ORIGINAL PAPER Peter Ventevogel Æ Gieljan De Vries Æ Willem F. Scholte Æ Nasratullah Rasa Shinwari Æ Hafizullah Faiz Ruhullah Nassery Æ Wim van den Brink Æ Miranda Olff Properties of the Hopkins Symptom Checklist-25 (HSCL-25) and the Self-Reporting Questionnaire (SRQ-20) as screening instruments used in primary care in Afghanistan Accepted: 9 January 2007 / Published online: 13 February 2007 j Abstract Background Recent epidemiological stud- ies in Afghanistan using mental health questionnaires yielded high prevalence rates for anxiety and depression. Objectives To explore the validity in the Afghan cultural context of two mental health ques- tionnaires, the Hopkins Symptom Checklist-25 (HSCL-25) and the Self-Reporting Questionnaire-20 (SRQ-20). Methods The two mental health question- naires were compared against a ‘gold standard’ semi- structured psychiatric interview, the Psychiatric Assessment Schedule (PAS). All instruments were administered to a sample of 116 Pashto-speaking patients (53 men, 63 women) attending primary health care facilities in Eastern Afghanistan. Re- sults Both HSCL-25 and SRQ-20 had modest prop- erties to correctly identify mental disorders, with an AUC (area under the curve) of 0.73 and 0.72 respec- tively. The optimal cut-off points for this population are different from those often used in transcultural research. For women the optimal cut-off points are higher than usual (2.25 for the HSCL-25 and 17 for the SRQ-20). For men the cut-off point for the HSCL-25 is lower than usual (1.50) and for the SRQ-20 it was 10). Conclusions This study underlines the necessity of validating instruments along with cultural context and gender. Earlier studies in Afghanistan may have overestimated the prevalence of mental disorders among women and underestimated the prevalence in men. j Key words screening – questionnaire – common mental disorders – primary care – gender differences – Afghanistan Introduction Several recent studies in Afghanistan have demon- strated very high levels of depressive and anxiety symptoms among the general population, especially in women [1, 22, 36]. These studies, as do many others in the aftermath of humanitarian emergencies in low income countries, used brief questionnaires administered by laypersons, to obtain a quick impression of the mental health status of the popu- lation. The authors were involved in one of these studies, a cross-sectional survey in which the Hop- kins Symptom Checklist-25 (HSCL-25) was used [36]. The decision to use this instrument was prag- matic—people who are not trained mental health professionals can be easily instructed, and little time is lost to administration. These instruments were, however, not originally designed to distinguish be- tween mental disorders and normal reactions to se- vere environmental stress, and have not been validated for use in Afghanistan. It remains unclear to what extent they can be used to estimate the prevalence of mental disorders in this context [4]. Therefore we felt the need to conduct this additional research. In this study, which should ideally have been done before the mentioned cross-sectional survey, we assessed the psychometric properties of SPPE 161 P. Ventevogel Æ N.R. Shinwari Æ H. Faiz HealthNet TPO, Mental Health Programme Jalalabad, Afghanistan P. Ventevogel Æ G. De Vries Æ W.F. Scholte Æ W. van den Brink M. Olff Academic Medical Centre, Dept. of Psychiatry Centre for Psychological Trauma University of Amsterdam Amsterdam, The Netherlands P. Ventevogel (&) HealthNet TPO Burundi 1110 Bujumbura, Burundi Fax: +257-242124 E-Mail: peterventevogel@yahoo.co.uk R. Nassery Directorate Mental Health Ministry of Public Health Kabul, Afghanistan Soc Psychiatry Psychiatr Epidemiol (2007) 42:328–335 DOI 10.1007/s00127-007-0161-8