A Screening Instrument for Psychological Distress in Botswana: Validation of the Setswana Version of the 28-Item General Health Questionnaire

Abstract

Objectives: To develop a Setswana version of the 28-item General Health Questionnaire (GHQ-28) for use in Botswana. Methods: A sample of 126 subjects attending primary healthcare clinics completed the GHQ-28, which contains four subscales of seven questions each for the following domains: somatic concerns, anxiety, social function and depression. All subjects were also interviewed with the Clinical Interview Schedule (CIS). Psychiatric casesness was ascertained by CIS scores greater than 20 and an overall severity of symptoms rating (OSR) of ≥2 on a 0—4 point scale. A receiver operating characteristic (ROC) analysis was undertaken to assess which GHQ cut-off score gave the best casesness yield as defined by the combined CIS and OSR assessments. Results: Of the 126 subjects enrolled, 122 completed the study, with 18 (14.5%) meeting criteria for caseness. There were no gender differences with respect to GHQ or CIS scores. The ROC analysis revealed that the GHQ threshold of 7/8 gave the best sensitivity (88%) and specificity (67%) results. The internal consistency of the translated GHQ was maintained with Cronbach α scores ranging from 0.76 to 0.91 for the subscales. Conclusions: The Setswana GHQ-28 represents a valid instrument of screening for psychological distress in a primary healthcare setting in Botswana.