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TRANSLATION OF REYNOLDS ADOLESCENT DEPRESSION SCALE - SECOND EDITION IN PAKISTAN: RELIABILITY ESTIMATES AND FACTOR ANALYSIS.

Byline: Saleha Sami, Riaz Ahmad and Sarwat Jahan Khanam

ABSTRACT

Objective: The purpose of current research is translation and adaptation of Reynolds Adolescent Depression Scale 2nd Edition (RADS-2).

Place and Duration of study: Karachi, Year 2012

Sample and Method: In the first phase of study, RADS-2 was translated into Urdu language and adapted according to the culture of Pakistan. After the stages of forward and backward translation, the cross language validity was assessed by using "single group bilingual design". The estimates show significant results (r=.883) at .001 alpha level. In second phase, the reliability of Urdu version of RADS-2 was established by the application of Urdu version on the randomly selected sample of 330 adolescents (130 males and 200 females) of 11 to 20 years from different educational institutes of Karachi city, Pakistan.

Results: Cronbach's alpha for RADS-2U was found to be .898. Inter-scale correlations for the four sub scales of Urdu version of RADS-2 were also significant at .001 alpha level. The scale demonstrated its strength by providing significant test-retest reliability (r=.858, p less than .001) and also for subscales, ranging from .718 to .870. Finding of Split half reliability is also showing strong positive correlation between two equal halves of RADS-2 Urdu version i.e. .874. Interpretations of four forced factors solution were almost as the original version of RADS-2. Factor 1=Dysphoric Mood / Hopelessness, Factor 2=Anhedonia /Negative affect, Factor 3=Negative self-evaluation and Factor 4=Somatic complaints. The Pakistani version of RADS-2 has found to be a reliable and worth using instrument to assess depressive symptomatology in adolescents of Pakistan.

Key Words: Depression; adolescent; translation; reliability; factor analysis

INTRODUCTION

Adolescence is supposed to be the age in which children are transformed into emotionally vulnerable, unstable and sensitive persons. It is the age group which has reputation for having problems and causing trouble1. In a survey it was found that one third of adolescents who consulted for psychiatric help were suffering from depression .

Depression is a widespread, complex and multifaceted disorder, which is difficult to describe in a few words . According to Steven Paul (chief of clinical neuroscience at the National Institute of Mental Health) "Depression is like a fever". Like fever it has numerous origins and treatments . It is really important to notice depressive symptomatology among adolescents and not to view that as normal aspect of their age group because if it is left untreated, it may go on for months or years and can come up with serious and life threatening consequences .

Diagnostic and epidemiological surveys and researches of children and adolescents suggests that among young people, depression is a significant problem , , as 3% to 5% of children and 7% to 10% of adolescents show clinical levels of depression , , with significantly higher lifetime rates of depression among adolescents. These kinds of findings and studies point to the critical need to identify depression in adolescents.

As described earlier that depression is the most prevalent mental health problem among young people and given the significant number of adolescents show clinical levels of depressive symptomatology the identification of these young people who need the evaluation and mental health services should be a priority. For this purpose there is an overwhelming need for reliable and valid instruments to identify depression in young people.

Irony is that most of the literature on depression among children and adolescents is derived from the research work done outside Pakistan. To enrich the field of research in the developing country like Pakistan there is an intense need to develop new valid and reliable instruments in national language Urdu or to translate, adapt, and validate the already existing instruments in English language with strong psychometric properties. It will also flourish cross cultural researches in this region.

The diversity of the population world wide suggests a great requirement for cross culturally validated research instruments. Likewise there is a need for relevant cross cultural studies to address a number of problems among these multinational and multicultural populations .

Test development is an expensive, demanding and time taking procedure, therefore considering the above mentioned need the present study was planned with the purpose to translate and adapt the Reynolds Adolescent Depression Scale 2nd Edition (RADS-2). This scale was selected because of its effectiveness and worldwide use commonly to measure depressive symptomatology among adolescents , . According to Reynolds , findings across most of the studies on RADS translations show the consistency to scores and similarities to mean scores. These research findings by researchers in China, Austria, Israel, Spain, Canada, Japan, Croataia, Australia and other countries have also supported the use of RADS across nations and cultures. The RADS-2 has also been translated in to a number of foreign languages including Brazilian, Portugese, Chinese, Hai-tian Creole, Herbrew, Korean, and Spanish as reported in research studies, as well as by others using the RADS-2 in clinical settings.

