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Moroccan colloquial Arabic version of the Mini International Neuropsychiatric Interview (MINI): qualitative and quantitative validation
European Psychiatry 20 (2005) 193–195 http://france.elsevier.com/direct/EURPSY/
Short communication
Moroccan colloquial Arabic version of the Mini International Neuropsychiatric Interview (MINI): qualitative and quantitative validation N. Kadri a,*, M. Agoub a, S. El Gnaoui a, Kh. Mchichi Alami a, T. Hergueta b, D. Moussaoui a a
University Psychiatric Center Ibn Rushd, Rue Tarik Ibnou Ziad, 20000 Casablanca, Morocco b Inserm, La Salpêtrière Hospital, Paris, France
Received 10 December 2002; received in revised form 8 November 2004; accepted 15 November 2004
Abstract The validation of mini international neuropsychiatric interview (MINI) into Moroccan Colloquial Arabic language demonstrated good psychometric properties. The concordance between translated MINI’s and expert diagnoses was good with kappa values greater than 0.80. The reliability inter-rater and test–retest were excellent with kappa values above 0.80 and 0.90, respectively. © 2005 Elsevier SAS. All rights reserved. Keywords: Colloquial Arabic MINI version; Qualitative validation; Concordance expert; Inter-rater reliability; Test–retest reliability
1. Introduction
2. Methods
In Morocco and despite a long history in treating mental ill people, till now no official data on the epidemiology of mental disorders are available. To be able to conduct an epidemiological survey, there is a need of reliable and valid instrument. For this, we have chosen the mini international neuropsychiatric interview (MINI) [2,3] to conduct such surveys in Morocco. This instrument was translated into many languages, and two classical Arabic versions were produced. Our group tested these versions among Moroccan population (patients and healthy volunteers). However, we noticed that they were not suitable to our context. The official language is Arabic. But, this most widely spoken language, Moroccan colloquial Arabic, is quite different from the classical Arabic. It is not used in medical settings in its written form. On the other hand, in Morocco medical sciences are taught in French. In practice, health professional make their work from French version of medical documentations and translate as they speak into the patient’s preferred tongue.
2.1. Translation procedures
* Corresponding author. E-mail address: [email protected] (N. Kadri). 0924-9338/$ - see front matter © 2005 Elsevier SAS. All rights reserved. doi:10.1016/j.eurpsy.2004.11.007
The group in charge of the translation, from French to Colloquial Arabic language, was a trilingual group (Arabic, French and English), composed by psychiatrists. The part of the translation procedure was divided into four distinct steps. First, the group had agreement meeting and worked and discussed comprehensibility, acceptability and cultural applicability of the questions, appropriateness of format, wording and phrasing. Second, each member of the group was in charge of a number of modules. Third, the members reviewed individually the translation of the modules done by the other members. Finally, a concordance meeting with the whole team was held after completion of each module, in the aim to read the chapter in Arabic, to compare it to the original French version and to work on the cultural and social weight of the words and sentences. 2.2. Back-translation procedures An independent group proceeded to the back-translation into French of the full revised translated version. Then, a comparison of the back-translation with the original version for semantic and conceptual equivalence was conducted.
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N. Kadri et al. / European Psychiatry 20 (2005) 193–195
2.3. Quantitative validation
3. Results
2.3.1. Study population The following minimum recruitment quotas were set: 30 cases of depressive disorders, 20 cases of manic episodes, 30 cases of anxiety disorders, 40 cases of psychotic disorders, and 30 patients with substance-related disorders. Fifty healthy non-psychiatric volunteers were recruited in a primary health care center.
A total of 175 psychiatric patients and 50 normal controls agreed to participate in the study. 3.1. Concordance between Moroccan MINI and expert diagnosis Table 1 shows the psychometric properties of the Moroccan MINI regarding the validity. General anxiety disorder and eating disorders were not included because of the small number of patients in our sample.
2.4. Validity and reliability procedures As in Morocco, there was no validated instrument to be compared with; it was chosen to test the validity of the Moroccan MINI against an expert opinion. The “MINI interviewer” was psychiatrist (M.A.), and had received by the authors a half-day training session. The expert (N.K.) was professor of psychiatry and used to use DSM-IV classification and clinical rating scales as well as diagnostic interviews. She provided DSM-IV diagnoses using whatever source of information she considered to be the most appropriate. Each patient was seen the same day by the two interviewers. Both “MINI interviewer” and expert were blind towards the other diagnosis. The inter-rater and test–retest reliability were assessed in a subgroup of 50 patients of the whole patient’s population. For the first one the MINI was administered by two distinct interviewers and for the latter; subsequently by one of them 2 days after the initial rating.
