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Detecting Depression in People Living with HIV in South Africa: The Factor Structure and Convergent Validity of the South African Depression Scale (SADS)

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Abstract

Screening measures for depression developed in high-income countries have not always demonstrated strong psychometric properties in South Africa and with people living with HIV (PLWH). The present study explored the psychometric properties of the 16-item South African Depression Scale (SADS) comprised of idioms of distress specific to isiXhosa culture in PLWH. The SADS was administered to 137 Xhosa-speaking PLWH who met diagnostic criteria for major depressive disorder (MDD) together with the Hamilton Depression Scale (HAM-D) and the Center for Epidemiological Studies Depression Scale (CES-D). We conducted exploratory factor analysis, correlation, and reliability statistics. Four factors of the SADS emerged: Sadness, lethargy/burdened, anhedonia/withdrawal, and cognitive/somatic. All factors correlated significantly with the HAM-D and CES-D. Internal consistency of the overall measure was high (α = .89). The SADS promises to be a robust measure of depression in isiXhosa-speaking PLWH in South Africa likely due to the inclusion of local idioms of distress.

RESUMEN

Las medidas de detección de la depresión que se desarrollaron en países de altos ingresos no siempre han demostrado fuertes propiedades psicométricas en Sudáfrica y con personas que viven con el VIH (PVVS). El estudio actual exploró las propiedades psicométricas de la Escala de Depresión Sudafricana de 16 preguntas (SADS) compuesta por modismos de angustia específicos de la cultura isiXhosa en PVVS. El SADS se administró a 137 PVVS Xhosa que cumplieron los criterios diagnósticos para el trastorno depresivo mayor (TDM) junto con la Escala de Depresión de Hamilton (HAM-D) y la Escala de Depresión del Centro de Estudios Epidemiológicos (CES-D). Realizamos análisis factorial exploratorio, correlación y estadísticas de fiabilidad. Cuatro factores del SADS emergieron: Tristeza, letargo/agobiado, anhedonia/ abstinencia, y cognitiva/somática. Todos los factores se correlacionaron significativamente con el HAM-D y el CES-D. La consistencia interna de la medida general fue alta (α = .89). El SADS promete ser una medida robusta de depresión en las PVVS que hablan isiXhosa en Sudáfrica, probablemente debido a la inclusión de expresiones idiomáticas locales de angustia.

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Acknowledgements

This project was supported by National Institute of Mental Health (NIMH) Grant R01MH103770 (Safren/O’Cleirigh). Some additional author time was supported by K24DA040489 (Safren), 1P30MH116867 (Safren), and K23DA041901 (Magidson). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Mental Health or the National Institutes of Health.

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Authors and Affiliations

  1. HIV Mental Health Research Unit, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa

    L. S. Andersen, J. A. Joska & J. A. Witten

  2. Department of Psychology, University of Maryland, College Park, MA, USA

    J. F. Magidson

  3. Behavioral Medicine Service, Massachusetts General Hospital/Department of Psychiatry, Harvard Medical School, Boston, MA, USA

    C. O’Cleirigh

  4. Department of Psychology, University of Miami, Florida, USA

    J. S. Lee & S. A. Safren

  5. Department of Psychology, Stellenbosch University, Western Cape, South Africa

    A. Kagee

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  1. L. S. Andersen
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  2. J. A. Joska
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  4. C. O’Cleirigh
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  5. J. S. Lee
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  6. A. Kagee
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  8. S. A. Safren
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Correspondence to L. S. Andersen.

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Andersen, L.S., Joska, J.A., Magidson, J.F. et al. Detecting Depression in People Living with HIV in South Africa: The Factor Structure and Convergent Validity of the South African Depression Scale (SADS). AIDS Behav 24, 2282–2289 (2020). https://doi.org/10.1007/s10461-020-02787-4

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