Cross-cultural validation of the Urdu translation of the Patient Health Questionnaire for Adolescents among children and adolescents at a Pakistani school

Abstract

Objectives: There is a high prevalence of depressive disorders among children and adolescents globally, accounting for 45% of disability-adjusted life years among 10- to 24-year-olds. Although it has been recognized as a major public health concern in Pakistan, there have been no studies exploring the development or cross-cultural validation of instruments for screening and assessing the severity of adolescent depression. Therefore, the present study was designed to validate the Urdu translation of the Patient Health Questionnaire for Adolescents (PHQ-A) among Pakistani children and adolescents.

Study design: This is a cross-sectional study.

Methods: A total of 452 children and adolescents responded to a survey comprising demographic characteristics, the Urdu translation of PHQ-A, and the Urdu version of Strengths and Difficulties Questionnaire (SDQ). It was hypothesized that total scores on the PHQ-A would correlate significantly with the SDQ scores. Reliability analysis and exploratory factor analyses were carried out using SPSS v.20. Additional confirmatory factor analyses were conducted using the FACTOR program.

Results: No floor and ceiling effects were reported for PHQ-A total scores. Factor analysis confirmed good results for language interchangeability and unidimensionality among the sampled adolescents. Similarly, the findings showed good internal consistency (Cronbach's alpha 0.76), test-retest reliability (intraclass correlation coefficient = 0.61; 0.53-0.68), and concurrent validity.

Conclusion: The Urdu translation of the PHQ-A is a valid and reliable instrument for assessing depression among Pakistani adolescents, based on the Diagnostic and Statistical Manual diagnosis criteria.

Keywords: Adolescents; Depression; PHQ-9; PHQ-A; Patient health questionnaire; Psychometrics; Validation.