Translation, cultural adaptation and validation of Patient Health Questionnaire and generalized anxiety disorder among adolescents in Nepal.

BACKGROUND: Depression and anxiety are significant contributors to the global burden of disease among young people. Accurate data on the prevalence of these conditions are crucial for the equitable distribution of resources for planning and implementing effective programs. This study aimed to culturally adapt and validate data collection tools for measuring depression and anxiety at the population level. METHODS: The study was conducted in Kathmandu, Nepal, a diverse city with multiple ethnicities, languages, and cultures. Ten focus group discussions with 56 participants and 25 cognitive interviews were conducted to inform adaptations of the Patient Health Questionnaire adapted for Adolescents (PHQ-A) and Generalized Anxiety Disorder (GAD-7). To validate the tools, a cross-sectional survey of 413 adolescents (aged 12-19) was conducted in three municipalities of Kathmandu district. Trained clinical psychologists administered the Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS-DSM 5 version) to survey participants. RESULTS: A number of cultural adaptations were required, such as changing statements into questions, using a visual scale (glass scale) to maintain uniformity in responses, and including a time frame at the beginning of each item. For younger adolescents aged 12 to 14 years, a PHQ-A cut-off of > = 13 had a sensitivity of 0.93, specificity of 0.80, positive predictive value (PPV) of 0.33, and negative predictive value (NPV) of 0.99. For older adolescents aged 15-19, a cut-off of > = 11 had a sensitivity of 0.89, specificity of 0.70, PPV of 0.32, and NPV of 0.97. For GAD-7, a cut-off of > = 8 had a sensitivity of 0.70 and specificity of 0.67 for younger adolescents and 0.71 for older adolescents, with a PPV of 0.39 and NPV of 0.89. The individual symptom means of both PHQ-A and GAD-7 items showed moderate ability to discriminate between adolescents with and without depression and anxiety. CONCLUSION: The PHQ-A and GAD-7 demonstrate fair psychometric properties for screening depression but performed poorly for anxiety, with high rates of false positives. Even when using clinically validated cut-offs, population prevalence rates would be inflated by 2-4 fold with these tools, requiring adjustment when interpreting epidemiological findings.

Stress, Anxiety, Depression and Their Associated Factors among Health Care Workers During COVID -19 Pandemic in Nepal.

BACKGROUND: Frontline Health Care Workers are at risk of developing mental and psychological distress during Corona virus disease 2019 pandemic. This study aimed to assess level of stress, anxiety, depression and their associated factors among health care workers during Corona virus disease 2019 pandemic in Nepal. METHODS: This is a web based cross-sectional survey conducted among 404 Health Care Workers during early phase of Corona virus disease 2019 pandemic. The participants were selected using convenience sampling technique and were invited to participate via various online networks. Depression, anxiety and stress were assessed using the Depression Anxiety Stress Scale-21 (DASS-21) and their associated factors were measured using structured questionnaires. Multivariable logistic regression was carried out to determine the associated factors. RESULTS: The symptoms of stress, anxiety and depression among health care workers were found to be 28.9%, 35.6% and 17.0% respectively. Females were found to be 2 fold more likely to have anxiety and depression than male. Nurses were found to be two times more likely to have anxiety than doctors. Laboratory personnel were almost three folds more likely to have anxiety than doctors. Health care workers with insufficient/ no PPE were almost three fold more likely to have depression. health care workers working in high-risk areas had almost 2 fold higher odds of having depression. CONCLUSIONS: Health care workers experienced symptoms of stress, anxiety and depression in varied level of severity. This experience was higher among the nurses and laboratory workers than doctors. Pandemic preparedness assuring PPE and appropriate psychological interventions may be beneficial to promote mental health and well-being of health care workers.

Intake Assessment and Diagnostic Accuracy of Attention Deficit Hyperactivity Disorder diagnostic Scale Being Developed for Children in Nepal.

