ArticleJournal of evaluation in clinical practice2020
Adaptation and validation of a structured version of the Hamilton Depression Rating Scale for use by non-clinicians in South Africa (AFFIRM-HDRS).
Article in Journal of evaluation in clinical practice, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers, 1 of them a synthesis that pooled it.
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Who cites it
11 citing papers in PubMed, 1 synthesis or guideline pooled it, 11 citations in OpenAlex.
- Screening tools for maternal mental health in Africa: a systematic review.Frontiers in global women's health · 2026Pooled it
- Task-sharing of psychological treatment for antenatal depression in Khayelitsha, South Africa: Effects on antenatal and postnatal outcomes in an individual randomised controlled trial.Behaviour research and therapy · 2020Trial
- Perinatal depressive symptoms among low-income South African women at risk of depression: trajectories and predictors.BMC pregnancy and childbirth · 2019Trial
- Food insecurity and postnatal depression: the mediating effect of perceived social support among women in Khayelitsha, South Africa.Social psychiatry and psychiatric epidemiology · 2026Article
- Exploring Saffron's Therapeutic Potential: Insights on Phytochemistry, Bioactivity, and Clinical Implications.Current pharmaceutical design · 2026Review
- The Neural Mechanisms of rTMS and Placebo Effects in Trigeminal Neuralgia: Evidence From fMRI Network Dynamics.Journal of pain research · 2025Article
- "Trajectories of treatment response in a cognitive-behavioral therapy intervention for depression and adherence in persons with HIV in South Africa".Journal of affective disorders · 2023Article
- Educational Intervention Effects on Depression and Anxiety in Patients after Myocardial Infarction: A Randomized Controlled Trial.Journal of cardiovascular development and disease · 2023Article
- Implementation of a task-shared psychosocial intervention for perinatal depression in South Africa: A grounded theory process evaluation.SSM. Mental health · 2022Article
- Is there an optimal screening tool for identifying perinatal depression within clinical settings of sub-Saharan Africa?SSM. Mental health · 2021Article
- Association between perinatal depressive symptoms and suicidal risk among low-income South African women: a longitudinal study.Social psychiatry and psychiatric epidemiology · 2019Article
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Authors and funding
4 authors at 1 institution in 2 countries.
Funding
Abstract
RATIONALE, AIMS AND
objectivesThe Hamilton depression rating scale (HDRS) is seen as an international gold standard for the measurement of depression. High rates of untreated depression, including perinatal depression, support the rationale to adapt and validate a structured version of the HDRS to be used by non-clinicians in low-income settings.
methodsUsing previous structured versions of the HDRS as a foundation, the tool was adapted, translated, and then validated with an isiXhosa speaking perinatal population in South Africa (n = 187), using cognitive testing, test-retest reliability, and inter-rater assessments. The AFFIRM-HDRS was compared with the Edinburgh postnatal depression scale (EPDS) using the non-parametric Spearman Rho test to assess concurrent validity. Internal consistency was examined using Cronbach's Alpha, and inter-rater and test-retest reliability were assessed with the intra-class coefficient (ICC). Cohen's Kappa was used to assess the overall percentage agreement for each individual item of the AFFIRM-HDRS.
resultsThe AFFIRM-HDRS showed good construct and content validity had significant associations with the EPDS (Rho = 0.60 and 0.43, P < .001), and acceptable internal consistency (Cronbach's alpha = 0.74.). Inter-rater reliability and test-retest scores were excellent, with intraclass correlations ranging from 0.97 (0.94-0.99) to 0.98 (0.97-0.99) between raters, and test-retest reliability being 0.90 (95% CI: 0.86-0.93). The tool performed similarly to previous structured versions. Individual item-rest correlations suggest that the items "Weight loss or gain," "Insight," and "Libido" did not fit well with the overall instrument, but that the rest of the items performed well.
conclusionThe AFFIRM-HDRS is adequately structured to be used by non-clinicians in an isiXhosa speaking perinatal population. It is hoped that this structured tool can be used to assist with identification and referral of these at-risk populations by non-clinicians in resource-constrained environments, thereby playing a role in addressing the treatment gap for perinatal depression in LMICs.
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