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© 2012 Elsevier Masson SAS. All rights reserved.
European Psychiatry 27 (2012) / supplement n°2 / S27-S31
Translation and adaptation of the Zung Self- Rating Depression Scale
for application in the bilingual Azerbaijani population
F. Mammadova a, * , M. Sultanov b , A. Hajiyeva a , M. Aichberger c , A. Heinz c
a Baku Psycho- Neurological Dispensary, Baku Azerbaijan
b Republic Psychiatric Hospital, Baku Azerbaijan
c Department of Psychiatry and Psychotherapy, Charité – Berlin, Germany
Keywords:
Depression
Scale
Adaptation
Cross- cultural
Translation
1. Introduction
ABSTRACT
The Zung Self- Rating Depression Scale (ZSDS) [24] is a 20-
item self- reported tool, developed to measure depressive symptoms
and for depression screening [25,3]. The Scale has been
established as a reliable and valid measure in these areas [2,9,18].
Application of the scale increases detection of depression in
primary care services, [21] and it is a useful instrument in various
clinical settings [11,1,7,15].
From the outset, the ZSDS scale has been shown to be an
effective instrument in cross- cultural settings. [24] Yet, such
application of self- reported instruments presents additional
challenges. The early studies, conducted in five European
nations and the United States using fi ve different languages,
* Corresponding Author.
E-mail address: dr.fi dan.i.mammadova@gmail.com (F. Mammadova)
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EUROPEAN
PSYCHIATRY
THE JOURNAL OF THE EUROPEAN PSYCHIATRIC ASSOCIATION
ISSN 0924-9338
June 2012
Vol. 27 - Supplement n°2
pp. S1-S81
Migration
and Mental Health
S1 Editorial
A. Heinz, U. Kluge
S4 The willingness to participate in health research
studies of individuals with Turkish migration
backgrounds: barriers and resources
D. Dingoyan, H. Schulz, M. Mösko
S10 Socio-economic status and emotional distress
of female Turkish immigrants and native
German women living in Berlin
MC. Aichberger, Z. Br omand, A. Heredia
Montesinos, S. Temur-Erman, A. Mundt,
A. Heinz, MA. Rapp, M. Schouler-Ocak
S17 Mental health of Turkish women in Germany:
resilience and risk factors
Z. Bromand, S. Temur-Erman, R. Yesil,
A. Heredia Montesinos, MC. Aichberger,
D. Kleiber, M. Schouler-Ocak, A. Heinz,
MC. Kastrup, MA. Rapp
S22 The infl uence of stigma on depression, overall
psychological distress, and somatization
among female Turkish migrants
A. Heredia Montesinos, MA. Rapp, S. T emur-
Erman, A. Heinz, U. Hegerl, M. Schouler-Ocak
S27 Translation and adaptation of the Zung
Self-Rating Depression Scale for application
in the bilingual Azerbaijani population
F. Mammadova, M. Sultanov, A. Hajiyeva,
M. Aichberger, A. Heinz
S32 Construction and interpretation of self-related
function and dysfunction in Intercultural
Psychiatry
A. Heinz, F. Bermpohl, M. Frank
S44 Explanatory models and concepts
of West African Malian patients
with psychotic symptoms
F. Napo, A. Heinz, A. Auckenthaler
S50 How to express mental health problems:
Turkish immigrants in Berlin compared
to native Germans in Berlin
and Turks in Istanbul
A. Vardar, U. Kluge, S. P enka
S56 Health services and the treatment
of immigrants: data on service use, interpreting
services and immigrant staff members
in services across Europe
U. Kluge, M. Bogic, W. Devillé, T. Greacen,
M. Dauvrin, S. Dias, A. Gaddini, NK. Jensen,
E. Ioannidi-Kapolou, R. Mertaniemi,
R. P uipcinós i Riera, S. Sandhu, A. Sar vary,
JFF. Soares, M. Stankunas, C. Straßmayr ,
M. Welbel, A. Heinz, S. Priebe
S63 The concept of “intercultural opening”:
development of an assessment tool
for the appraisal of its current implementation
in the mental health care system
S. P enka, U. Kluge, A. Vardar, T. Borde,
D. Ingleby
S 70 Cross-cultural training in mental health care
– challenges and experiences from Sweden
and Germany
S. Bäär nhielm, M. Mösko
S75 Teaching psychiatry and establishing
psychosocial services – lessons
from Afghanistan
I. Missmahl, U. Kluge, Z. Br omand, A. Heinz
S80 Epilogue
A. Kleinman
Background.- A self- reported Zung Self- Rating Depression Scale (ZSDS) is recognized as a reliable and
valid measure for assessment of depressive symptoms, applicable cross- culturally. The aim of the
study was to adapt ZSDS for application in the bilingual Azerbaijani population.
Methods.- ZSDS was translated into Azerbaijani and Russian. Two pilot studies on small samples (n=30
and n=45) were conducted to improve the scale’s acceptability. A readability study was conducted
on a bigger sample of depressed subjects (n=55) and healthy controls (n=120). Chronbach’s alpha for
the total scale, item- test correlations, alpha if item deleted, and sensitivity and specifi city at various
cut- off levels were calculated.
Results.- The drop- out rate was 83.3% at the fi rst pilot study due to problems of comprehension of
item 5 and culturally unacceptable wording of item 6. After rewording of the items drop- out reduced
to 20%. On the reliability study Chronbach’s alpha for the total scale was 0.8727, and item- test
correlations for the most individual items were satisfactory. An optimal cut- off point was 45 points
with sensitivity=90.91%, specifi city=80.83%.
Conclusions.- Adaptation of the Zung Self- Reported Depression Scale improved cultural acceptability
of the scale in the context of the Azerbaijani study population.
© 2012 Elsevier Masson SAS. All rights reserved.
established a high correlation between the self- rated ZSDS
and physician- administered depression rating scales across
the countries. There was, however, a quantitatively signifi cant
variance in the mean ZSDS across different populations [22,23].
Furthermore, later research, conducted in three Asian counties
and the US (four different languages spoken) also showed that
means scores of ZSDS varied signifi cantly across countries [6].
Thus, Zung Self- Rating Depression Scale has been proved to be
a reliable self- rated depression tool, applicable cross- culturally.
It must, however be adapted and validated in each cultural
population context for accurate assessment of depression
symptoms severity and application of the scale as a screening
instrument.
The aim of the study was to adapt the ZSDS for application
to the bilingual Azerbaijani population, also to assess the
reliability of the Azerbaijani and Russian translations in this
cultural context.