METHOD

Sample

The present study was accomplished in two steps. The first step comprises of translation, adaptation, and estimation of linguistic equivalence and second step encompasses estimation of reliability (internal consistency, test-retest and split-half) of Pakistani version of RADS-2. For the first step i.e. translation and adaptation, and estimation of linguistic equivalence, the sample of 74 bilingual adolescent students from educational organizations of Karachi, Pakistan was recruited. For the second step 330 adolescent students (200 females and 130 males) were selected randomly from different academic institutes. Out of 330, 80 were reassessed for test retest reliability. The age range of sample for both steps was from 11 to 20 years.

Measures

Reynolds Adolescent Depression Scale 2nd Edition

Reynolds Adolescent Depression Scale 2ndEdition (RADS-2) is a brief, self-report measure that includes subscales which evaluate the current level of an adolescent's depressive symptomatology along four basic dimensions of depression: Dysphoric Mood, Anhedonia /Negative Affect, Negative Self-Evaluation, and Somatic Complaints. An expanded age range for RADS-2 is 11 to 20 years. It consists of 30 items and its total score range is between 30 and 120. The RADS-2 standard (T) scores and associated clinical cutoff scores provide the clinician or researcher with an indication of the clinical severity of the individual's depressive symptoms (normal, mild, moderate, or severe). RADS-2 is a reliable and valid instrument with internal consistency of .92, test re-test reliability .85 and criterion-related validity .82.

Procedure

For adaptation and translation of RADS-2 the following steps were taken:

Formulation of experts committee

In present study, three bilingual experts from the faculty and PhD. fellows of Institute of Clinical Psychology, University of Karachi were included in the committee as per criteria given by Hambleton , i.e. the translator must be highly qualified with good technical knowledge and full understanding of the both source and target languages.

Forward and Back Translation

One of the judgmental designs for adapting test is forward translation. For this purpose the selected instrument (RADS-2) was given to two bilingual experts of Psychology and one language expert familiar with both relevant cultures. They were requested to translate the original English version into targeted language (Urdu). After the forward translation three more experts were approached for the back translation. In the back translation design, the adapted test which was in target language was translated back to the source language by the different translators. Those experts were not previously familiar with the scale. They were requested to adapt the translated versions into original (English) language.

After the translations have been done, the committee thoroughly analyzed those translations and made consensus on a final draft of Urdu version of RADS-2.The final draft of target language along with final back translation (English) then sent to the author of the original scale for final approval through Psychological Assessment Resource U.S.A.

Cross Language Validation

After the completion of translation and adaptation a study was conducted to check whether the translated version is conceptually equivalent to the original version or not. The study was conducted by using "single group bilingual design". This design involves the administration of two different language versions (original and targeted) of the scale to a single group of bilinguals . At this step of the study a sample of 74 bilingual adolescent students were selected through applying purposive sampling technique. Both the version of RADS-2 (Urdu and original) were administered on participants after the interval of one week.

Estimation of Reliability

In the second stage, the reliability studies were conducted to establish test retest reliability, split half reliability and internal consistency. The sample of 80 adolescent students (31 males and 49 females) with the age range of 11 to 20 years was selected for test retest reliability study, with the inter test interval of one week. The alpha reliability estimates and split half reliability were obtained for the sample of 330 adolescents (130 males and 200 females) from different schools and colleges of Karachi, Pakistan.

Factor Analysis

Factor analysis was also computed through principal component extraction method for the above mentioned sample with Varimax rotation method and fixed four-factor solution.

Data Analysis

The data was statistically treated with the help of Statistical Package for Social Sciences (SPSS, Version 17.0). Pearson Product Moment Correlation, Cronbach's alpha, split half reliability and principal component factor analysis were calculated.

RESULTS

Table 1 Linguistic equivalence of Urdu (Adapted) and English (Original) Version of RADS-2

Item No.###Pearson r###Level of Sig.###Item No.###Pearson r###Level of Sig.

Total###.883###.000###16###.637###.000

1###.485###.000###17###.636###.000

2###.455###.000###18###.669###.000

3###.585###.000###19###.716###.000

4###.689###.000###20###.593###.000

5###.668###.000###21###.491###.000

6###.703###.000###22###.716###.000

7###.560###.000###23###.375###.001

8###.726###.000###24###.501###.000

9###.513###.000###25###.450###.000

10###.312###.007###26###.541###.000

11###.509###.000###27###.710###.000

12###.353###.002###28###.522###.000

13###.781###.000###29###.681###.000

14###.758###.000###30###.348###.002

15###.596###.000###-###-###-

Note: N=74; 1 week inter test interval

Table 2 Reliability Statistics

Cronbach's Alpha###Cronbach's Alpha Based on

###Standardized Items###No of Items

###.898###.898###30

Table 3 Test Re-test Reliability of RADS-2

###Correlation###Level of

###(Pearson r)

