Table 3 Summary of findings by PHQ-9 item and types of cognitive process problems discussed (N = 20)
From: Cognitive testing of the PHQ-9 for depression screening among pregnant and postpartum women in Kenya
Item (N women who had comprehension, decision process, or response process problems with a given item) | Comprehension problems: What does the participant think the question is asking? | Decision process problems: Does the participant want to tell the truth and/or devote mental energy to the question? | Response process problems: Can the participant map her internal answer with a given answer choice?a |
|---|---|---|---|
1. Little interest or pleasure in doing things (N = 9) | Often related it to tasks that women feel they should do but don’t enjoy (e.g., household chores, work) | Reluctance to endorse this item if it meant failing to perform “duties” | None |
2. Feeling down, depressed, hopeless (N = 2) | None | Some hesitation to endorse if participants felt they should “turn to God for acceptance” when experiencing these feelings | None |
3. Trouble falling asleep, staying asleep, or sleeping too much (N = 5) | None | None | Difficulty responding for those who experienced only one type of sleep issue, or if it occurred for part of a day (e.g., during a nap) |
4. Tired or little energy (N = 3) | Comprehended similarly to item 1 and participants discussed feeling little energy to do household chores or work | Reluctance to endorse this item if it meant failing to perform “duties” | None |
5. Poor appetite or overeating (N = 4) | None | None | Participants were generally not sure how to respond if they experienced only one type of appetite issue, or if it occurred for part of a day (e.g., during a midday meal) |
6. Feeling bad about yourself—or that you are a failure or have let your family down (N = 5) | None | Reluctance to endorse this item if it meant failing to perform “duties” | None |
7. Trouble concentrating on things such as reading the newspaper or watching television (N = 8) | Comprehension difficulties among participants who could not relate to given examples | None | Difficulty responding for those who experienced this issue for only part of a day, or if they did not own a television or read the newspaper regularly |
8. Moving or speaking so slowly that other people could have noticed, or the opposite—being so fidgety or restless that you have been moving around more than usual (N = 17)b | Difficulty understanding the word “fidgety” on the English PHQ-9 (a direct translation of this word was not available for the Kiswahili PHQ-9 translation). | None | Difficulty responding for those who experienced only one type of issue, or if it occurred for part of a day |
9. Thoughts that you would be better off dead or of hurting yourself in some way (N = 2) | None | Some hesitation to endorse if participants felt they should “turn to God for acceptance” when experiencing these feelings | None |