Validation of three psychometric instruments for screening for perinatal common mental disorders in men in the north of Vietnam

Background: Perinatal non-psychotic common mental disorders (PCMDs) are less well recognised in men than in women. However, there are adverse consequences of PCMD for men, their partners and their infants. There is a need for simple, readily administered screening tools for use in research and primary health care for men, including in low income settings. The aim of this study was to validate three scales for screening PCMDs in men in northern Vietnam.

Methods: Translated and culturally verified versions of the Edinburgh Postnatal Depression Scale (EPDS), Zung's Self-rated Anxiety Scale (Zung SAS), and the General Health Questionnaire 12 items (GHQ-12) were validated against a gold-standard diagnostic tool, the Structured Clinical Interview for DSM IV diagnoses in a community-based sample of 231 Vietnamese men who were partners of pregnant women or women who had recently given birth. Post-hoc analyses, Receiver Operating Characteristic (ROC) analyses, and Cronbach's alpha were performed to examine the validity and internal reliability of the three scales.

Results: The prevalence of PCMDs in men was 17.8% (95%CI: 13.3-22.3). The AUROC of the EPDS 76.7% (95%CI: 67.9-85.5), the Zung SAS was 77.5% (95%CI: 68.9-86.0) and the GHQ-12 was 79.2% (95%CI: 71.2-87.1). The selected cut-off point to detect clinically significant symptoms in men using the EPDS was 4/5 (Sensitivity (Se) 68.3% and specificity (Sp) 77.4%), the Zung SAS was 35/36 (Se 70.7% and Sp 79.0%) and the GHQ-12 was 0/1 (Se 75.6% and Sp 74.7%).

Conclusions: PCMDs in men are an unrecognised public health problem in northern Vietnam. Overall the cut off scores to detect clinically significant symptoms are lower than those reported in high income settings. Cut off scores on the EPDS and Zung SAS are slightly higher in men than in women in northern Vietnam, but these scales are suitable for use with men in this setting. Although not suitable to detect PCMD in women, the GHQ-12 is suitable to detect PCMD in men.