Skip to main content

Advertisement

SpringerLink
Log in

Making assessment locally relevant: measuring functioning for maternal depression in Khayelitsha, Cape Town

  • Original Paper
  • Published:
Social Psychiatry and Psychiatric Epidemiology Aims and scope Submit manuscript

Abstract

Purpose

We developed a locally relevant functioning assessment instrument (FAI) for pregnant women and mothers of young babies to complement a widely validated instrument—the World Health Organization’s Disability Assessment Schedule (WHODAS) 12-item version. The FAI is an outcome measure in a randomised controlled trial on the effectiveness of a lay counsellor administered intervention for distressed pregnant women in Khayelitsha, Cape Town.

Methods

Nine items most commonly reported by 40 pregnant women or mothers with young babies in qualitative interviews were selected for the instrument, with a 10th item ‘Other’. The FAI was validated with 142 pregnant women and mothers in Khayelitsha. Analysis was conducted to assess internal reliability, exploratory factor analysis and convergent validity.

Results

The FAI had good internal reliability (Cronbach’s alpha = 0.77) and the explanatory factor analysis showed a clear 3-factor solution, relating to domestic, childcare and social activities. The FAI scores showed floor effects, but were positively correlated with the two measures of functioning (WHODAS 2.0 and Washington Group Short Set). The FAI scores also correlated with the measure of depression (Edinburgh Postnatal Depression Scale—EPDS), reflecting increased functional limitations associated with increased depressive symptoms.

Conclusion

The results show that the FAI has good internal reliability, and good convergent and construct validity as a measure of functioning for this context. This paper reports on the process of developing an instrument and highlights the importance of using instruments that are locally relevant to ensure accurate measurement of functional status.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Notes

  1. If depression symptoms do not affect a person’s functioning, they may have a less severe episode compared with a person who does experience functional limitations.

  2. ‘Tasks’ and ‘activities’ are both included as the former refers more to specific work tasks requiring to be done, while ‘activities’ refer to broader events or happenings. These terms are commonly used in combination, for example in the ICF [6].

  3. See Washington Group website http://www.cdc.gov/nchs/washington_group.htm and Miller, Mont, Maitland, Altman, & Madans [35] and UNESCAP [37].

References

  1. Cohen ME, Marino RJ (2000) The tools of disability outcomes research functional status measures. Arch Phys Med Rehabil 81:S21–S29. doi:10.1053/apmr.2000.20620

    Article  CAS  PubMed  Google Scholar 

  2. Üstün TB, Kostanjsek N, Chatterji S, Rehm J (2010) Measuring health and disability manual for WHO disability assessment schedule

  3. Kulnik ST, Nikoletou D (2013) WHODAS 2.0 in community rehabilitation: a qualitative investigation into the validity of a generic patient-reported measure of disability. Disabil Rehabil 36:146–154. doi:10.3109/09638288.2013.782360

    Article  PubMed  Google Scholar 

  4. Federici S, Meloni F (2010) International encyclopedia of rehabilitation WHODAS II : Disability self-evaluation in the ICF conceptual frame. Int Encycl, Rehabil

    Google Scholar 

  5. Bolton P, Tang AM (2002) An alternative approach to cross-cultural function assessment, pp 537–543. doi: 10.1007/s00127-002-0580-5

  6. WHO (2001) International classification of functioning, disability and health (ICF). World Health Organization, Geneva

    Google Scholar 

  7. Langlieb A, Guico-Pabia C (2010) Beyond symptomatic improvement: assessing real-world outcomes in patients with major depressive disorder. Prim Care Companion J Clin Psychiatry 12:e1–e14

    Google Scholar 

  8. Cabello M, Mellor-Marsá B, Sabariego C et al (2012) Psychosocial features of depression: a systematic literature review. J Affect Disord 141:22–33. doi:10.1016/j.jad.2011.12.009

    Article  PubMed  Google Scholar 

  9. Sheehan D, Lecrubier Y, Harnett Sheehan K et al (1998) The mini-international neuropsychiatric interview (M.I.N.I): The development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry 59:22–33

    PubMed  Google Scholar 

  10. Bolton P, Bass J, Verdeli H et al (2003) Group interpersonal psychotherapy for depression in rural Uganda: a randomised controlled trial. JAMA 289:3117–3124

