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

Abstract

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.

KEYWORDS:

• Depression
• older adults
• Tanzania
• sub-Saharan Africa
• Low- and middle-income countries

Acknowledgements

We would like to thank all participants, officials and health care workers who assisted in the organisation and completion of this research.

Disclosure statement

None.

Description of authors’ roles

This study was conceived, organised and managed by SU, RW, IH, S-MP, CD and WKG. Data collection was by MHM, EG, DA and SS. Statistical analysis and writing of the first draft of the paper was done by MHM, S-MP and WKG. All listed authors were involved in the preparation, review and critique of the final manuscript.

Additional information

Funding

This study was funded by Grand Challenges Canada (grant number 0086-04) and Newcastle University Masters in Research Programme.