3.2. Inter-rater and test–retest reliability All of the kappa values were above 0.80 and the majority, nine out of 11, was 0.90 or higher, indicating an excellent inter-rater reliability.
4. Discussion Overall, the results of the quantitative validity study were satisfactory. The data suggest that the Moroccan version of the MINI succeeded in validity in eliciting symptom criteria used in making DSM-IV diagnoses. As it is often the case in such instruments, inter-rater and test–retest reliability results were very good. These results might be partially explained by the fact that most of the population tested was satisfying the diagnostic criteria of mental disorders according to DSM-IV criteria and was followed up in psychiatric facilities. Nevertheless, the study had several limitations such as the low number of cases for some diagnoses such as dysthymia, PTSD, generalized anxiety disorder and eating disorders, we did not include patients from other facilities than mental health institutions and the MINI is in large part devoted to the screening of psychiatric disorders especially in primary care set-
2.4.1. Data analysis For each axis-I disorders generated by the Moroccan MINI diagnostic concordance against expert opinion was assessed using Cohen’s kappa values, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). Kappa values were also used to test inter-rater and test–retest reliabilities.
Table 1 Concordance between Moroccan MINI and expert diagnoses Disorder (n = 225) Major depressive disorder Dysthymia Current manic disorder Panic disorder Agoraphobia Social phobia Obsessive compulsive disorder Posttraumatic disorder Current alcohol dependence Lifetime alcohol dependence Current drug dependence Lifetime drug dependence Current psychotic disorder
TP 29 4 19 9 12 12 9 2 14 14 16 18 40
TN 194 220 203 215 211 211 215 222 209 208 207 204 182
FP 1 1 1 1 1 2 1 0 0 0 0 0 0
FN 1 0 2 0 0 0 0 1 2 3 2 3 3
Kappa 0.95 0.88 0.91 0.94 0.91 0.91 0.94 0.79 0.92 0.89 0.93 0.91 0.95
Sensitivity 0.96 1.00 0.90 1.00 1.00 1.00 1.00 0.66 0.87 0.82 0.88 0.85 0.93
Specificity 0.99 0.99 0.99 0.99 0.99 0.99 0.99 1.00 1.00 1.00 1.00 1.00 1.00
PPV 0.96 0.80 0.95 0.90 0.85 0.85 0.90 1.00 1.00 1.00 1.00 1.00 1.00
NPV 0.99 1.00 0.98 1.00 1.00 1.00 1.00 0.99 0.99 0.98 0.99 0.98 0.98
PPV = positive predictive value; NPV = negative predictive value; TP = true positive; TN = true negative; FP = false positive; FN = false negative.
N. Kadri et al. / European Psychiatry 20 (2005) 193–195
tings, and the comparisons with an expert’s diagnosis instead of using another structured diagnostic interview because of the lack of valid Moroccan Arabic instruments to be compared with. But this method was widely used before and we think we take all dispositions to keep the blindness of each interviewer, which can be the most important. Because of the simplicity, ease of use and its brevity the Moroccan Arabic version of the MINI can be incorporated into routine psychiatric evaluation or in the general practitioner consultations. The MINI was used in multicenter clinical trials and epidemiology studies [1]. For research matters, this instrument will be used soon in a Moroccan national epidemiological survey, which will allow us, for the first time, to have prevalence rates of mental disorders in a representative sample of the general population of Morocco.
195
References
[1]
Duburq A, Blin P, Charpak Y, Blachier C, Allicar MP, Bouhassira M, et al. Use of a structured diagnostic interview to identify depressive episodes in an epidemiologic study: a posteriori internal validation. Rev Epidemiol Santé Publ 1999;47:455–63.
[2]
Lecrubier Y, Sheehan DV, Weiller E, Amorim P, Bonora I, Harnett Sheehan K, et al. The Mini International Neuropsychiatric Interview (MINI). A short diagnostic structured interview: reliability and validity according to the CIDI. Eur Psychiatry 1997;12:224–31.
[3]
Sheehan DV, Lecrubier Y, Harnett Sheehan K, Janavs J, Weiller E, Keskiner A, et al. The validity of the Mini International Neuropsychiatric Interview according to the SCID-P and its reliability. Eur Psychiatry 1997;12:232–41.
