The cross-cultural validation and adaptation of the Patient Health Questionnaire-9 (PHQ-9) and the Warwick-Edinburgh Mental Wellbeing scale (WEMWBS) amongst persons affected by leprosy in India.
Introduction: There is need for validated instruments that measure the mental status amongst persons affected by leprosy in India. The Patient Health Questionnaire-9 (PHQ-9) and the Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS) are such tools. The PHQ-9 measures symptoms of depression and the WEMWBS measures mental wellbeing in general. Both instruments are already used amongst different target groups and in different contexts.
Objective: This study cross-culturally validates the PHQ-9 and WEMWBS to measure the level of depression or mental wellbeing amongst Hindi speaking persons affected by leprosy in India.
Methods: A cross-sectional study design with a mixed methods approach was used. A qualitative pilot study was performed to assess the conceptual, item, semantic and operational equivalence of the two instruments for persons affected by leprosy. In the quantitative study, measurement equivalence was assessed by investigating the internal consistency, construct validity, floor and ceiling effects and interpretability.
Results: During the qualitative study, seven persons affected by leprosy were interviewed. The results showed sufficient conceptual equivalence for both instruments. The item, semantic and operational equivalence showed to be inacceptable. Adjustments were made to improve the instruments. The adjusted tools were assessed in the quantitative study. The quantitative study included 101 persons affected by leprosy and 62 controls. The results show that both instruments have sufficient measurement equivalence. The internal consistency of the PHQ-9 and WEMWBS was good (α = 0.81, α = 0.81). The construct validity was satisfactory. For the PHQ-9 and WEMWBS, floor and ceiling effects were not found and the interpretability was acceptable.
Conclusion: The Hindi versions of the PHQ-9 and WEMWBS have been adjusted and the instruments are cross-culturally validated to measure the level of depression or mental wellbeing amongst persons affected by leprosy in Jharkhand and similar Hindi speaking areas.