Skip to main content

Advertisement

SpringerLink
Log in

The Utility of the Hopkins Symptom Checklist as a Trans-Diagnostic Screening Instrument for Common Mental Disorders Among Persons Seeking HIV Testing

  • Original Paper
  • Published:
AIDS and Behavior Aims and scope Submit manuscript

Abstract

There is a need for effective psychiatric screening of HIV test seekers, given the high rates of psychopathology in this population. We used receiver operating characteristic curve analysis to establish the utility of the short version of the Hopkins Symptom Checklist (HSCL-25) to correctly identify common mental disorders (CMDs) among persons seeking HIV testing. The HSCL-25 is moderately accurate in identifying CMDs (sensitivity = 69%, specificity = 71%). The HSCL-25 performed better than the Beck Depression Inventory at detecting depressive disorders, and was comparable to the Beck Anxiety Inventory and Posttraumatic Stress Scale-Self-report at detecting cases of generalised anxiety disorder and posttraumatic stress disorder, respectively. However, the instrument generates a high number of false positives and is poor at detecting cases of alcohol use disorder, which limits its utility as a trans-diagnostic screening tool in HIV testing sites.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Abbreviations

AUDIT:

Alcohol use identification test

ARV:

Anti-retroviral

AUD:

Alcohol use disorders

BAI:

Beck Anxiety Inventory

BDI:

Beck Depression Inventory

CMDs:

CMDs

DSM:

Diagnostic and statistical manual for mental illness

GAD:

Generalised anxiety disorder

HIV:

Human immunodeficiency virus

HSCL:

Hopkins symptom checklist

HSCL-25:

Hopkins symptom checklist-short version

MDD:

Major depressive disorder

NPV:

Negative predictive value

PTSD:

Posttraumatic stress disorder

PDD:

Persistent depressive disorder

PPV:

Positive predictive value

PTSS:

Posttraumatic Stress Scale–Self-report

ROC:

Receiver operating characteristic

SCID:

Structured clinical interview

SAMISS:

Substance abuse and mental illness symptom screener

References

  1. Collins PY, Holman AR, Freeman MC, Patel V. What is the relevance of mental health to HIV/AIDS care and treatment programs in developing countries? A Systematic review. Aids. 2006;20(12):1571–82.

    PubMed  PubMed Central  Google Scholar 

  2. Breuer E, Myer L, Struthers H, Joska JA. HIV/AIDS and mental health research in sub-Saharan Africa: a systematic review. Afr J AIDS Res. 2011;10(2):101–22.

    PubMed  Google Scholar 

  3. Lyketsos CG, Hanson A, Fishman M, McHugh PR, Treisman GJ. Screening for psychiatric morbidity in a medical outpatient clinic for HIV infection: the need for a psychiatric presence. Int J Psychiatry Med. 1994;24(2):103–13.

    CAS  PubMed  Google Scholar 

  4. Chibanda D, Cowan FM, Healy JL, Abas M, Lund C. Psychological interventions for common mental disorders for people living with hiv in low- and middle-income countries: systematic review. Trop Med Int Heal. 2015;20(7):830–9.

    Google Scholar 

  5. Myer L, Smit J, Le Roux L, Parker S, Stein DJ, Seedat S. Common mental disorders among hiv-infected individuals in South Africa: prevalence, predictors, and validation of brief psychiatric rating scales. AIDS Patient Care STDS. 2008;2(2):147–58.

    Google Scholar 

  6. Israelski DM, Prentiss DE, Lubega S, Balmas G, Garcia P, Muhammad M, et al. Psychiatric co-morbidity in vulnerable populations receiving primary care for HIV/AIDS. AIDS Care—Psychol Socio-Medical Asp AIDS/HIV. 2007;19(2):220–5.

    CAS  Google Scholar 

  7. Klinkenberg WD, Sacks S. Mental disorders and drug abuse in persons living with HIV/AIDS. AIDS Care—Psychol Socio-Medical Asp AIDS/HIV. 2004;16(Suppl 1):S22–42.

    Google Scholar 

  8. O’Cleirigh C, Magidson JF, Skeer MR, Mayer KH, Safren SA. Prevalence of psychiatric and substance abuse symptomatology among HIV-infected gay and bisexual men in HIV primary care. Psychosomatics. 2015;56(5):470–8.