    Article  PubMed  Google Scholar 

  11. Bender A (2011) Restoring function in MDD: Balancing Efficacy and Tolerability to optimally manage major depressive disorder. Can J Diagnosis 28:13–21

    Google Scholar 

  12. Ustün B, Kennedy C (2009) What is “functional impairment”? Disentangling disability from clinical significance. World Psychiatry 8:82–85

    PubMed Central  PubMed  Google Scholar 

  13. Lund C, Breen A, Flisher AJ et al (2010) Poverty and common mental disorders in low and middle income countries: A systematic review. Soc Sci Med 71:517–528. doi:10.1016/j.socscimed.2010.04.027

    Article  PubMed  Google Scholar 

  14. Fisher J, de Mello MC, Patel V et al (2012) Prevalence and determinants of common perinatal mental disorders in women in low- and lower-middle-income countries: a systematic review. Bull World Health Organ 90(2):139–149H. doi:10.2471/BLT.11.091850

    Article  PubMed Central  Google Scholar 

  15. Senturk V, Hanlon C, Medhin G et al (2012) Impact of perinatal somatic and common mental disorder symptoms on functioning in Ethiopian women: the P-MaMiE population-based cohort study. J Affect Disord 136:340–349. doi:10.1016/j.jad.2011.11.028

    Article  PubMed Central  PubMed  Google Scholar 

  16. Hartley M, Tomlinson M, Greco E et al (2011) Depressed mood in pregnancy: prevalence and correlates in two Cape Town peri-urban settlements. Reprod Health 8:9. doi:10.1186/1742-4755-8-9

    Article  PubMed Central  PubMed  Google Scholar 

  17. Bass JK, Ryder RW, Lammers M et al (2008) Post-partum depression in Kinshasa. Democratic Republic of Congo : Validation of a concept using a mixed-methods cross-cultural approach. 13:1534–1542. doi:10.1111/j.1365-3156.2008.02160.x

    Google Scholar 

  18. Rahman A, Malik A, Sikander S et al (2008) Cognitive behaviour therapy-based intervention by community health workers for mothers with depression and their infants in rural Pakistan: a cluster-randomised controlled trial. Lancet 372:902–909. doi:10.1016/S0140-6736(08)61400-2

    Article  PubMed Central  PubMed  Google Scholar 

  19. Betancourt TS, Bass J, Borisova I et al (2009) Assessing local instrument reliability and validity: a field-based example from northern Uganda. Soc Psychiatry Psychiatr Epidemiol 44:685–692. doi:10.1007/s00127-008-0475-1

    Article  PubMed Central  PubMed  Google Scholar 

  20. Cooper PJ, Tomlinson M, Swartz L et al (2009) Improving quality of mother-infant relationships and infant attachment in socioeconomically deprived community in South Africa: randomised controlled trial. BMJ 338:1–8. doi:10.1136/bmj.b974

    Article  Google Scholar 

  21. Tomlinson M (2009) Setting priorities for global mental health research. Bull World Health Organ 87:438–446. doi:10.2471/BLT.08.054353

    Article  PubMed Central  PubMed  Google Scholar 

  22. Cooper PJ, Tomlinson M, Swartz L et al (1999) Post-partum depression and the mother-infant relationship in a South African peri-urban settlement. Br J Psychiatry 175:554–558. doi:10.1192/bjp.175.6.554

    Article  CAS  PubMed  Google Scholar 

  23. De Bruin GP, De Swartz L, Tomlinson M et al (2006) The factor structure of the Edinburgh Postnatal Depression scale in a South African peri- urban settlement. South African J Psychol 34:113–121

    Article  Google Scholar 

  24. Gibson J, McKenzie-McHarg K, Shakespeare J et al (2009) A systematic review of studies validating the Edinburgh Postnatal Depression Scale in antepartum and postpartum women. Acta Psychiatr Scand 119:350–364. doi:10.1111/j.1600-0447.2009.01363.x

    Article  CAS  PubMed  Google Scholar 

  25. Peltzer K, Phaswana-Mafuya N (2010) Levels of ability and functioning of persons living with HIV and AIDS using the WHO DAS II in a South African context. J Soc Dev Afr 23:33–54. doi:10.4314/jsda.v23i2.54256

    Google Scholar 

  26. Schneider M (2009) The difference a word makes: responding to questions on “disability” and “difficulty” in South Africa. Disabil Rehabil 31:42–50. doi:10.1080/09638280802280338

