Psychometric properties of the culturally adapted 10-item Hopkins Symptom Checklist (HSCL-10-SW) anxiety subscale for southwestern Madagascar

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, prior to this study, there were no validated scales to measure anxiety disorder symptoms in Madagascar.We assessed the psychometric properties of the culturally adapted 10item 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% females) aged 16 (mean age 36.9) and above in October 2023.Our Exploratory Factor Analysis (EFA) supported a two-factor structure: (1) Fear Anxiety and (2) Cognitive-Somatic Anxiety.We conducted a Confirmatory Factor Analysis (CFA) using the two-factor structure we obtained from the EFA.We evaluated the discriminant validity between anxiety disorders (HSCL-10-SW) and depression (PHQ-8).We found discriminant validity between Fear Anxiety and Depression factors.In contrast, we found that the Cognitive-Somatic and Depression factors overlapped and could not be distinguished from each other.In general, depression and anxiety disorders often overlap, and it is not unexpected that there are challenges in isolating mutually exclusive symptoms between them.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. Impact statement:Madagascar lacks mental health care specialists, with only 24 psychiatrists for ~30 million people.Specifically, the southwestern region of Madagascar has only one psychiatrist for roughly 2 million people, indicating a tremendous need for mental health support.To acknowledge mental health needs in this region, we constructed the HSCL-10-SW, an adapted version of the Hopkins Symptom Checklist, as the first validated scale to measure symptoms of anxiety disorders in Madagascar.The HSCL-10-SW will help non-mental health specialists assess the needs and treatment gaps in southwestern Madagascar.Evaluating the degree of