    PubMed  Google Scholar 

  9. Brandt R. The mental health of people living with HIV/AIDS in Africa: a systematic review. Afr J AIDS Res. 2009;8(2):123–33.

    PubMed  Google Scholar 

  10. Kagee A, Saal W, De Villiers L, Sefatsa M, Bantjes J. The prevalence of common mental disorders among South Africans seeking HIV testing. AIDS Behav. 2017;21(6):1511–7.

    PubMed  PubMed Central  Google Scholar 

  11. Kagee A, Saal W, Bantjes J. Distress, depression and anxiety among persons seeking HIV testing. AIDS Care—Psychol Socio-Medical Asp AIDS/HIV. 2017;29(3):280–4.

    Google Scholar 

  12. Springer SA, Dushaj A, Azar MM. The impact of DSM-IV mental disorders on adherence to combination antiretroviral therapy among adult persons living with HIV/AIDS: a systematic review. AIDS Behav. 2012;16(8):2119–43.

    PubMed  PubMed Central  Google Scholar 

  13. Kagee A, Tsai AC, Lund C, Tomlinson M. Screening for common mental disorders in low resource settings: reasons for caution and a way forward. Int Health. 2013;5(1):11–4.

    PubMed  Google Scholar 

  14. Saal W, Kagee A, Bantjes J. Utility of the Beck Depression Inventory in measuring major depression among individuals seeking HIV testing in the Western Cape, South Africa. AIDS Care. 2018;30(Sup1):29–36.

    CAS  PubMed  Google Scholar 

  15. Kagee A, Bantjes J, Saal W, Sefatsa M. Utility of the Posttraumatic Stress Scale–Self-report version in screening for posttraumatic stress disorder among persons seeking HIV testing. South African J Psychol. 2018;49(1):136–47.

    Google Scholar 

  16. Saal W, Kagee A, Bantjes J, (under review). Evaluation of the Beck Anxiety Inventory in predicting generalized anxiety disorder among individuals seeking HIV testing in the Western Cape, South Africa. South African J Psychiatry.

  17. Maruish ME, editor. Handbook of psychological assessment in primary care settings. New York: Routledge Taylor & Francis; 2017. p. 783.

    Google Scholar 

  18. Diez-Canseco F, Toyama M, Ipince A, Perez-Leon S, Cavero V, Araya R, et al. Integration of a technology-based mental health screening program into routine practices of primary health care services in Peru (The Allillanchu Project): development and implementation. J Med Internet Res. 2018;20(3):e100.

    PubMed  PubMed Central  Google Scholar 

  19. World Health Organization. Integrating mental health into primary care: a global perspective. Geneva: World Health Organisation; 2008. p. 1–206.

    Google Scholar 

  20. Spitzer RL, Williams JBW, Johnson JG, Kroenke K, Linzer M, Degruy FV, et al. Utility of a new procedure for diagnosing mental disorders in primary care: the PRIME-MD 1000 study. JAMA. 1994;272(22):1749–56.

    CAS  PubMed  Google Scholar 

  21. Rahm AK, Boggs JM, Martin C, Price DW, Beck A, Backer TE, et al. Facilitators and barriers to implementing screening, brief intervention, and referral to treatment (SBIRT) in primary care in integrated health care settings. Subst Abus. 2015;36(3):281–8.

    PubMed  Google Scholar 

  22. Freeman C, Tyrer PJ, Tyrer P. Research methods in psychiatry. London: RCPsych Publications; 2006.

    Google Scholar 

  23. Habibzadeh F, Habibzadeh P, Yadollahie M. On determining the most appropriate test cut-off value: the case of tests with continuous results. Biochem Medica. 2016;26(3):297–307.

    Google Scholar 

  24. Sox HC, Blatt MA, Higgins MC, Marton KI. Selection and interpretation of diagnostic tests. In: Sox HC, Blatt MA, Higgins MC, Marton KI, editors. Medical decision making. Chichester: Wiley; 2013. p. 243–87.

    Google Scholar 

  25. Mitchell AJ, Coyne JC. Do ultra-short screening instruments accurately detect depression in primary care? A pooled analysis and meta- analysis of 22 studies. Br J Gen Pract. 2007;57(535):144–51.

