Barnabas Natamba

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

BackgroundThere are limited data on the prevalence and approaches to screening for depression among pregnant women living in resource poor settings with high HIV burden.MethodsWe studied the reliability and accuracy of the Center for Epidemiologic Studies Depression (CES-D) scale in 123 (36 HIV-infected and 87 -uninfected) pregnant women receiving antenatal care at Gulu Regional Referral Hospital, Uganda. CES-D scores were compared to results from the psychiatrist-administered Mini-International Neuropsychiatric Interview (MINI) for current major depressive disorder (MDD), a “gold standard” for assessing depression. We employed measures of internal consistency (Cronbach’s alpha), and criterion validity [Area Under the Receiver Operating Characteristic Curve (AUROC), sensitivity (Se), specificity (Sp), and positive predictive value (PPV)] to evaluate the reliability and validity of the CES-D scale.Results35.8% of respondents were currently experiencing an MDD, as defined from outputs of the MINI-depression module. The CES-D had high internal consistency (Cronbach’s alpha = 0.92) and good discriminatory ability in detecting MINI-defined current MDDs (AUROC = 0.82). The optimum CES-D cutoff score for the identification of probable MDD was between 16 and 17. A CES-D cutoff score of 17, corresponding to Se, Sp, and PPV values of 72.7%, 78.5%, and 76.5%, is proposed for adoption in this population and performs well for HIV-infected and -uninfected women. After adjusting for baseline differences between the HIV subgroups (maternal age and marital status), HIV-infected pregnant women scored 6.2 points higher on the CES-D than HIV-uninfected women (p = 0.032).ConclusionsThe CES-D is a suitable instrument for screening for probable major depression among pregnant women of mixed HIV status attending antenatal services in northern Uganda.

Reliability and validity of an individually focused food insecurity access scale for assessing inadequate access to food among pregnant Ugandan women of mixed HIV status

OBJECTIVE To determine the reliability, validity and correlates of measures of food insecurity (FI) obtained using an individually focused food insecurity access scale (IFIAS) among pregnant women of mixed HIV status in northern Uganda. DESIGN A mixed-methods study involving cognitive interviews nested within a cross-sectional survey. SETTING The antenatal care clinic of Gulu Regional Referral Hospital. SUBJECTS Survey respondents included 403 pregnant women, recruited in a ratio of one HIV-infected to two HIV-uninfected respondents, twenty-six (nine of them HIV-infected) of whom were asked to participate in the cognitive interviews. RESULTS Over 80% of cognitive interview participants reported understanding the respective meanings of six of the nine items (i.e. items 4 to 9) on the IFIAS. Two main factors emerged from rotated exploratory factor analysis of the IFIAS: mild to moderate FI (IFIAS items 1-6) and severe FI (items 7-9). Together, they explained 90·4% of the FI measures variance. The full IFIAS and the two subscales had moderate to high internal consistency (Cronbachs α ranged from 0.75 to 0.87). Dose-response associations between IFIAS scores, and measures of socio-economic status and womens diet quality, were observed. Multivariate linear regression revealed significant positive associations between IFIAS scores and HIV infection, maternal age, number of children and a history of internal displacement. IFIAS scores were negatively associated with womens diet diversity score, asset index and being employed. CONCLUSIONS The IFIAS showed strong reliability, validity and contextual relevance among women attending antenatal care in northern Uganda.

The association between food insecurity and depressive symptoms severity among pregnant women differs by social support category: a cross-sectional study

Common mental disorders, such as depression and anxiety, affect approximately 16% of pregnant women in low- and middle-income countries. Food insecurity (FI) has been shown to be associated with depressive symptoms. It has also been suggested that the association between FI and depressive symptoms is moderated by social support (SS); however, there is limited evidence of these associations among pregnant women living in low-income and middle-income countries. We studied the association between FI and depressive symptoms severity and assessed whether such an association varied among Ugandan pregnant women with low vs. high SS. Cross-sectional data were collected among 403 pregnant women in northern Uganda. SS was assessed using an eight-item version of the Duke-UNC functional SS scale. FI and depressive symptoms were assessed by, respectively, the individually focused FI scale and the Center for Epidemiologic Studies-Depression scale. Women were categorized into two SS groups, based on scoring < or ≥ to the median SS value. Multivariate linear regression models indicated an independent association between FI and depressive symptoms severity. The association between FI and depressive symptoms severity was moderated by SS i.e. was stronger among women in the low SS category (adjusted beta (95%CI): 0.91 (0.55; 1.27)) than for women belonging to the high SS group (0.53 (0.28; 0.78)) (adjusted p value for interaction = 0.026). There is need for longitudinal or interventional studies among pregnant women living in northern Uganda or similar contexts to examine the temporal sequence of the associations among food insecurity, depressive symptoms severity and social support.