Lessons in cross-cultural measurement of depressive symptoms: findings from a mixed-methods study in Ghana

ABSTRACT

As the public health importance of depression grows in low-income countries, development of culturally relevant and valid measurement tools is increasingly necessary to inform effective interventions. This research was embedded within the Family Health and Wealth Study, an ongoing multi-country cohort study. We use mixed methods to assess the reliability and various aspects of validity, including cultural relevance, of a 10-item version of the Center for Epidemiologic Studies Depression (CES-D 10) Scale among men and women of reproductive age in Kumasi, Ghana. The scale demonstrated adequate internal consistency reliability, and factor analysis supported a one-factor model for both men and women in the study setting. However, qualitative findings highlighted several additional relevant symptom groups in the study population that were not included in the scale: loss of concentration, loss of appetite, suicidal ideation and becoming quiet or withdrawn. Although quantitative analyses indicated that the CES-D 10 scale demonstrated adequate reliability and validity as a measure of depressive symptoms, qualitative analyses revealed that this scale failed to fully capture depression as it is conceptualized in the study community. Our results underline the importance of integrating culturally-specific information on mental health when developing and adapting measurement tools in new settings.

KEYWORDS:

• depression
• Ghana
• culture
• measurement
• CES-D scale
• mixed methods
• gender

Acknowledgements

We thank our collaborators at the Kwame Nkrumah University of Science and Technology in Kumasi, Ghana, especially Easmon Otupiri, Denis Yar and the team of research assistants. We are also grateful to the Family Health and Wealth Study participants, as well as the community care providers in Kumasi who participated in our qualitative study.

Disclosure statement

No potential conflict of interest was reported by the authors.

Notes on contributors

Stephanie R. Psaki was a doctoral student in the Department of Population, Family and Reproductive Health at the Johns Hopkins School of Public Health at the time this research was conducted. She is now an Associate in the Poverty, Gender and Youth division at the Population Council.

Michelle J. Hindin is a Professor in the Department of Population, Family and Reproductive Health at the Johns Hopkins School of Public Health.

Additional information

Funding

This work was supported by the Bill & Melinda Gates Institute for Population and Reproductive Health; a Global Health Field Research Award from the Johns Hopkins Center for Global Health; the Dr. Michael Koenig Memorial Fund; and the Edward J. Dehne Award in Population Dynamics.