Are visual measures of mood superior to questionnaire measures in non-Western settings?

OBJECTIVE: We hypothesised that, in a non-Western setting where literacy was not universal, a visual measure (the FACES test) would be more valid than a traditional psychiatric questionnaire [the General Health Questionnaire (GHQ)] as a screening test for mood disorders. METHODS: The study was nested within a randomised controlled trial of 450 patients with a common mental disorder (CMD). Subjects were evaluated at 2, 6 and 12 months after enrolment with the Clinical Interview Standardised-Revised (CISR) (the gold standard), the GHQ5 (the shortened version of the GHQ-12) and the FACES test. RESULTS: Correlation coefficients and Receiver Operating Characteristic (ROC) curves show superiority of the GHQ5 in the detection of CMD based on the CISR, compared with the visual FACES test. Less-educated subjects had particular difficulty completing the FACES. The kappa coefficient of agreement between the two instruments, using the cut-off point for the GHQ5 estimated by the ROC curves, was between 0.70 and 0.75. CONCLUSIONS: Contrary to our hypothesis, the questionnaire-based measure was significantly superior to a visual measure of mood, especially for less-educated subjects. A short five-item version of the GHQ has a good discriminatory ability for CMD and may be used as a brief alternative to standardised interviews in clinical and survey settings.