BACKGROUND: Establishment of accurate diagnosis of participants is vital before starting the development of diagnostic scale. The aim of this study was to develop psychometrically sound Attention Deficit Hyperactivity Disorder diagnostic scale for children. METHODS: Informed consent was taken. Initial diagnosis of Attention Deficit Hyperactivity Disorder was made by using Diagnostic and Statistical Manual-5. Socio-demographic data were obtained. Behavior observation, parental information and teacher's report were also analyzed. Then, Kiddie-Schedule for Affective disorders and Schizophrenia, Child and Adolescent Symptoms Inventory, Stroop Color and word test were done to obtain confirmatory data. Verbatim collection was done to develop the culture specific items. Likewise, standardization was done Results: Accurate diagnosis was established with the help of various tools and techniques. Comorbid conditions were excluded. Diagnostic accuracy was assessed where reliability of each item was ? 0.90; whereas, sensitivity and specificity were 97.0% and 96.6%, respectively with cut off score of 38.5. All items are highly co-related with Attention Deficit Hyperactivity Disorder items of Child and Adolescent Symptoms Inventory-5. CONCLUSIONS: Results clearly indicated that diagnostic accuracy values of this scale is high.

Identification and Management of COVID-19 Related Child and Adolescent Mental Health Problems: A Multi-Tier Intervention Model.

Nepal is a low and medium-income country (LMIC), situated in South-east Asia, with a population of 29 million, of which, 40-50% are children and adolescents. The Coronavirus Disease 2019 (COVID-19) pandemic has affected the lives of people around the world, including Nepal. The child and adolescent mental health (CAMH) needs and services in Nepal have a significant gap. CAMH in Nepal suffers from lack of specialized training in this field as well as scarcity of human resources and services. There is only one full-time child and adolescent psychiatry (CAP) out-patient clinic in the country. Some recent activities have focused on CAMH in Nepal but the COVID-19 pandemic has produced new challenges. Access to mental health services for children and adolescents (C&A) across Nepal has been adversely affected. Factors such as closure of schools, confinement at home, lockdown, transportation problems, uncertainty, loss of usual routine and fear of infection have affected the mental health of C&A. This has highlighted a need to build capacity of available local human resources, enhance community support, teach measures of coping with stress and improve CAMH service delivery by strengthening the referral system, but these have to be addressed overcoming problems of travel restrictions and limited resources. To address these needs, online platform can be a suitable approach. With this view, a multi-tier CAMH intervention model was developed, which utilizes online platform for training mental health professionals across Nepal, who would then facilitate sessions for C&A, teachers, parents and caregivers; and link them to CAMH services locally, and remotely through teleconsultation. This started as a pilot from June 2020 and will continue till end of February 2021, with the aim to reach 40,000 C&A, parents, teachers and caregivers. As of Nov 2020, this model has been used to successfully conduct 1,415 sessions, with 28,597 population reached. Among them, 16,571 are C&A and 12,026 are parents, teachers and caregivers, across all 7 provinces of Nepal. In this paper, the multi-tier intervention to address the COVID-19 related CAMH problems has been discussed as a feasible framework for resource limited settings and LMICs like Nepal.

Validation of Attention Deficit Hyperactivity Disorder Diagnostic Scale for Children.

BACKGROUND: There is no valid Attention Deficit Hyperactivity Disorder diagnostic tool to fit Nepalese culture and language till date. Current study is intended to develop and validate the Attention Deficit Hyperactivity Disorder scale for children in Nepal. METHODS: Mixed method study was conducted with 840 samples (i.e. children with Attention Deficit Hyperactivity Disorder =356, Anxiety =128 and General Population=356).Items generation, scale development and scale evaluation were the three consecutive steps followed to develop and validate the scale.Children with Attention Deficit Hyperactivity Disorder (already met the Diagnostic and statistical Manual-5 criteria) were further assessed by Kiddie-Schedule for Affective disorders and Schizophrenia (K-SADS-PL), Child and Adolescent Symptoms Inventory (CASI-5) to confirm the diagnosis and psychometric validation. Pilot studies were done for items clarity. Each data obtained from three comparison groups (Attention Deficit Hyperactivity Disorder , Anxiety and General Population) were included for standardization process where tests of dimensionality, reliability, validity,calculating norms (cut off) were doneas scale evaluation process. RESULTS: The final version of the scale had 21 items. Three sub-scales (Inattention, Impulsivity and Hyperactivity) were identified by using Principal Axis Factor Analysis.All factors showed strong statistically significant convergent validity and Discriminant validity Cronbach's alpha of each item is ? 0.91.As total score criteria, 38.5 is considered as the best cut-off point for this scale. CONCLUSIONS: By using systematic process, a valid and reliable Attention Deficit Hyperactivity Disorder diagnostic scale is being developed in Nepalese culture and language.