    PubMed  PubMed Central  Google Scholar 

  26. Patel V, Araya R, Chowdhary N, King M, Kirkwood B, Nayak S, et al. Detecting common mental disorders in primary care in India: a comparison of five screening questionnaires. Psychol Med. 2008;38(2):221–8.

    CAS  PubMed  Google Scholar 

  27. Mulrow CD, Williams JW, Gerety MB, Ramirez G, Montiel OM, Kerber C. Case-finding instruments for depression in primary care settings. Ann Intern Med. 1995;122(12):913–21.

    CAS  PubMed  Google Scholar 

  28. Hough R, Landsverk J, Stone J, Jacobson GR. Comparison of psychiatric screening questionnaires for primary care patients. MD: Rockville; 1983.

    Google Scholar 

  29. Ali GC, Ryan G, De Silva MJ. Validated screening tools for common mental disorders in low and middle income countries: a systematic review. PLoS ONE. 2016;11(6):e0156939.

    PubMed  PubMed Central  Google Scholar 

  30. Chishinga N, Kinyanda E, Weiss HA, Patel V, Ayles H, Seedat S. Validation of brief screening tools for depressive and alcohol use disorders among TB and HIV patients in primary care in Zambia. BMC Psychiatry. 2011;11:75.

    PubMed  PubMed Central  Google Scholar 

  31. Chibanda D, Verhey R, Gibson LJ, Munetsi E, Machando D, Rusakaniko S, et al. Validation of screening tools for depression and anxiety disorders in a primary care population with high HIV prevalence in Zimbabwe. J Affect Disord. 2016;198:50–5.

    Google Scholar 

  32. Natamba BK, Achan J, Arbach A, Oyok TO, Ghosh S, Mehta S, et al. Reliability and validity of the center for epidemiologic studies-depression scale in screening for depression among HIV-infected and -uninfected pregnant women attending antenatal services in northern Uganda: a cross-sectional study. BMC Psychiatry. 2014;14(1):2197.

    Google Scholar 

  33. Spies G, Kader K, Kidd M, Smit J, Myer L, Stein DJ, et al. Validity of the K-10 in detecting DSM-IV-defined depression and anxiety disorders among HIV-infected individuals. AIDS Care. 2009;21(9):1163–8.

    CAS  PubMed  Google Scholar 

  34. Breuer E, Stoloff K, Myer L, Seedat S, Stein DJ, Joska JA. The validity of the substance abuse and mental illness symptom screener (SAMISS) in people living with HIV/AIDS in primary HIV care in Cape Town, South Africa. AIDS Behav. 2014;18(6):1133–41.

    PubMed  Google Scholar 

  35. Derogatis LR, Lipman RS, Rickels K, Uhlenhuth EH, Covi L. The Hopkins symptom checklist (HSCL): a self-report symptom inventory. Behav Sci. 1974;19(1):1–15.

    CAS  PubMed  Google Scholar 

  36. American Psychiatric Association Committee on Nomenclature and Statistics. Diagnostic and statistical manual of mental disorders. 4th ed. Washington, DC: American Psychiatric Association; 1994.

    Google Scholar 

  37. Knaevelsrud C, Brand J, Lange A, Ruwaard J, Wagner B. Web-based psychotherapy for posttraumatic stress disorder in war-traumatized Arab patients: randomized controlled trial. J Med Internet Res. 2015;17(3):e71.

    PubMed  PubMed Central  Google Scholar 

  38. Jakobsen M, Thoresen S, Johansen LEE. The validity of screening for post-traumatic stress disorder and other mental health problems among asylum seekers from different countries. J Refug Stud. 2011;24(1):171–86.

    Google Scholar 

  39. Wind TR, van der Aa N, de la Rie S, Knipscheer J. The assessment of psychopathology among traumatized refugees: measurement invariance of the Harvard Trauma Questionnaire and the Hopkins Symptom Checklist-25 across five linguistic groups. Eur J Psychotraumatol. 2017;8(sup2):1321357.

    PubMed  PubMed Central  Google Scholar 

  40. Kagee A. Symptoms of distress and posttraumatic stress among South African former political detainees. Ethn Heal. 2005;10(2):169–79.

