Adaptation and Latent Structure of the Swahili Version of Beck Depression Inventory II in a Low Literacy Population in the Context of HIV
Objective We set out to adapt the Beck Depression Inventory (BDI) II in Kenya and examine its factorial structure. Methods In the first phase we carried out in depth interviews involving 29 adult members of the community to elicit their understanding of depression and identify aspects of the BDI II that required adaptation. In the second phase, a modified version of BDI II was administered to 221 adults randomly selected from the community to allow for the evaluation of its psychometric properties. In the third phase of the study we evaluated the discriminative validity of BDI 11 by comparing a randomly chosen community sample (n 29) with caregivers of adolescents affected by HIV (n 77) Results A considerable overlap between the BDI symptoms and those generated in the interviews was observed. Relevant idioms and symptoms such as 'thinking too much' and 'Kuchoka moyo (having a tired heart) were identified. The administration of the BDI had to be modified to make it suitable for the low literacy levels of our participants. Fit indices for several models (one factorial, two factor model and a three factor model) were all within acceptable range. Evidence indicated that while multidimensional models could be fitted, the strong correlations between the factors implied that a single factor model may be the best suited solution (alpha [0.89] and a significant correlation with locally identified items [r 0.51] confirmed the good psychometric properties of the adapted BDI II. No evidence was found to support the hypothesis that somatization was more prevalent. Lastly, caregivers of HIV affected adolescents had significantly higher scores compared to adults randomly selected from the community F(1, 121) 23.31, p .001 indicating the discriminative validity of the adapted BDI II. Conclusions With an adapted administration procedure, the BDI II provides an adequate measure of depressive symptoms which can be used alongside other measures for proper diagnosis in a low literacy population.
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