A multi-stage random sampling was used to find households for inclusion in the survey. The selection of villages (the smallest administrative unit in Rwanda), households and study participants in the eight districts of the Southern province of Rwanda was made in three phases. Out of the total number of 3512 existing villages, 35 villages were randomly selected using a random function. The number of households in each village was selected proportionate to the total number of households in each village and the person to be interviewed was randomly selected among eligible people in each household i.e. men and women aged between 20 and 35 years. The first participant in each village was selected from the closest household to the center of the village and a calculated sampling interval was applied to get the next household.
To assess the mental health status, four modules from the MINI International Neuropsychiatric interview (DSM-IV) version 5.0.0, were used to identify major depressive episodes in the past two weeks and in earlier periods of 2 week-duration or more, generalized anxiety disorder, suicide risk and post-traumatic stress disorder (PTSD). The MINI is designed as a brief structured interview for diagnosing the major psychiatric disorders according to DSM-IV criteria and International Classification of Diseases-10. Validation studies show that the MINI has similar validity and reliability properties as the WHO-CIDI (Composite International Diagnostic Interview for ICD-10) instrument [22]. The advantage with the MINI is that it contains less items, takes less time to administer and can be used by trained interviewers but does not necessarily require clinical staff. To measure physical, sexual and psychological violence exposure, we used the items from the Women's Health and Life experiences questionnaire, developed by WHO [23] and used in several countries all over the world [24]. The questionnaires were translated in Kinyarwanda, one of the national languages in Rwanda.
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The research protocol and tools were approved for scientific and ethical integrity by the Rwanda National Ethics Committee (Review Approval Notice No 165/RNEC/2011) and the National Institute of Statistics of Rwanda (No 1043/2011/10/NISR). The study strictly followed WHO guidelines on ethical issues related to violence-research [30], all participants were informed about their free choice to participate and to withdraw at whatever time they wanted during the study. Interviewers secured written consent from all respondents before the interview. To maintain confidentiality, the interview was conducted in privacy and with one interview in each household. Respondents were informed that questions could be sensitive and were reassured regarding the confidentiality of their responses. As IPV and mental disorders are delicate issues, it was agreed that those in need of any kind of assistance should be taken to a nearby health centre accompanied by the community health worker.
3 GENERAL INSTRUCTIONS The M.I.N.I. was designed as a brief structured interview for the major Axis I psychiatric disorders in DSM-IV and ICD-10. Validation and reliability studies have been done comparing the M.I.N.I. to the SCID-P and the CIDI. The results of these studies show that the M.I.N.I. has acceptably high validation and reliability scores, but can be administered in a much shorter period of time (mean 18.7 11.6 min., median 15 min.) than the above referenced instruments. It can be used by clinicians, after a brief training session. Lay interviewers require more extensive training. Interview : In order to keep the interview as brief as possible, inform the patient that you will conduct a clinical interview that is more structured than usual, with very precise questions about psychological problems which requires a yes or no answer. General format : The M.I.N.I. is divided into modules identified by letters, each corresponding to a diagnostic category. At the beginning of each module (except for psychotic disorders module), screening question(s) corresponding to the main criteria of the disorder are presented in a gray box. At the end of each module, diagnostic box(es) permit(s) the clinician to indicate whether the diagnostic criteria are met. Conventions : Sentences written in normal font should be read exactly as written to the patient in order to standardize the assessment of diagnostic criteria. Sentences written in CAPITALS should not to be read to the patient. They are instructions for the interviewer to assist in the scoring of the diagnostic algorithms. Sentences written in bold indicate the time frame being investigated. The interviewer should read them as often as necessary. Only symptoms occurring during the time frame indicated should be considered in scoring the responses. Sentences (in parentheses) are clinical examples of the symptom.these may be read to the patient to clarify the question. Answers with an arrow above them ( ) indicate that one of the criteria necessary for the diagnosis(es) is not met. In this case, the interviewer should go to the end of the module, to circle in all the diagnostic boxes and move to the next module. When terms are separated by a slash (/), the interviewer should read only those symptoms known to be present in the patient (for example, question A3). Rating instructions: All questions read must be rated. The rating is done at the right of each question by circling either or. The clinician should be sure that each dimension of the question is taken into account by the patient (i.e.: time frame, frequency, severity, and/or alternatives). Symptoms better accounted for by an organic cause or by the use of alcohol or drugs should not be coded positive in the M.I.N.I.. The M.I.N.I. Plus has questions that investigate these issues. For any questions, suggestions, need for a training session, or information about updates of the M.I.N.I., please contact : David SHEEHAN, M.D., M.B.A. University of South Florida Institute for Research in Psychiatry 3515 East Fletcher Avenue Tampa, FL USA tel : fax : dsheehan@com1.med.usf.edu Yves LECRUBIER, M.D. / Thierry HERGUETA, M.A. INSERM U302 Hôpital de la Salpétrière 47, boulevard de l Hôpital F PARIS - FRANCE tel : +33 (0) fax : +33 (0) hergueta@ext.jussieu.fr
The MINI-Plus 5.0.0 is an internationally validated brief structured interview that is used extensively as a diagnostic tool for psychiatric disorders from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition and the International Classification of Diseases-10. The reliability and validity of this instrument is well established [24], and the Korean translation is also validated [19].