Significance

RADS-2###.858###.000

The sub scale of Dysphoric Mood###.811###.000

The sub scale of Anhedonia/ Negative Affect###.718###.000

The sub scale of Negative Self-Evaluation###.830###.000

The sub scale of Somatic Complaints###.870###.000

Note: With 1 week inter test interval, N=80

Table 4 Split-Half Reliability of RADS-2 Urdu Version

Cronbach's Alpha###Part 1 Value###.826

###N of Items###15

###Part 2 Value###.814

###N of Items###15

###Total N of Items###30

###Correlation###.777

###Between Forms

Spearman-Brown Coefficient###.874

Guttman Split-Half Coefficient###.874

Note: N=330,

Table 5 KMO and Bartlett's Test

Kaiser-Meyer-Olkin Measure of###Sampling Adequacy.###.907

Bartlett's Test of Sphericity###Approx. Chi-Square###3168.032

###df###435

###Sig.###.000

Table 6 Eigen Values and Percentages of Variance Explained by Forced 4 Factor Solution Obtained Through Principal Component Analysis

Factors###Eigen values###% of Variance###Cumulative Percentages

###Explained

1###8.339###27.795###27.795

2###2.420###8.065###35.861

3###1.291###4.304###40.165

4###1.243###4.142###44.306

Note: N=330

Table 7 Rotated Component Matrixa

###Component###

###Symptom Content

###1###2###3###4###

A1###.263###.548###.060###.149###Reduced Affect

DM2###.106###-.077###.577###.115###School Anxiety

DM3###.661###.037###.192###.079###Loneliness

NS4###.268###.122###.678###-.028###Feelings of Rejection

A5###.307###.571###-.100###.065###Self-worth

DM6###.527###.132###.376###.045###Social withdrawal

DM7###.645###.063###.184###.240###Sadness

DM8###.431###.058###.235###.422###Crying

NS9###.487###.184###.538###.130###Worthlessness

A10###-.110###.702###.057###.004###Anhedonia-peers

SC11###.098###.103###.324###.635###Somatic complaints

A12###.011###.510###.116###-.094###Low self-worth

NS13###.630###.140###.277###.120###Discouragement

NS14###.406###.188###.478###.227###Self-injurious

NS15###.236###.316###.393###.231###Self-esteem

DM16###.553###-.017###.277###.407###Irritability

SC17###.638###.107###.039###.082###Pessimism

SC18###.472###-.118###-.155###.499###Fatigue

NS19###.644###.076###.226###.062###Self-reproach

NS20###.614###.194###.333###.048###Self-deprecation

DM21###.530###.206###.297###.184###Self-pity

SC22###.438###-.028###.154###.215###Anger

A23###-.166###.579###.107###.174###Reduced speech

SC24###.258###.042###.492###.303###Sleep disturbance

A25###.133###.615###-.039###-.171###Anhedonia-general

DM26###.337###-.084###.008###.582###Worry

SC27###.083###.064###.210###.653###Somatic complaint

SC28###.504###.036###-.055###.430###Loss of interest

A29###.159###.481###.072###.035###Appetite disturbance

NS30###.521###.088###.095###.292###Helplessness

Note: Extraction Method: Principal Component Analysis, Rotation Method: Varimax with Kaiser Normalization. a. Rotation converged in 11 iterations.

DISCUSSION

RADS-2 is a widely used instrument to measure depressive symptomatology among children and adolescents of 11 to 20 years of age. Even in our country Pakistan it has been used in number of researches and PhD dissertations but the application was limited due to language barrier. Present study was aimed to translate and adapt RADS-2 in Pakistan's national language Urdu and to establish its reliability and factor analysis so that this esteemed instrument can be used in our general population who cannot understand English language. In general the findings suggest significant results.

After translation and adaptation of RADS-2 in Urdu (targeted language) from English (source language), the linguistic equivalence of the translated version was calculated. In Table 1 results are showing strong correlation between two versions of RADS-2 (i.e. r = .883 at .001 level of significance). Table 1 is also showing strong item by item correlation between the items of original version and adapted version (at .01 level of significance).

The internal consistency of adapted version of RADS-2 was also obtained through Cronbach's alpha. Result suggests promising internal consistency of the Urdu version of RADS-2 (Refer to Table 2; .898).

