Abstract
Mental health conditions, including anxiety disorders, are a major cause of morbidity across Sub-Saharan Africa. There are scarce mental health resources and providers in Madagascar, which substantiates a need for clear and accessible assessment tools for assessing mental health conditions. Yet, before this study, there were no validated scales to measure anxiety disorder symptoms in Madagascar. We assessed the psychometric properties of the culturally adapted 10-item Hopkins Symptom Checklist (HSCL-10-SW) anxiety subscale in the Bay of Ranobe region, in southwestern Madagascar. The study participants were part of the ongoing HIARA cohort study. The HSCL-10-SW includes the original HSCL-10 anxiety subscale in addition to three culturally relevant items that were derived through qualitative research: irritability, lost in thoughts/overthinking and forgetfulness. We administered the HSCL-10-SW to 809 participants (41.2% males) aged 16 years (mean age 36.9) and above in October 2023. Our exploratory factor analysis supported a two-factor structure: Fear Anxiety and Cognitive-Somatic Anxiety. We found discriminant validity between Fear anxiety and Depression factors. Although the HSCL-10-SW demonstrated acceptable psychometric validity, we suggest that additional qualitative studies should be conducted to explore the local conceptualization of anxiety disorders in southwestern Madagascar.