The Sierra Leone Perinatal Psychological Distress Scale (SLPPDS)

Abstract

The Sierra Leone Perinatal Psychological Distress Scale (SLPPDS; Bah et al., 2025) is an original 10-item instrument developed specifically for screening perinatal psychological distress among women in Sierra Leone. The scale was developed using an emic-etic approach to ensure cultural sensitivity, beginning with 31 preliminary items reflecting local signs of distress. These items underwent refinement through cognitive interviews and rigorous translation/back-translation procedures involving Krio, the widely spoken language in the region, to establish conceptual equivalence and strong face validity. The validation process involved administration to pregnant women and new mothers across the Western Area and Bombali regions. Statistical analysis, including Principal Component Analysis (PCA) and subsequent Exploratory Factor Analysis (EFA) with varimax rotation, resulted in the final 10-item, one-factor solution. This structure was confirmed using Confirmatory Factor Analysis (CFA), which demonstrated an excellent fit to the data. Comprehensive evidence for the scale’s internal consistency, convergent validity, discriminant validity, and diagnostic validity has been reported.

Keywords

Perinatal Psychological Distress, Mental Health Screening, African Cultural Groups, Sierra Leone, Diagnostic Validity, Cut-Off Point, Face Validity, Rating Scale, Krio.

Authors

Bah, Abdulai Jawo, Wurie, Haja Ramatulai, Samai, Mohamed, Horn, Rebecca, Ager, Alastair.

Purpose

The fundamental purpose of the SLPPDS is to serve as a culturally appropriate screening tool for identifying perinatal psychological distress in the specific population of women in Sierra Leone. This objective necessitated the development of an instrument that integrates the unique cultural expressions and experiences of distress observed among pregnant women and new mothers in this West African context.

The SLPPDS aims to facilitate early identification of women requiring mental health support during the perinatal period, thereby addressing a critical gap in localized mental health screening instruments in low-resource settings.

Construct

The primary psychological construct measured by the SLPPDS is Perinatal Psychological Distress. This construct encompasses emotional, cognitive, and somatic symptoms experienced by women during pregnancy and the postpartum period.

The scale’s development was guided by the principle that distress presentation is culturally mediated, leading to a focus on locally relevant indicators of mental health challenges, distinguishing it from scales developed primarily in Western contexts.

Validity

The SLPPDS demonstrates robust evidence across multiple domains of validity:

• Construct Validity: Statistical analyses consistently supported a unidimensional structure, with all items loading onto a single factor. This finding confirms that the scale measures a coherent, singular construct of perinatal psychological distress.

• Content Validity: Content validation was achieved through rigorous item generation and refinement processes. Crucially, face validity was assessed and confirmed through feedback provided directly by the target population, ensuring the items were relevant and understandable to perinatal women in Sierra Leone.

• Convergent Validity: Evidence for convergent validity was established by examining the relationship between SLPPDS scores and levels of dysfunction. A consistent and significant positive correlation was found, where increasing scores of psychological distress severity coincided with increased levels of reported dysfunction.

• Discriminant Validity: The scale successfully differentiated between clinical cases and non-cases. The mean total symptom score for identified cases (M=13.6, SE 0.9) was significantly higher than for non-cases (M < 3.3, SE 0.9, P < .0001). This pattern was also mirrored in scores from the comparator PHQ-9 scale.

• Diagnostic Validity: The scale exhibits strong diagnostic utility, reporting a sensitivity of 80.0 and a specificity of 85.7. The Receiver Operating Characteristic (ROC) area under the curve was 0.90, with an optimal cut-off point reported at 0.81.

Reliability

The internal reliability of the SLPPDS is considered high. The measure of internal consistency, calculated using Cronbach’s alpha, was reported as 0.883, indicating excellent homogeneity among the 10 scale items.

Factor Analysis

The psychometric validation of the SLPPDS utilized a sequence of factor analytic techniques to confirm its structure:

• Principal Component Analysis (PCA): The initial PCA identified only one factor with an eigenvalue exceeding 1.0 (Watkins, 2018). This finding supported the hypothesis of a unidimensional construct underlying the distress symptoms.

• Exploratory Factor Analysis (EFA): Following the PCA, Principal Axis Factoring was conducted. An EFA employing a varimax rotation for a one-factor solution accounted for 54.9% of the total variance. This process led to the strategic elimination of 15 items from the initial pool, resulting in the final 10-item scale.

• Confirmatory Factor Analysis (CFA): The final one-factor model was tested using CFA, which demonstrated an excellent fit to the collected data (Tabachnick & Fidell, 2007). Key goodness-of-fit indices included a Root Mean Square Error of Approximation (RMSEA) of 0.054, a Comparative Fit Index (CFI) of 0.952, an Incremental Fit Index (IFI) of 0.955, and a Normal Fit Index (NFI) of 0.845.

Instrument

Test Type: Original

Format: The SLPPDS utilizes a unique response format tailored for low-literacy settings. It employs a four-point Likert scale, visually represented by jerry cans used as aids (T. S. Betancourt et al., 2015).

Language Available: Krio (Creole, Patois), English

Population Group: Human, Female

Age Group: Adulthood (18 years and older)

Population Details: The scale was validated on pregnant women and new mothers residing in the Western Area and Bombali regions of Sierra Leone.

Test Methodology: The validation employed a rigorous set of psychometric methodologies, including Test Validity (Construct, Content, Convergent, Discriminant, Diagnostic), Test Reliability (Internal Consistency), and Factor Analysis (Principal Component Analysis, Exploratory Factor Analysis, Confirmatory Factor Analysis), along with assessments of Test Sensitivity and Test Specificity.

Keywords

Psychometrics, Unidimensionality, Cronbach’s Alpha, Likert Scale, Western Area, Bombali, African Health, Screening Tool.

Authors

Author ORCID Identifier:

• Bah, Abdulai Jawo: http://orcid.org/0000-0002-3334-7882

• Horn, Rebecca: http://orcid.org/0000-0002-9869-544X

• Ager, Alastair: http://orcid.org/0000-0002-9474-3563

Affiliation Email addresses: Bah, Abdulai Jawo: [email protected]

Correspondence Address: Bah, Abdulai Jawo: [email protected]

Permissions & Fee and Test Year

Permissions: Contact Corresponding Author for usage and distribution permissions.

Fee: No fee is required for the use of the scale.

Test Year: 2025

Reference’s

Bah, A. J., Wurie, H. R., Samai, M., Horn, R., & Ager, A. (2025). Developing and validating the Sierra Leone perinatal psychological distress scale through an emic-etic approach. Journal of Affective Disorders Reports, 19, Article 100852. https://doi.org/10.1016/j.jadr.2024.100852

Items of the the Sierra Leone Perinatal Psychological Distress Scale (SLPPDS)

IMPORTANT: The following scale items must be preserved in their original language and must not be changed in any way.

• This is a 10-item measure.