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S30 F. Mammadova et al. / European Psychiatry 27 (2012) / supplement n°2 / S27-S31
Sensitivity
1.00
0.75
0.50
0.25
0.00
0.00
0.25
Notes: Area under ROC curve=0.9440
Fig. 1. Roc curve for ZSDS Scores.
0.50
1 - Specificity
0.75
1.00
developed taking into consideration the particularities of the local
population [14]. Application of the scale in the Eskimo community
required the scale’s items to be modifi ed to fi t idioms of the local
population [10]. Similar to our study, adaptation of the Arabic
ZSDS translation demonstrated diffi culties in acceptability of item
6 (I still enjoy sex), which was considered to be unacceptable due
to cultural and religious sensitivities [12].
One publication cited a multiple- choice format of the ZSDS
as a reason for non- completion [7]. Our study, however suggests
that the main reason of non- completion, particularly in
cross- cultural application of the scale, is poor acceptability
of straightforward use of a Western developed self- reported
questionnaire.
Our results suggest that the Russian and Azerbaijani translations
are suitable for application in the bilingual Azerbaijani
population. We were able to establish an optimal cut- off point of
the ZSDS scale for the particular Azerbaijani population context.
Identifi cation of an optimal cut- off point for a self- reported tool,
used as a screening instrument is a complicated issue: we need a
cut- off point with sensitivity as high as possible to provide effective
detection of the positive cases, but have to consider that this
should not be at the expense of low specifi city [5,13,17,19]. The
data obtained suggests that application of the adapted version
of scale ZSDS at the cut- off point of 45 provides high sensitivity
and specifi city of the scale as a depression screening tool among
the Azerbaijani female population.
The obtained data also provides fi ndings on the performance
of separate items of the ZSDS. The context of the item 5
(“my appetite is as it used to be”) and items 7 (“I notice that
I am losing weight”), which are associated with depression
somatic symptoms of marked loss of appetite and weight loss
respectively, showed low item- test correlations. Deletion
of these items improves the total scale performance. These
fi ndings suggest that the above mentioned symptoms are less
common among the studied population. Item 8 (“I have trouble
with constipation”), which has the lowest item- test correlation,
is not associated with any ICD- 10 diagnostic criteria of
depressive disorder [20]. Deletion of this item also improves
the total scale performance. Poor performance of the item 8
may be because its context is not specifi c to depressive disorder
symptoms [16,20].
Despite valuable data having been obtained, interpretation
is limited by the relatively small non- representative sample
achieved in this study. A wider- ranging study on a large randomized
population sample is now being planned for the further
validation of the scale to be used as a depression screening
instrument in the general Azerbaijani population.
5. Conclusions
Adaptation of the Zung Self- Reported Depression Scale’s
translations into Azerbaijani and Russian improved cultural
acceptability of the scale in the studied Azerbaijani population.
The adapted version of the Zung Self- Rating Depression
Scale is a reliable instrument for depression screening among
the Azerbaijani population. A study using a larger randomized
sample is needed for the further validation of the ZSDS to be
applied as a depression screening instrument in the general
Azerbaijani population.
Confl ict of interest statement
None.
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