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Development of a brief screening method for identification of depression in older adults in Sub-Saharan Africa

Lookup NU author(s): Professor Richard Walker, Dr Catherine DotchinORCiD, Dr Stella Paddick


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© 2021 Informa UK Limited, trading as Taylor & Francis Group.Objectives: To develop a brief, culturally appropriate screening tool for identifying late life depression (LLD), for use by non-specialist clinicians in primary and out-patient care settings in sub-Saharan Africa (SSA). Background: Depressive disorders are a leading contributor to the global health burden. LLD is common and cases will increase as populations’ age, particularly in low- and middle-income countries (LMICs), such as those in SSA. A chronic mental health workforce shortage and the absence of culturally adapted LLD screening tools to aid non-specialist clinicians have contributed to a significant diagnostic gap. Design: A systematic random sample of older people attending general medical clinics were interviewed using a 30-item LLD questionnaire, developed utilizing a Delphi consensus analysis of items from the Geriatric Depression Scale, Patient Health Questionnaire-2 and questions developed from a study of lay conceptualisations of depression in Tanzania. The items were assessed for validity against blinded DSM 5 diagnosis of depression by a research doctor. Factor and item analysis were then used to refine the questionnaire. Results: The 12-item Maddison Old-age Scale for Identifying Depression (MOSHI-D) was developed. It has good internal consistency (Cronbach’s α = 0.820) and construct and criterion validity (AUROC = 0.880). Conclusions: On initial evaluation, the MOSHI-D showed good internal validity. It should be easy for non-specialists to administer. External validation and further refinement will be conducted. A culturally-appropriate LLD screen may improve mental health care integration into existing healthcare settings within SSA and facilitate greater patient access to care, in accordance with current WHO strategy.

Publication metadata

Author(s): Howarth-Maddison M, Gamassa E, Safic S, Andrea D, Urasa S, Walker RW, Gray WK, Haule I, Dotchin CL, Paddick S-M

Publication type: Article

Publication status: Published

Journal: Aging and Mental Health

Year: 2021

Volume: 26

Issue: 1

Pages: 40-47

Online publication date: 04/01/2021

Acceptance date: 25/11/2020

ISSN (print): 1360-7863

ISSN (electronic): 1364-6915

Publisher: Routledge


DOI: 10.1080/13607863.2020.1857696


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