Short communication
Moroccan colloquial Arabic version of the Mini International Neuropsychiatric Interview (MINI): qualitative and quantitative validation N. Kadri a,*, M. Agoub a, S. El Gnaoui a, Kh. Mchichi Alami a, T. Hergueta b, D. Moussaoui a a
University Psychiatric Center Ibn Rushd, Rue Tarik Ibnou Ziad, 20000 Casablanca, Morocco b Inserm, La Salpêtrière Hospital, Paris, France
Received 10 December 2002; received in revised form 8 November 2004; accepted 15 November 2004
Abstract The validation of mini international neuropsychiatric interview (MINI) into Moroccan Colloquial Arabic language demonstrated good psychometric properties. The concordance between translated MINI’s and expert diagnoses was good with kappa values greater than 0.80. The reliability inter-rater and test–retest were excellent with kappa values above 0.80 and 0.90, respectively. © 2005 Elsevier SAS. All rights reserved. Keywords: Colloquial Arabic MINI version; Qualitative validation; Concordance expert; Inter-rater reliability; Test–retest reliability
1. Introduction
2. Methods
In Morocco and despite a long history in treating mental ill people, till now no official data on the epidemiology of mental disorders are available. To be able to conduct an epidemiological survey, there is a need of reliable and valid instrument. For this, we have chosen the mini international neuropsychiatric interview (MINI) [2,3] to conduct such surveys in Morocco. This instrument was translated into many languages, and two classical Arabic versions were produced. Our group tested these versions among Moroccan population (patients and healthy volunteers). However, we noticed that they were not suitable to our context. The official language is Arabic. But, this most widely spoken language, Moroccan colloquial Arabic, is quite different from the classical Arabic. It is not used in medical settings in its written form. On the other hand, in Morocco medical sciences are taught in French. In practice, health professional make their work from French version of medical documentations and translate as they speak into the patient’s preferred tongue.
2.1. Translation procedures
* Corresponding author. E-mail address: [email protected] (N. Kadri). 0924-9338/$ - see front matter © 2005 Elsevier SAS. All rights reserved. doi:10.1016/j.eurpsy.2004.11.007
The group in charge of the translation, from French to Colloquial Arabic language, was a trilingual group (Arabic, French and English), composed by psychiatrists. The part of the translation procedure was divided into four distinct steps. First, the group had agreement meeting and worked and discussed comprehensibility, acceptability and cultural applicability of the questions, appropriateness of format, wording and phrasing. Second, each member of the group was in charge of a number of modules. Third, the members reviewed individually the translation of the modules done by the other members. Finally, a concordance meeting with the whole team was held after completion of each module, in the aim to read the chapter in Arabic, to compare it to the original French version and to work on the cultural and social weight of the words and sentences. 2.2. Back-translation procedures An independent group proceeded to the back-translation into French of the full revised translated version. Then, a comparison of the back-translation with the original version for semantic and conceptual equivalence was conducted.
194
N. Kadri et al. / European Psychiatry 20 (2005) 193–195
2.3. Quantitative validation
3. Results
2.3.1. Study population The following minimum recruitment quotas were set: 30 cases of depressive disorders, 20 cases of manic episodes, 30 cases of anxiety disorders, 40 cases of psychotic disorders, and 30 patients with substance-related disorders. Fifty healthy non-psychiatric volunteers were recruited in a primary health care center.
A total of 175 psychiatric patients and 50 normal controls agreed to participate in the study. 3.1. Concordance between Moroccan MINI and expert diagnosis Table 1 shows the psychometric properties of the Moroccan MINI regarding the validity. General anxiety disorder and eating disorders were not included because of the small number of patients in our sample.
2.4. Validity and reliability procedures As in Morocco, there was no validated instrument to be compared with; it was chosen to test the validity of the Moroccan MINI against an expert opinion. The “MINI interviewer” was psychiatrist (M.A.), and had received by the authors a half-day training session. The expert (N.K.) was professor of psychiatry and used to use DSM-IV classification and clinical rating scales as well as diagnostic interviews. She provided DSM-IV diagnoses using whatever source of information she considered to be the most appropriate. Each patient was seen the same day by the two interviewers. Both “MINI interviewer” and expert were blind towards the other diagnosis. The inter-rater and test–retest reliability were assessed in a subgroup of 50 patients of the whole patient’s population. For the first one the MINI was administered by two distinct interviewers and for the latter; subsequently by one of them 2 days after the initial rating.