The GAD-7 and GAD-2 were designed for use in primary care patients [15, 16]. The GAD-7 consists of a self-report questionnaire that allows for the rapid detection of GAD [15]. Subjects are asked if they were bothered by anxiety related problems over the past two weeks by answering seven items on a 4-point scale. The total scores ranged from 0 to 21. At a cutoff score of 9, the GAD-7 had a sensitivity of 89 % and a specificity of 82 % for detecting GAD compared with a structured psychiatric interview [15]. The GAD-2 is a short version of the tool that is composed of the first two questions of the GAD-7 [16]. At a cutoff score of 2, the GAD-2 had a sensitivity of 86 % and a specificity of 83 % for detecting GAD [16]. The GAD-7 was translated into the Korean language, and was freely downloadable on the Patient Health Questionnaire website (www.phqscreeners.com) [25]. The translated version was translated back into English by a Korean English teacher. Finally, the two versions were compared by a native English speaker who concluded that they were identical. Thereafter, we administered it to 20 Korean PWE for the evaluation of potential problems in comprehension or cultural differences. No further adaptations were required.
Short and ultra-short prototypes were developed for Major Depressive Disorder (MDD), Generalised Anxiety Disorder (GAD), Panic Disorder (PD) and Social Phobia (SP). Prototypes were compared to typical short and ultra-short self-report screening scales, such as the Centre for Epidemiology Scale, CES-D and the GAD-7, and their short forms. The Mini International Neuropsychiatric Interview (MINI) version 6 [1] was used as the gold standard for obtaining clinical criteria through a telephone interview. From a population sample, 225 individuals who endorsed a prototype and 101 who did not were administered the MINI. Receiver operating characteristic (ROC) curves were plotted for the short and ultra short prototypes and for the short and ultra short screening scales.
The Mini International Neuropsychiatric Interview (MINI) version 6 [1] was used as the gold standard for obtaining clinical criteria for comparing the sensitivity and specificity of the prototypes to the scales. The MINI is a brief interview that has strong concordance with diagnoses based on the Structured Clinical Interview for DSM-III-R (SCID) or the Composite International Diagnostic Interview (CIDI) [30]. Only the modules assessing depression, social phobia, panic disorder and generalised anxiety disorder (GAD) were administered, corresponding to each of the prototypes being assessed. Exclusion criteria including drug use, medication use and alternative diagnosis (for GAD) were not assessed, to maintain comparability to the prototypes and scales used in the survey.
Surveys included the short and the ultra short versions of the prototypes, the four standard scales and their short forms (CES-D, GAD-7, SPIN and PDSS-SR), questions on background characteristics, and a consent form for clinical interview. These surveys were mailed to the 14,000 potential participants, along with information about the study. A subsample of respondents was then selected for a clinical interview. An algorithm for clinical interview selection was designed prior to the study, aiming to administer clinical interviews with all of the respondents with high scores on the prototypes and some of the participants with low scores according to a weekly quota system. A random sample of respondents who did not identify with any of the prototypes was also selected for interview. Only participants who provided a telephone number and consented to be interviewed were contacted. Participants who identified at any level with the schizophrenia prototype (n = 64) were excluded from having a phone interview. 2ff7e9595c
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