03498nas a2200169   4500000000100000008004100001260004400042653001200086653001500098653001100113653001400124100002100138245011900159300000700278490003800285520300500323       2019                            d  bVrije Universiteit AmsterdamaAmsterdam10aleprosy10aDepression10aStigma10aIndonesia1 aVan der Linden A00aCross-cultural validation of the PHQ-9 in Bahasa Indonesia to measure depression among persons affected by leprosy  a580 vThesis for the master of Medicine3 a<p><strong>Introduction</strong><br />
Although leprosy is curable since 1981, people affected by leprosy still experience stigmatisation and&nbsp;discrimination. The stigma towards people affected by leprosy may lead to a decreased quality of life.&nbsp;Few studies have focused on major depressive disorder as a comorbidity of leprosy. There is no simple&nbsp;and widely validated instrument that has been validated to diagnose depression among people&nbsp;affected by leprosy. For this study, the PHQ-9 was cross-culturally validated in Bahasa Indonesia. The&nbsp;PHQ-9 has been validated in other countries in Asia, however not in Indonesia or for people affected&nbsp;by leprosy.</p>

<p><strong>Objective</strong><br />
The purpose of this study is to (A) perform a cultural validation of the PHQ-9 in Bahasa Indonesia and&nbsp;(B) to measure the depression status of people affected by leprosy with the validated PHQ-9.</p>

<p><strong>Methods</strong><br />
This study took place in Central Java. The PHQ-9 was translated and back-translated and after that, 15&nbsp;semi-structured interviews and one focus group were conducted for assessing the conceptual,&nbsp;operational, item and semantic equivalence. After analysing the interviews, a refined version of the&nbsp;PHQ-9 was made. For the quantitative part, 114 people affected by leprosy and 54 control group were&nbsp;included to assess the measurement equivalence. Forty-nine people repeated the questionnaire one&nbsp;week later. The following psychometric properties were calculated using SPSS: internal consistency,&nbsp;construct validity, reliability, floor and ceiling effects, interpretability, cut-off score and the prevalence&nbsp;of depression.</p>

<p><strong>Results</strong><br />
Two questions were adapted and after that all questions were considered relevant, comfortable and&nbsp;clear. The internal consistency was defined with Cronbach’s alpha and 0.718. Floor and ceiling effects&nbsp;were not found. The reliability was measured with the repeated interviews. The intra-class coefficient&nbsp;was 0.713 (p&lt;0.001). For the construct validity, the Spearman correlation showed that there was a&nbsp;positive correlation between the total score of the PHQ-9 and the total score of the BDI-II. The means&nbsp;and standard deviations of the people affected by leprosy group and the control group showed that&nbsp;the PHQ-9 was able to distinguish between groups defined by gender, leprosy-related physical&nbsp;problems and visible signs of leprosy. A cut-off point of 10 was adopted on the basis of the original&nbsp;validation of the PHQ-9. The results showed a higher prevalence of depression in the people affected&nbsp;by leprosy group, but this was not significant.</p>

<p><strong>Conclusion</strong><br />
The PHQ-9 is suitable to be used as a screening instrument of depression for people affected by leprosy&nbsp;and in Indonesia. The item, semantic and measurement equivalence are good.</p>