Mental health is our emotional, psychological, and social well-being and is deeply connected to how we think, feel, and behave. Mental health may also impact how we respond to stress, how we function in our community, or how we are able to be productive. When these things are negatively impacted, mental health problems may be present. Common mental disorders include conditions such as depression (persistent sadness and loss of interest in activities that impacts daily living), anxiety (intense and long-lasting worry and/or fear that impacts daily living), and trauma. There are well-established relationships which are common mental health problems and other health issues as well as significant life events and social contexts, like childbirth, parenthood, job loss, natural disasters, and significant social isolation. Improved maternal mental health has been linked to positive child development and psychopathology outcomes. While there is much less research, paternal mental health and grandparent mental health has also been shown to be related to child health outcomes. Caregiver mental health is one important component of overall well-being.
The mental health of caregivers can be assessed through use of well-validated scales that have been carefully culturally adapted for target populations. Typically, scales are meant to assess mental health symptom severity and not make a diagnosis. Common mental health symptoms may range from somatic (physical symptoms like not being hungry or having headaches), to low mood (e.g., crying often, not enjoying activities), to worry and rumination (e.g., thinking too much), to thoughts of wanting to die or harm oneself. Scales are meant to capture the range of possible symptoms, the severity of them, and the impact they may have on one’s ability to function.
Assessing caregiver mental health can provide important insights into how to optimize nutrition related programs. This toolkit provides scales to assess mental health symptom severity of common mental disorders that are commonly used in low-resourced settings (with adaptation) and do not need to be delivered by mental health specialists. Importantly, these scales measure symptom severity (e.g., how intense each symptom is experienced and how many different symptoms are present) and are not meant to provide a clinical diagnosis of depression or anxiety. Symptom severity can be very helpful to identify how much someone is suffering and understand if they are at risk for a particular disorder.
Given that mental disorders, like depression and anxiety, can manifest in different ways across cultures and context, cultural validation of psychometric instruments (tools to measure mental health) is very important to ensure we are measuring these conditions accurately and reliably. For example, some cultures commonly experience depression in more somatic ways (headaches, stomach pain, etc) while others are more emotional symptoms (hopelessness, lack of pleasure, etc). Validated tools will often have a peer-reviewed publication citing that the properties of the scale are reliable and accurate for a particular location/culture.
Types of Measures
- Generalized Anxiety Disorder (GAD-7) (7 items)
General psychological distress
- Self-report questionnaire (SRQ-20) (20 items)
- Kessler Psychological Distress Scale (10 items)
- General Health Questionnaire (GHQ-12) (12 items)
- Patient Health Questionnaire (PHQ-9) (9 items)
- Edinburgh Postnatal Depression Scale (EPDS) (11 items)
This toolkit includes 6 measures.
Generalized Anxiety Disorder Scale-7 (GAD-7)
The Generalized Anxiety Disorder Screen (GAD-7) is a 7-item Likert scale that measures common symptoms of anxiety.
Self -Report Questionnaire (SRQ-20)
Self-report measure to detect non-specific psychological distress; subscales include depression/ anxiety, somatic symptoms, reduced vital energy and depressive thoughts.
Kessler Psychological Distress Scale-10 (K-10)
This is a 10-item questionnaire that yields a global measure of distress (eliciting both anxiety and depressive symptoms) that has been validated in various cultural settings.
General Health Questionnaire (GHQ-12)
This scale measures general psychological distress with a recall period of “recently”. This tool is thought to be helpful in some cultures as it does not have as many somatic items and, theoretically, may be better at detecting mental problems among populations with lots of physical comorbidities.
Patient Health Questionnaire (PHQ-9)
Used to measure the severity of depressive symptoms and, in contexts where the scale is clinically validated, screen for possible depression. The recall period is over the last two weeks.
Edinburgh Postnatal Depression Scale (EPDS)
Evaluates symptoms of depressed mood among perinatal women including feelings of anxiousness (including panic) or worry for no good reason, feelings that things have been overwhelming, difficulty sleeping, feeling sad or miserable, as well as thoughts of harming oneself.