    Article  PubMed  Google Scholar 

  27. Schneider M, Dasappa P, Khan N, Khan A (2009) Measuring disability in censuses: The case of South Africa. ALTER Eur J Disabil Res/Rev Eur Rech sur le Handicap 3:245–265. doi:10.1016/j.alter.2009.04.002

    Article  Google Scholar 

  28. Lawrie TA, Hofmeyer GJ, de Jager M, Berk M (1998) Validation of the Edinburgh Postnatal depression scale on a cohort of South African Women. SAMJ 88:1340–1344

    CAS  PubMed  Google Scholar 

  29. Myer L, Smit J, Le Roux L et al (2008) Common mental disorders among HIV-infected individuals in South Africa: Prevalence, predictors and validation of brief psychiatric rating scales. AIDS patient care STDstient 22:147–158. doi:10.1089/apc.2007.0102

    Article  Google Scholar 

  30. Olley BO, Seedat S, Nei DG, Stein DJ (2004) Predictors of major depression in recently diagnosed patients with HIV/AIDS in South Africa. AIDS Patient Care STDS 18:481–487. doi:10.1089/1087291041703700

    Article  CAS  PubMed  Google Scholar 

  31. Willis GB (2005) Cognitive interviewing: A tool for improving questionnaire design. SAGE, Thousand Oaks

    Google Scholar 

  32. IBM Corp. (2012) IBM SPSS statistics for windows, version 21.0

  33. Rochat TJ, Tomlinson M, Newell M-L, Stein A (2013) Detection of antenatal depression in rural HIV-affected populations with short and ultrashort versions of the Edinburgh Postnatal depression scale (EPDS). Arch Womens Ment Health. doi:10.1007/s00737-013-0353-z

    PubMed Central  PubMed  Google Scholar 

  34. Kolen MJ, Lee W-C (2011) Psychometric properties of raw and scale scores on mixed-format tests. Educ Meas Issues Pract 30:15–24. doi:10.1111/j.1745-3992.2011.00201.x

    Article  Google Scholar 

  35. Miller K, Mont D, Maitland A et al (2010) Results of a cross-national structured cognitive interviewing protocol to test measures of disability. Qual Quant 45:801–815. doi:10.1007/s11135-010-9370-4

    Article  Google Scholar 

  36. Luciano JV, Ayuso-Mateos JL, Fernández A et al (2010) Psychometric properties of the twelve item World Health Organization disability assessment schedule II (WHO-DAS II) in Spanish primary care patients with a first major depressive episode. J Affect Disord 121:52–58

    Article  PubMed  Google Scholar 

  37. UNESCAP (2010) Results of the testing of the ESCAP/WG extended question set on disability. Bangkok

Download references

Acknowledgments

The research reported in this publication was supported by the National Institute of Mental Health of the National Institutes of Health under award number 5U19MH095699 and in part by the National Research Foundation of South Africa (NRF) (Grant Number 85042). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or NRF.

Conflict of interest

None of the authors have any conflict of interest.

Ethical standard

This study was approved by the Faculty of Health Sciences Human Research Ethics Committee of the University of Cape Town (REC Ref: 226/2011). All participants were required to sign consent before they were interviewed for the free listing and validation phases.

Trial registration

Clinical Trials (ClinicalTrials.gov): NCT01977326; Pan African Clinical Trials Registry (http://www.pactr.org): PACTR201403000676264.

Author information

Authors and Affiliations

  1. Department of Psychiatry and Mental Health, Alan J Flisher Centre for Public Mental Health, University of Cape Town, 46 Sawkins Rd, Rondebosch, Cape Town, 7700, South Africa

    Marguerite Schneider, Emily Baron, Thandi Davies & Crick Lund

  2. Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

    Judith Bass

Authors
  1. Marguerite Schneider
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Emily Baron
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Thandi Davies
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Judith Bass
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Crick Lund
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Marguerite Schneider.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Schneider, M., Baron, E., Davies, T. et al. Making assessment locally relevant: measuring functioning for maternal depression in Khayelitsha, Cape Town. Soc Psychiatry Psychiatr Epidemiol 50, 797–806 (2015). https://doi.org/10.1007/s00127-014-1003-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00127-014-1003-0

Keywords

Search

Navigation