Depression among African patients : three diagnostic approaches

Abstract

The aim of this study was to determine the usefulness of the following instruments for the diagnosis of depression among Africans: The Beck Depression Inventory (2nd Edition) (BDI-II), the Minnesota Multiphasic Personality Inventory (Revised) (MMPI-2) and the Rorschach Inkblot Test (scored in terms of Exner's Comprehensive System). With regard to the MMPI-2, the focus was on the Depressed Suicidal Ideation Critical Item Scale, but the following Critical Item Scales were also examined: Acute Anxiety State, Somatic Symptoms and Family Conflict. With regard to the Rorschach, the Depression Index (DE PI) and the Suicide Constellation (S-CON) were examined. A Structured Questionnaire was used to obtain background information on the patients. The sample consisted of 162 African patients between the ages of 18 and 50 years that were seen in a private practice in Pretoria, Gauteng. All the patients had an educational level of at least Grade 12. The patients were diagnosed according to DSM-IV criteria as suffering from Dysthymia, Major Depression or Adjustment Disorder with Depressed Mood. The personal background information about the patients that was examined included: sources of and reasons for referral, presenting symptoms, views about the causes of depression, and experience of the self. Relevant statistical analyses were done to investigate the reliability and validity of the measurement instruments and to determine if there were any gender or age biases in the results. In contrast to the findings of earlier research that depressed African patients mainly present with physical complaints, the patients who participated in the study predominantly presented with emotional and cognitive symptoms similar to what is found in Western countries. Only a few patients referred to traditional African beliefs such as witchcraft, and most of them interpreted their illness in terms of interpersonal problems, especially in their relationships with other family members. The BDI-II was found to be a reliable and valid instrument that could be used for the diagnosis of depression among African patients. Of the 162 MMPI protocols, 46.3% were invalid. It was especially on the L, F, F(B) and Cs scales that large numbers of patients obtained scores higher than the cut-off scores. The reliabilities of the Critical Item Scales were acceptable, except for the Family Conflict scale, and these scales thus generally appear to be useful for diagnostic purposes in an African context. The mean score on the Depressed Suicidal Ideation Scale was, however, relatively low. The MMPI-2 rendered a large number of misdiagnoses of Schizophrenia and Personality Disorder and only a few of the patients obtained a diagnosis of a depressive disorder. Although the patients found the MMPI-2 too long and the language too complex, they generally experienced the test positively. The DEPI and S-CON rendered a large number of false negatives which indicates that if these indeces are used for assessing depression, it should be done in conjunction with other diagnostic methods. The Rorschach nevertheless proved to be useful for identifying psychodynamic processes that could be used therapeutically. A low and statistically non-significant positive correlation was found between the BDI-II and the DEPI. Both the BDI-II and the DEPI correlated positively with the Depressed Suicidal Ideation scale. The S-CON did not correlate significantly with any of the other scales.