3.2. Inter-rater and test–retest reliability All of the kappa values were above 0.80 and the majority, nine out of 11, was 0.90 or higher, indicating an excellent inter-rater reliability.
4. Discussion Overall, the results of the quantitative validity study were satisfactory. The data suggest that the Moroccan version of the MINI succeeded in validity in eliciting symptom criteria used in making DSM-IV diagnoses. As it is often the case in such instruments, inter-rater and test–retest reliability results were very good. These results might be partially explained by the fact that most of the population tested was satisfying the diagnostic criteria of mental disorders according to DSM-IV criteria and was followed up in psychiatric facilities. Nevertheless, the study had several limitations such as the low number of cases for some diagnoses such as dysthymia, PTSD, generalized anxiety disorder and eating disorders, we did not include patients from other facilities than mental health institutions and the MINI is in large part devoted to the screening of psychiatric disorders especially in primary care set-
2.4.1. Data analysis For each axis-I disorders generated by the Moroccan MINI diagnostic concordance against expert opinion was assessed using Cohen’s kappa values, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). Kappa values were also used to test inter-rater and test–retest reliabilities.
Table 1 Concordance between Moroccan MINI and expert diagnoses Disorder (n = 225) Major depressive disorder Dysthymia Current manic disorder Panic disorder Agoraphobia Social phobia Obsessive compulsive disorder Posttraumatic disorder Current alcohol dependence Lifetime alcohol dependence Current drug dependence Lifetime drug dependence Current psychotic disorder
TP 29 4 19 9 12 12 9 2 14 14 16 18 40
TN 194 220 203 215 211 211 215 222 209 208 207 204 182
FP 1 1 1 1 1 2 1 0 0 0 0 0 0
FN 1 0 2 0 0 0 0 1 2 3 2 3 3
Kappa 0.95 0.88 0.91 0.94 0.91 0.91 0.94 0.79 0.92 0.89 0.93 0.91 0.95
Sensitivity 0.96 1.00 0.90 1.00 1.00 1.00 1.00 0.66 0.87 0.82 0.88 0.85 0.93
Specificity 0.99 0.99 0.99 0.99 0.99 0.99 0.99 1.00 1.00 1.00 1.00 1.00 1.00
PPV 0.96 0.80 0.95 0.90 0.85 0.85 0.90 1.00 1.00 1.00 1.00 1.00 1.00
NPV 0.99 1.00 0.98 1.00 1.00 1.00 1.00 0.99 0.99 0.98 0.99 0.98 0.98
PPV = positive predictive value; NPV = negative predictive value; TP = true positive; TN = true negative; FP = false positive; FN = false negative.
N. Kadri et al. / European Psychiatry 20 (2005) 193–195
tings, and the comparisons with an expert’s diagnosis instead of using another structured diagnostic interview because of the lack of valid Moroccan Arabic instruments to be compared with. But this method was widely used before and we think we take all dispositions to keep the blindness of each interviewer, which can be the most important. Because of the simplicity, ease of use and its brevity the Moroccan Arabic version of the MINI can be incorporated into routine psychiatric evaluation or in the general practitioner consultations. The MINI was used in multicenter clinical trials and epidemiology studies [1]. For research matters, this instrument will be used soon in a Moroccan national epidemiological survey, which will allow us, for the first time, to have prevalence rates of mental disorders in a representative sample of the general population of Morocco.
195
References
[1]
Duburq A, Blin P, Charpak Y, Blachier C, Allicar MP, Bouhassira M, et al. Use of a structured diagnostic interview to identify depressive episodes in an epidemiologic study: a posteriori internal validation. Rev Epidemiol Santé Publ 1999;47:455–63.
[2]
Lecrubier Y, Sheehan DV, Weiller E, Amorim P, Bonora I, Harnett Sheehan K, et al. The Mini International Neuropsychiatric Interview (MINI). A short diagnostic structured interview: reliability and validity according to the CIDI. Eur Psychiatry 1997;12:224–31.
[3]
Sheehan DV, Lecrubier Y, Harnett Sheehan K, Janavs J, Weiller E, Keskiner A, et al. The validity of the Mini International Neuropsychiatric Interview according to the SCID-P and its reliability. Eur Psychiatry 1997;12:232–41.