as independent variables; anxiety and depression scores being outcome variables. Data analysis was done via descriptive statistics (SPSS-20), qualitative data expressed as frequencies, percentages; quantitative as mean ± standard deviation(SD). Cross tabulation was done via chi-square, p-value < 0.05 considered as significant. RESULTS: Out of 203 volunteers, 97(47.78%) responded. Score of anxiety was 7.04±4.470, maximum being 19, scores of depression was 4.94±3.605, maximum score being 15. Mild to moderate anxiety and depression were revealed in 33(34%) and 24(24.8%) respectively, while 7(7.2%) and 1(1.0%) had severe anxiety and depression respectively. There was strong positive relation between anxiety and depression (p<0.001). There was significant impact of service years on depression (p-0.011) and gender on anxiety (p-0.002), 9(17.31%) males and 24(53.33%) females had mild to moderate anxiety while 4(7.69%) males and 3(6.66%) females revealed severe anxiety and other variables did not reveal significant impact on HADS scores. CONCLUSION: Doctors showed high grades of anxiety and depression. They must be promptly screened and managed at all medical institutions.