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S28 F. Mammadova et al. / European Psychiatry 27 (2012) / supplement n°2 / S27-S31
2. Materials and Methods
2.1. Translation and pilot studies
The original ZSDS was translated from English into Azerbaijani
and Russian. The translations were then back- translated into
English. The latter were conducted by an independent translator,
who was not familiar with the English original. The back-
translations were compared with the English ZSDS original by a
native English speaker, and were ratifi ed as accurate and valid.
Two pilot studies were conducted to facilitate adaptation
of the validated ZSDS translations. The participants were asked
to provide comments as necessary. The first pilot study of
Azerbaijani and Russian ZSDS versions was conducted among a
sample of 30 subjects (21 Azerbaijani- speaking and 9 Russian-
speaking). The fi rst pilot showed high drop- out rate, due to skipping
of two items within the scale. These items were reworded
in Azerbaijani and Russian to improve their acceptability. The
reworded items were back translated into English to check
similarity in terms of the meaning between the reworded items
and the items in the English original. After the rewording the
second pilot study was conducted among a sample of 45 subjects
(42 Azerbaijani- speaking and 3 Russian- speaking) to check again
the acceptability of the scale.
The reworded Azerbaijani and Russian ZSDS versions were
chosen for further use in the study.
2.2. Reliability study
The second phase of the study was a reliability study of the
ZSDS Azerbaijani and Russian versions and was conducted on
a sample of 175 subjects with a mean age of 32.66 SD=11.28
(range 19- 64), 58 males (33.14%) and 117 females (66.86%). 104
(59.43%) subjects of the sample were Azerbaijani- speaking and
71 (40.57%) were Russian- speaking. The total sample consisted
of 2 sub- samples: depressed patients diagnosed with depression
according to ICD- 10 criteria [20] (n=55) and healthy control
sample (n=120). The depressed patients’ sample (15 males and
40 females) had a mean age of 32.74, SD=9.23 (range 18- 61). The
healthy controls sample (43 males and 77 females) had a mean
age of 32.61, SD=9.23 (range 19- 64).
The depressed patients were attending Baku the city Psycho-
Neurological Dispensary, outpatient department of the Republic
Psychiatric Hospital, “Saglam Aile” Private Medical Center and
“Funda” Private Medical Center, Baku, Azerbaijan. The healthy
control sample was composed of members of the mentioned
medical centers staff, relatives of the patients and the research team
members. All sample subjects were tested once by the Azerbaijani
or Russian ZSDS versions, according the fi rst language they spoke.
All the obtained data were summarized in a database built
on SPSS 16.0 software for Windows, which was used for the
later statistical analysis. Chronbach’s alpha coeffi cient for
the total scale was calculated to check the reliability of the
ZSDS scale adaptations. Item- test correlations and alpha if
item deleted were calculated to check performance of the
individual items. Sensitivity and specifi city of the ZSDS scale
at various cut- off levels for the total sample were calculated
to choose an optimal cut- off point.
3. Results
The fi rst pilot study revealed a very high drop- out rate of
25 subjects (83.3%) due to skipping of the item 5 (missed out
by 8 subjects (26.7%) and item 6 (missed out by 23 subjects
(76.7%). The participants, who missed items of the ZSDS scale,
were interviewed to provide reasoning for not completing the
scale. According to comments and explanations, made by the
participants, item 5 (I eat as much as I used to) was missed
out due to the diffi culty in comprehension of the item’s wordfor-
word translation. Skipping of item 6 (I still enjoy sex) was
explained by the fact that it is culturally unacceptable to report
about one’s sexual activity (or to be sexually active), particularly
for local unmarried women (19 out 21 unmarried female participants
(90.0%) missed item 6). There was a high overlap between
subjects not responding both to items 5 and 6, respectively: 6 out
8 subjects (75%), who missed item 5, missed item 6 as well. Such
a high overlap can be explained by a high non- responsiveness
to item 6, which covers 76.7% of the total sample in the fi rst
pilot study.
Item 5 was reworded and translated (in back translation) as
“my appetite is as it used to be”. Item 6 was reworded as well,
and translated back into English as “my sexual drive (interest)
is as it used to be”.
In comparison with the fi rst pilot, the second pilot study
of the Azerbaijani and Russian ZSDS versions, which was
conducted after the rewording of the scale items, revealed a
signifi cantly lower drop- out rate of 20.0% (9 subjects) due to
miss of item 6. Only 5 out 29 unmarried female participants
(17.2%) missed item 6. There was no miss of item 5, as there
had been in the fi rst pilot.
The processing of the data from the second phase of the study
(reliability study) revealed the following fi ndings: Chronbach’s
alpha for the total scale was equal to 0.8727, and this value
suggests that the scale has a good general internal consistency.
However, items of the scale did not perform similarly, in terms
of the item- test correlations. The range of item- test correlations
is signifi cantly wide with the highest correlation for item 1 (0.71)
and the lowest for item 8 (0.24). Sixteen items, if deleted, would
decrease the total scale alpha. three items (item 5, item 7, and
item 8), if deleted, would increase the total scale alpha, and these
three times have low item- test correlations, which are 0.38, 0.29,
and 0.24 respectively. Item 6, if deleted, would have no impact
on the total scale alpha (Table 1).
Sensitivity and specifi city of the scale at various cut- off levels
for the total sample were calculated. (Table 2) The results established
that an optimal cut- off point can be suggested at >=45
with sensitivity=90.91%, specifi city=80.83%. The area under ROC
curve for ZSDS scores=0.9440. (Fig. 1)
Proofs
4. Discussion
Publications on using of the ZSDS in various cultural contexts
indicate that, despite being successful, there are diffi culties presenting
the language adaptation of the scale. Adaptation of the
ZSDS for using in a Spanish- speaking population demonstrated the
scale’s usefulness [4], but presented interpretation diffi culties of
the scale’s Spanish version. The spanish version was needed to be