BACKGROUND In South Africa, the prevalence of symptoms of common mental disorders (CMD), i.e. depression, anxiety and suicidal thoughts are high. This study aimed to use a cognitive interviewing technique to validate the content and structure of a 4-item screening tool, to adapt the tool accordingly, and to use receiver operating curve (ROC) analysis to determine the optimum cut-point for identifying pregnant women with symptoms of CMD. METHODS We conducted a mixed method study at a Midwife Obstetric Unit in Cape Town. Women attending the clinic for their first antenatal visit during the recruitment period, whose first language was English, Afrikaans or isiXhosa, were invited to participate. A 4-item screening tool was administered in the first language of the interviewee, after which a cognitive interviewing technique was used to examine the question-response processes and considerations used by respondents as they formed answers to the screening tool questions. The Edinburgh Postnatal Depression Scale (EPDS) was used to identify women with symptoms of CMD. RESULTS A 2-week recall period performed well. Questions about (1) being unable to stop worrying, or thinking too much, (2) feeling down, depressed or hopeless, and (3) having thoughts and plans to harm yourself, were well understood. The question that referred to feeling little interest or pleasure in doing things, was poorly understood across all languages. Using ROC analysis with the EPDS as the reference standard, and a cut-point of ≥13, we showed that a 3-item version of the screening tool was able to correctly classify 91% of the women screened. CONCLUSIONS Cognitive interviewing enabled testing and refining of the language and constructs of an ultra-brief screening tool. The shortened, 3-item tool is well understood and effective at identifying pregnant women with symptoms of CMD, across the three most commonly spoken languages and cultures in Cape Town.

中文翻译：

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验证针对低社会经济环境中孕妇的简短心理健康筛查工具。


背景技术在南非，常见精神障碍(CMD)症状，即抑郁、焦虑和自杀念头的患病率很高。本研究旨在使用认知访谈技术来验证四项筛查工具的内容和结构，相应地调整该工具，并使用受试者工作曲线（ROC）分析来确定识别孕妇的最佳切点有 CMD 症状。方法 我们在开普敦的助产士产科单位进行了一项混合方法研究。在招募期间到诊所进行第一次产前检查且母语为英语、南非荷兰语或伊西科萨语的妇女被邀请参加。使用受访者的第一语言使用 4 项筛选工具，然后使用认知访谈技术来检查受访者在回答筛选工具问题时使用的问题-回答过程和考虑因素。爱丁堡产后抑郁量表 (EPDS) 用于识别患有 CMD 症状的女性。结果 两周的回忆期表现良好。关于（1）无法停止担心或想太多，（2）情绪低落、沮丧或绝望，以及（3）有伤害自己的想法和计划的问题，都是很容易理解的。所有语言都很难理解这个问题，即对做事缺乏兴趣或乐趣。使用以 EPDS 作为参考标准和≥13 的切点的 ROC 分析，我们表明筛查工具的 3 项版本能够对 91% 的女性筛查进行正确分类。结论 认知访谈能够测试和完善超简短筛选工具的语言和结构。 这个简短的 3 项工具在开普敦三种最常用语言和文化中识别患有 CMD 症状的孕妇方面很容易理解且有效。