    Google Scholar 

  41. Ventevogel P, De Vries G, Scholte WF, Shinwari NR, Faiz H, Nassery R, et al. Properties of the Hopkins symptom checklist-25 (HSCL-25) and the Self-Reporting Questionnaire (SRQ-20) as screening instruments used in primary care in Afghanistan. Soc Psychiatry Psychiatr Epidemiol. 2007;42(4):328–35.

    PubMed  Google Scholar 

  42. Silove D, Manicavasagar V, Mollica R, Thai M, Khiek D, Lavelle J, et al. Screening for depression and PTSD in a Cambodian population unaffected by war: comparing the Hopkins Symptom Checklist and Harvard Trauma Questionnaire with the structured clinical interview. J Nerv Ment Dis. 2007;195(2):152–7.

    PubMed  Google Scholar 

  43. Hollifield M, Warner TD, Lian N, Krakow B, Jenkins JH, Kesler J, et al. Measuring trauma and health status in refugees: a critical review. J Am Med Assoc. 2002;288(5):611–21.

    Google Scholar 

  44. Hinton WL, Du N, Chen YCJ, Tran CG, Newman TB, Lu FG. Screening for major depression in vietnamese refugees—a validation and comparison of two instruments in a health screening population. J Gen Intern Med. 1994;9(4):202–6.

    CAS  PubMed  Google Scholar 

  45. Mollica RF, Wyshak G, de Marneffe D, Khuon F, Lavelle J. Indochinese versions of the Hopkins Symptom Checklist-25: a screening instrument for the psychiatric care of refugees. Am J Psychiatry. 1987;144(4):497–500.

    CAS  PubMed  Google Scholar 

  46. Vinck P, Pham PN. Association of exposure to violence and potential traumatic events with self-reported physical and mental health status in the Central African Republic. JAMA. 2010;304(5):544–52.

    CAS  PubMed  Google Scholar 

  47. Vuković IS, Jovanović N, Kolarić B, Vidović V, Mollica RF. Psychological and somatic health problems in bosnian refugees: a three year follow-up. Psychiatr Danub. 2013;26(3):442–9.

    Google Scholar 

  48. Kagee A. Psychological distress among persons living with HIV, hypertension, and diabetes. AIDS Care—Psychol Socio-Medical Asp AIDS/HIV. 2010;22(12):1517–21.

    Google Scholar 

  49. Al-Turkait FA, Ohaeri JU, El-Abbasi AHM, Naguy A. Relationship between symptoms of anxiety and depression in a sample of arab college students using the Hopkins Symptom Checklist 25. Psychopathology. 2011;44(4):230–41.

    PubMed  Google Scholar 

  50. Glaesmer H, Braehler E, Grande G, Hinz A, Petermann F, Romppel M. The German Version of the Hopkins Symptoms Checklist-25 (HSCL-25)—Factorial structure, psychometric properties, and population-based norms. Compr Psychiatry. 2014;55(2):396–403.

    PubMed  Google Scholar 

  51. Mouanoutoua VL, Brown LG. Hopkins Symptom Checklist-25, Hmong Version: a screening instrument for psychological distress. J Pers Assess. 1995;64(2):376–83.

    CAS  PubMed  Google Scholar 

  52. Kaaya SF, Lee B, Mbwambo JK, Smith-Fawzi MC, Leshabari MT. Detecting depressive disorder with a 19-item local instrument in Tanzania. Int J Soc Psychiatry. 2008;54(1):21–33.

    PubMed  Google Scholar 

  53. Fröjdh K, Håkansson A, Karlsson I. The Hopkins Symptom Cheklist-25 is a sensitive case-finder of clinically important depressive states in elderly people in primary care. Int J Geriatr Psychiatry. 2004;19(4):386–90.

    PubMed  Google Scholar 

  54. Kleijn WC, Hovens JE, Rodenburg JJ. Posttraumatic Stress Symptoms in Refugees: assessments with the Harvard Trauma Questionnaire and the Hopkins Symptom Checklist–25 in different languages. Psychol Rep. 2001;88(2):527–32.

    CAS  PubMed  Google Scholar 

  55. Lhewa D, Banu S, Rosenfeld B, Keller A. Validation of a tibetan translation of the hopkins symptom checklist-25 and the harvard trauma questionnaire. Assessment. 2007;14(3):223–30.

