Scale properties of the Kreyòl Distress Idioms (KDI) screener: association of an ethnographically-developed instrument with depression, anxiety, and sociocultural risk factors in rural Haiti

Abstract

Psychiatric instruments have limitations cross-culturally due to variations in conceptualizations and communication of mental distress. We evaluated a locally-developed screening tool for measuring mental distress in rural Haiti. We employed mixed methods to develop the Kreyòl Distress Idioms (KDI) screening tool. We piloted the KDI in an epidemiologic survey (n = 408) and assessed it using principal component analysis and comparison with the Beck Depression Inventory and Beck Anxiety Inventory (BDI, BAI). Linear regression was used to identify risk factors. Principal component analysis extracted four components: (1) lack of control over thoughts and behaviors, (2) worry and rumination, (3) somatic indicators of anxiety, and (4) fatigue and foreshortened future. The KDI correlated with the BAI (r = 0.67) and BDI (r = 0.52). Factors associated with KDI score included female gender, older age, alcohol consumption, traumatic exposures, and having a household member with mental distress. Belief that disasters cause distress was associated with higher KDI scores, whereas belief that interpersonal relationships cause distress was associated with lower scores. Associations with BDI and BAI scores and established predictors of mental distress support convergent and external validity of the KDI. The KDI provides a more ethnographically-valid measure for mental distress in Haiti than culturally-adapted psychiatric instruments.

Keywords:

• idioms of distress
• Haiti
• principal component analysis
• depression
• anxiety

Supplemental data

Supplemental data for this article can be accessed at http://dx.doi.org/10.1080/17542863.2015.1015580.

Notes on contributors

Bonnie N. Kaiser, PhD, MPH is a postdoctoral associate at the Duke Global Health Institute at Duke University. Her research explores perceptions and experiences of mental distress in Haiti's Central Plateau, with a focus on idioms of distress and mental health communication, development and testing of transcultural screening tools, and treatment resources and decision-making.

Brandon A. Kohrt, MD, PhD, is Assistant Professor of Psychiatry and Behavioral Sciences, Global Health, and Cultural Anthropology in the Duke Global Health Institute. His research addresses cultural adaptation of assessment tools, psychological treatments, and mental health treatment in primary care for conflict- and disaster-affected settings.

Dr. Wagenaar's research focuses on implementation science for health systems improvement in low-and middle-income countries, with a particular focus on mental healthcare and suicide prevention. He is currently a research coordinator for Health Alliance International, a center of the Department of Global Health at the University of Washington in Seattle.

Dr. Kramer is a social epidemiologist with particular interest in women's and children's health, social determinants of health, and life course processes. He is currently an assistant professor of Epidemiology at Emory University.

Kristen McLean, MPH, is a PhD candidate at Yale University studying medical anthropology and global health. She has specific research interests in the areas of mental health, resilience, and family wellbeing, particularly in settings of conflict and other social adversities.

Ashley K. Hagaman, MPH, is a doctoral candidate with the School of Human Evolution and Social Change at Arizona State University. Her research investigates mental health and suicide detection, prevention, and health systems in the context of global health politics in low income settings.

Nayla M. Khoury, MD, MPH is a fourth year psychiatry resident at Cambridge Health Alliance, a Harvard Medical School teaching hospital. She is also a certified yoga instructor and a board member on the Institute for Meditation and Psychotherapy. Interests include: cross-cultural psychiatry, issues related to violence, resiliency, and working with youth.

Hunter Keys earned dual MSN (emergency nurse practitioner) and MPH degrees from Emory University, with research interests in mental health and stigma, migration, and humanitarian emergencies. He is a PhD candidate at the Amsterdam Institute for Social Science Research, University of Amsterdam.

Additional information

Funding

The authors gratefully acknowledge the contributions of field research assistants Desir Fitzner, Wilfrid Jean, Adner Louis, Anel Lavard, and Alexis Ronel. The authors appreciate the support of Cate Oswald, Pere Eddy Eustache, and their colleagues at Partners in Health/Zanmi Lasante. This work was supported by Emory University's Global Health Institute Multidisciplinary Team Field Scholars Award, Emory University's Global Field Experience Award, and Graduate Research Fellowship grant 0234618 from the National Science Foundation (BNK).