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Published on: February 11, 2017
Validation of the Child Depression Screening Tool in three African settings: Rwanda, Senegal and South Africa
Sharain Suliman1, Jenny Bloom1, Naeem Dalal2,3
1MRC Genomics of Brain Disorders Unit and Department of Psychiatry, Stellenbosch University, Cape Town, South Africa.
Insights
A new screening tool, the Child Depression Screening Tool (CDST), has been adapted for children in Sub-Saharan Africa. This tool effectively identifies childhood depression, particularly in vulnerable youth facing chronic illness or hardship.
Area of Science:
- Child and Adolescent Psychiatry
- Global Mental Health
- Psychometric Validation
Background:
- Childhood depression is underdiagnosed in Sub-Saharan Africa due to a lack of validated screening tools.
- Existing tools often fail to account for cultural contexts and specific stressors like chronic illness, trauma, and socioeconomic hardship.
- The COVID-19 pandemic exacerbated mental health challenges for children in the region.
Purpose of the Study:
- To adapt and validate the Child Depression Screening Tool (CDST) for use in South African, Senegalese, and Rwandan children.
- To assess the prevalence and associated factors of depression in children experiencing chronic illness, trauma, and adversities.
- To establish the psychometric properties of the adapted CDST for screening childhood depression in diverse African settings.
Main Methods:
- Adaptation of the Child Depression Screening Tool (CDST) for South African (SA), Senegalese (S), and Rwandan (R) contexts.
- Administration of the adapted CDST and a DSM-5-based diagnostic interview to 1,001 children aged 7–16 years.
- Receiver operating characteristic (ROC) analysis to determine optimal cut-points and assess tool performance.
Main Results:
- The prevalence of depression ranged from 9.5% to 16.8% across the study sites.
- Depression was more common in children with chronic illnesses and those exposed to adverse life events.
- Factors associated with depression included older age, female sex, school dislike, and cannabis use in specific contexts. The CDST demonstrated satisfactory performance (79-89%) with an optimized cut-point of 5.0.
Conclusions:
- The adapted Child Depression Screening Tool (CDST) is a valid and reliable measure for screening depression in children across diverse Sub-Saharan African settings.
- The CDST offers a practical and sustainable solution for identifying childhood depression, facilitating timely intervention and treatment.
- Further validation in other African countries and settings is recommended to broaden its clinical utility and impact.
Abstract:
The unavailability of reliable, easy-to-use depression screening tools adapted for Sub-Saharan African children is a significant barrier to the treatment of childhood depression. We thus adapted the Child Depression Screening Tool (CDST) to the South African (SA), Senegalese (S) and Rwandan (R) contexts, as a tool to screen for depression in children suffering from chronic illnesses, trauma and difficulties related to COVID-19, family and community hardships. A DSM-5-based diagnostic interview and the CDST screening measure were administered to 1,001 participants aged between 7 and 16 years. The prevalence of depression ranged between 9.5 and 16.8%. It was more prevalent in youth with chronic illness and those exposed to adverse life events. Older age (R and SA), female sex (S), dislike of school (R and SA) and cannabis use (SA) were also associated with worse depression. Receiver operating characteristic analysis showed satisfactory performance (79-89%) and that sensitivity and specificity were optimized at a CDST cut-point of 5.0. The CDST is a valid tool to screen for depression in the settings assessed. If found to be suitable in other countries and settings, it may offer a clinically sound, sustainable path towards the identification of child depression in Africa.