    PubMed  Google Scholar 

  56. Kaaya SF, Fawzi MCS, Mbwambo JK, Lee B, Msamanga GI, Fawzi W. Validity of the Hopkins Symptom Checklist-25 amongst HIV-positive pregnant women in Tanzania. Acta Psychiatr Scand. 2002;106(1):9–19.

    CAS  PubMed  PubMed Central  Google Scholar 

  57. Kagee A, Martin L. Symptoms of depression and anxiety among a sample of South African patients living with HIV. AIDS Care—Psychol Socio-Medical Asp AIDS/HIV. 2010;22(2):159–65.

    Google Scholar 

  58. Orlando M, Burnam MA, Beckman R, Morton SC, London AS, Bing EG, et al. Re-estimating the prevalence of psychiatric disorders in a nationally representative sample of persons receiving care for HIV: results from the HIV cost and services utilization study. Int J Methods Psychiatr Res. 2002;11(2):75–82.

    PubMed  Google Scholar 

  59. Bantjes J, Kagee A. Common mental disorders and psychological adjustment among individuals seeking HIV testing: a study protocol to explore implications for mental health care systems. Int J Ment Health Syst. 2018;12(1):16.

    PubMed  PubMed Central  Google Scholar 

  60. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Arlington: American Psychiatric Publishing; 2013.

    Google Scholar 

  61. Milanović SM, Erjavec K, Poljičanin T, Vrabec B, Brečić P. Prevalence of depression symptoms and associated socio-demographic factors in primary health care patients. Psychiatr Danub. 2015;27(1):31–7.

    PubMed  Google Scholar 

  62. Cerimele JM, Chwastiak LA, Dodson S, Katon WJ. The prevalence of bipolar disorder in general primary care samples: a systematic review. Gen Hosp Psychiatry. 2014;36(1):19–25.

    PubMed  Google Scholar 

  63. Ormel J, Vonkorff M, Ustun TB, Pini S, Korten A, Oldehinkel T. Common mental disorders and disability across cultures: results From the WHO Collaborative Study on Psychological Problems in General Health Care. JAMA. 1994;272(22):1741–8.

    CAS  PubMed  Google Scholar 

  64. Lee JW, Jones PS, Mineyama Y, Zhang XE. Cultural differences in responses to a likert scale. Res Nurs Health. 2002;25(4):295–306.

    PubMed  Google Scholar 

  65. Newby JM, McKinnon A, Kuyken W, Gilbody S, Dalgleish T. Systematic review and meta-analysis of transdiagnostic psychological treatments for anxiety and depressive disorders in adulthood. Clin Psychol Rev. 2015;40:91–110.

    PubMed  Google Scholar 

  66. Titova N, Deara BF, Staplesa LG, Teridesa MD, Karina E, Sheehana J, et al. Disorder-specific versus transdiagnostic and clinician-guided versus self-guided treatment for major depressive disorder and comorbid anxiety disorders: a randomized controlled trial. J Anxiety Disord. 2015;35:88–102.

    Google Scholar 

  67. Caspi A, Moffitt TE. All for one and one for all: mental disorders in one dimension. Am J Psychiatry. 2018;175(9):831–44.

    PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

This research was funded by grants from the South African National Research Foundation (Grant No. 93515, awarded to Ashraf Kagee) and the South African Medical Research Council (Career Development Grant awarded to Jason Bantjes).

Author information

Authors and Affiliations

  1. Department of Psychology, Stellenbosch University, Private Bag X1, Matieland, 7602, South Africa

    Jason Bantjes, Ashraf Kagee & Wylene Saal

Authors
  1. Jason Bantjes
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ashraf Kagee
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Wylene Saal
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jason Bantjes.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOCX 222 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Bantjes, J., Kagee, A. & Saal, W. The Utility of the Hopkins Symptom Checklist as a Trans-Diagnostic Screening Instrument for Common Mental Disorders Among Persons Seeking HIV Testing. AIDS Behav 24, 629–636 (2020). https://doi.org/10.1007/s10461-019-02524-6

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10461-019-02524-6

Keywords

Search

Navigation