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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
F. Mammadova et al. / European Psychiatry 27 (2012) / supplement n°2 / S27-S31 S29 Table 1 Correlations between individual items and total scores (N=175). Item Item- test correlation Item- rest correlation Interim covariance Alpha if item is deleted ZSDS 1 .708 .659 .265 .860 ZSDS 2 .439 .362 .282 .870 ZSDS 3 .527 .456 .276 .867 ZSDS 4 .456 .376 .280 .870 ZSDS 5 .382 .293 .285 .873 ZSDS 6 .428 .339 .281 .872 ZSDS 7 .290 .215 .293 .874 ZSDS 8 .239 .165 .296 .875 ZSDS 9 .516 .446 .278 .867 ZSDS 10 .681 .629 .266 .861 ZSDS 11 .694 .642 .266 .861 ZSDS 12 .623 .561 .269 .863 ZSDS 13 .673 .617 .266 .861 ZSDS 14 .662 .599 .264 .862 ZSDS 15 .508 .429 .276 .868 ZSDS 16 .493 .416 .278 .868 ZSDS 17 .639 .578 .268 .863 ZSDS 18 .667 .606 .264 .861 ZSDS 19 .483 .424 .283 .868 ZSDS 20 .655 .591 .264 .862 ZSDS Zung Self- rating Depression Scale Table 2 Results of sensitivity and specifi city analysis. Cut- off point Sensitivity Specifi city Correctly classifi ed LR+ LR- ≥34 100.00% 35.83% 56.00% 1.558 0.000 ≥35 100.00% 40.00% 58.86% 1.667 0.000 ≥36 98.18% 44.17% 61.14% 1.758 0.041 ≥37 98.18% 51.67% 66.29% 2.031 0.035 ≥38 98.18% 55.83% 69.14% 2.223 0.033 ≥39 98.18% 60.83% 72.57% 2.507 0.029 ≥40 98.18% 65.83% 76.00% 2.874 0.028 ≥41 98.18% 68.33% 77.71% 3.101 0.027 ≥42 98.18% 71.67% 80.00% 3.465 0.025 ≥43 94.55% 75.83% 81.71% 3.912 0.072 ≥44 92.73% 77.50% 82.29% 4.121 0.094 ≥45 90.91% 80.83% 84.00% 4.743 0.113 ≥46 89.09% 85.00% 86.29% 5.939 0.128 ≥47 89.09% 86.67% 87.43% 6.682 0.126 ≥48 83.64% 90.83% 88.57% 9.124 0.180 ≥49 80.00% 92.50% 88.57% 10.667 0.216 ≥50 74.55% 93.33% 87.43% 11.18 0.272 Likelihood ratio for a positive test result (LR +), likelihood ratio for a negative test result (LR- ). Proofs
Page 1 and 2: 68767 EUROPEAN PSYCHIATRY THE JOURN
Page 3 and 4: Vol. 27, Supplement n°2, June 2012
Page 5 and 6: Editorial © 2012 Elsevier Masson S
Page 7 and 8: health of Turkish woman in Germany:
Page 9 and 10: studies [8,6,27]. Commonly suggeste
Page 11 and 12: lack of desire to obtain an educati
Page 13 and 14: the study should be emphasised [4,1
Page 15 and 16: clear is the picture regarding depr
Page 17 and 18: SD=15.9; t(183)= - 2.575; p=.011).
Page 19 and 20: as caring for children and taking c
Page 21 and 22: © 2012 Elsevier Masson SAS. All ri
Page 23 and 24: were then scrutinized independently
Page 25 and 26: [6] Berry J, Kim U. Acculturation a
Page 27 and 28: A. Heredia Montesinos et al. / Euro
Page 29 and 30: 3.2. Interrelations of stigma, depr
Page 31: © 2012 Elsevier Masson SAS. All ri
Page 35 and 36: [17] Su KP, Chiu TH, Huang CL, et a
Page 37 and 38: society, history (slavery and colon
Page 39 and 40: That the model is false suggests th
Page 41 and 42: 6. Ego disorders in psychosis - tra
Page 43 and 44: In this state, socially unaccepted
Page 45 and 46: generating a model of the self with
Page 47 and 48: Acknowledgements This work was supp
Page 49 and 50: to Kleinman, explanatory models con
Page 51 and 52: categories was performed very caref
Page 53 and 54: [31] Mayring P. Qualitative Inhalts
Page 55 and 56: patients (often with lower social s
Page 57 and 58: are listed by Turkish immigrants in
Page 59 and 60: [19] Schnegg M, Lang H. Die Analyse
Page 61 and 62: 1. Introduction The number of immig
Page 63 and 64: on the availability of service usag
Page 65 and 66: Studies in some European countries
Page 67 and 68: © 2012 Elsevier Masson SAS. All ri
Page 69 and 70: our study, we composed an assessmen
Page 71 and 72: With regard to content, the pilot a
Page 73 and 74: Acknowledgments We are very gratefu
Page 75 and 76: cross- cultural mental health train
Page 77 and 78: 3.3.2. German experiences Despite t
Page 79 and 80: [31] Mösko M, Gil- Martinez F, Sch
Page 81 and 82: 2. Psychosocial care as a necessary
Page 83 and 84:
* First Rank Symptoms according to
Page 85 and 86:
Epilogue A. Kleinman Esther and Syd
Page 87 and 88:
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