The test re-test reliability of Urdu version of Reynolds Adolescent Depression Scale was also calculated. Table 3 reflect strong positive correlation between the two administrations with one week interval (r= .858) significant at .001 level. Furthermore all the sub scales also demonstrate promising results. For the sub scale of Dysphoric Mood the r= .811, for Anhedonia / Negative Affect r= .718, for Negative Self-Evaluation r = .830 and for Somatic Complaints r = .870 (all are significant at .001 level of significance).

Split half reliability assessed by Spearman-Brown Coefficient is also showing strongly positive correlation between two equal halves of RADS-2 Urdu version i.e. .874 (Refer to Table 4).

Factor analysis used as an exploratory and confirmatory technique. It is frequently used to develop questionnaires to measure an ability or trait of the questionnaire, to ensure that the items are related to the construct intended to measure . Factor analysis was also applied on RADS-2U with the same intention.

Initially sampling adequacy was tested empirically by applying Kaiser-Meyer-Olkin (KMO) and Bartlett tests of sampling adequacy. KMO = .907 showing high and satisfactory sampling adequacy. Bartlett's test of sphericity is also significant which shows that data is suitable for analysis (Refer to Table 5)

30 items of Reynolds Adolescent Depression Scale (RADS-2U) after the approval from the original author and Psychological Assessment Resource (PAR) USA were factor analyzed and the principal component was obtained with forced 4 factor solution to determine the underlying factor structure of the adapted version of RADS-2 in Pakistani culture on the data of 330 adolescents.

An examination of the symptom contents appearing in forced 4 factor solution showed that they were relatively conceptually distinct from each other (Refer to table 6) and fairly same as in the original RADS-2 manual with some cultural differences.

In original version of RADS-2 Factor-1i.e. Dysphoric Mood was comprised of items 2, 3, 6, 7, 8, 16, 21, and 26. In our findings except item 2 (having symptom content of school anxiety) all other items were loaded on factor 1 with first highest component matrix and second highest component matrix for item 26 (with the symptom content of worry). Item 26 share Factor 4 (Somatic Complain) with highest component matrix which suggests that in Pakistani culture the symptom content of worry is more associated with somatic complaints than dysphoric mood. As far as item 2 is concerned it was loaded on Factor 3 (Negative self-evaluation) and did not share any other factor. This is may be because the targeted population in present study was adolescents belonging to student class and for students their schools play a vital role in the development of self concept and for self development.

In our culture and society parents, others and even students themselves evaluate their selves from their academic performances and achievements, this might be the reason behind the fall of symptom content school anxiety under the factor of Negative self evaluation.

Factor-2 (Anhedonia/ Negative affect) was comprised of items 1, 5, 10, 12, 23, 25 and 29 in the factor analysis of original version of RADS-2 and findings of present study were same for the Urdu version. All seven items fall under factor 2.

Factor-3 (Negative Self-Evaluation) was comprised of item 4, 9, 13, 14, 15, 19, 20 and 30. In the present analysis all items except item 30 with symptom content of helplessness fall in factor 3 with highest (item 4, 9, 14, 15) or second highest component matrix (item 13, 19, and 20). Item 30 fall under the factor of dysphoric mood suggesting that in our culture feeling helplessness has been taken generalized not personal and is more associated with the dysphoric mood rather than negative self evaluation

Factor-4 (Somatic Complaints) consisted on items 11, 17, 18, 22, 24, 27, and 28. In the factor analysis of RADS-2 Urdu, all items except item 17 fall under the same factor 4 i.e. somatic complaints. Item 11, 18, and 27 fall in with the first highest component matrix and item 22, 24, and 28 falls in with the second highest component matrix. Item 17 has high factor loading on factor 1, i.e. dysphoric mood. If we consider the symptom content of item 17 its pessimism and findings suggest that in our culture pessimism depict dysphoric mood of a person rather than somatic complaints.

Summing up, the Urdu version of RADS-2 presents the adequate estimates of reliability and factor analysis which provide base for the further development of depression scales for children and adolescents in our culture. This adapted Urdu version of RADS-2 can be considered a useful instrument not only for clinicians but also for educational personnel in Pakistan to assess the etiology and development of depressive symptoms in adolescents within the context of our culture.

Institute of Clinical Psychology, University of Karachi, Pakistan

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Author:Sami, Saleha; Ahmad, Riaz; Khanam, Sarwat Jahan
Publication:Pakistan Journal of Clinical Psychology
Article Type:Report
Geographic Code:9PAKI
Date:Dec 31, 2013
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