Hindi translation and validation of Ultra Brief peripartum Mental Health Screening Tool (UBPMHST)

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However, existing screening tools often face linguistic and cultural barriers when applied in diverse populations especially of LMIC’s. This study aimed to translate and validate an ultra brief, simple, binary-scoring, novel mental health screening tool into Hindi language, evaluating its psychometric properties and cultural relevance among Hindi-speaking women. The scale developed in 2019, includes symptoms of depressed mood, anxiety symptoms and suicidal ideation, which is possibly more feasible and acceptable for use by non-specialist health workers in busy, low-resource primary care settings. However, a Hindi translated, validated version of the scale is not yet available for use among Indian population. Methods As specified by the World Health organisation, the translation process involved forward and backward translations, expert panel reviews, and pilot testing to ensure linguistic equivalence and cultural appropriateness. Subsequently, the translated tool underwent psychometric validation, including exploratory factor analyses, assessment of internal consistency, concurrent validity against established measures like a widely used screening tool (Edinburgh Postnatal Depression rating scale) in the said population. The study recruited a diverse sample of 194 peripartum women seeking antenatal and postnatal care and treatment from a tertiary care healthcare setting, ensuring representation across socio-demographic variables. Results The findings of this study underscore the successful translation and validation of an ultra-brief peripartum mental health screening tool for common mental health disorders into Hindi language, demonstrating its reliability, validity, and clinical relevance among Hindi-speaking women. Through rigorous psychometric evaluation, the translated tool exhibited robust internal consistency (Cronbach’s α = 0.80; P < 0.001), cross language concordance (ICC ≥ 0.7), test retest reliability (ICC = 0.952; P < 0.00), factor structure, content validity (CVI = 0.911), and concurrent validity (Pearson’s correlation coefficient 0.67 in ANC/ 0.71in PNC; P < 0.05), thus providing a valuable instrument for identifying peripartum mental health concerns within this population. Conclusion Findings elucidated the reliability, validity, and clinical utility of the translated screening tool in screening for peripartum common mental health disorders among Hindi-speaking women, thereby facilitating timely identification and support for maternal mental health concerns. Translation validation Common mental health disorder (CMD) brief screening tool peripartum females Key messages The Hindi translated version of UBPMHST has adequate reliability, validity and clinical utility for screening for common mental health disorders among Hindi speaking peripartum females. Background The peripartum period, encompassing pregnancy and the postpartum phase, represents a critical juncture in a woman's life, characterized by profound physiological, psychological, and social changes. For majority of women, pregnancy and motherhood is a positive psychological life event, however, for a few, this life-changing process might result in a mental health problem. It is estimated that about 15–25% of women will experience a mental health problem either during pregnancy or in the first-year post pregnancy which might present either as a new problem altogether or as a reoccurrence of a pre-existing mental health problem which can contribute to adverse outcomes for women, their infants, partners as well as other family members ( 1 ). Specific impacts of perinatal common mental health disorders like depression and anxiety on the mother and baby include poor birth outcomes, substandard attachment and bonding between mother and baby, ongoing emotional and cognitive difficulties for children, and enduring mental health disorders for the woman ( 2 , 3 ). Rates for PND range between 13% in the first few weeks to 20% in the first year postpartum in industrialised countries with higher rates reported in some developing countries ( 4 ). The rate of anxiety disorders is estimated to be between 14–15%, while approximately two-thirds of women who experience perinatal depression have co-morbid anxiety ( 1 , 5 ). Perinatal mental health problems, once known to be rare in lower middle-income countries (LMICs) due to protective role of traditional care and support system, have grown substantially in recent times with their prevalence being much higher in LMICs than in high-income nations. Meta-analyses from LMIC have reported pooled prevalence estimates of 19% for perinatal depression ( 6 ), and 34 and 26% for antenatal and postnatal anxiety respectively ( 7 ). In India, an estimated 18 and 22% of women experience antenatal and postnatal depression, respectively ( 8 ), while perinatal anxiety has not been systematically studied. Identification and management of perinatal CMDs must not be side lined. It is now widely accepted, screening during pregnancy is crucial in its own right as many women might show symptoms, potentially amenable to early intervention and treatment. Perinatal period provide for an ideal framework for psychosocial screening and early intervention strategies if adequately trained staff are available to screen and provide follow-up services to those identified as being at risk ( 9 ) while a lack of such mental health screening creates a significant lost opportunity for diagnosis and management. WHO also recommends integration of mental health services into primary care, with increasing advocacy for universal, routine screening at primary antenatal care level by nonspecialist health workers ( 10 ) which has the potential to catalyse the process of further assessment and referral for treatment and follow up care. A stepped care approach, where initial screening is followed by more in-depth screening or assessment may mitigate the burden of false positives also by reducing the number of incorrectly diagnosed patients referred for further treatment. Numerous screening tools have already been developed over the last two decades, but the applicability of these tools across diverse linguistic and cultural contexts remains limited because primarily, these have been designed and developed in HICs and their application to LMIC populations and contexts is questionable as only few have been translated from English into other languages for use in resource-constrained countries. A major barrier to screening and evaluating interventions is a lack of cross-culturally validated mental health assessment instruments. The use of metaphors and culturally-specific terms are quite common by women while describing their feelings ( 11 ) and a strict translation of screening instruments would then be insufficient ( 12 ) making linguistic and semantic equivalence equally important in preparing assessment instruments in a country as culturally, linguistically and socially varied as the Indian subcontinent. Screening tools must be locally validated against a ‘gold standard’ diagnostic interview prior to use, in order to assess their validity, establish appropriate diagnostic thresholds and ensure their cultural appropriateness and acceptability ( 13 ). Furthermore, lack of local validation brings into question of reliability of prevalence estimates from different settings, as most prevalence studies rely on the use of screening tools to determine cases. Although there have been efforts towards developing simple and easily administered screening instruments for various common mental health disorders (CMD) in primary care, there is a dire need for a uniform user-friendly screening instrument to be made available to primary healthcare personnel across most regions in India especially for use during the perinatal period ( 14 ). UBPMHST (Ultra brief peripartum mental health Screening tool) ( 15 ) is one such ultra-short, novel, simple, binary scoring screening tool, developed in South Africa to include symptoms of depressed mood, anxiety symptoms and suicidal ideation that could be possibly more feasible and acceptable for use by non-specialist health workers in busy, low-resource primary care setting. However, it’s translation and subsequent validation for use in Indian population has not yet been undertaken. This study addresses this existing gap by focusing on the translation and validation of UBPMHST into Hindi language, one of the most widely spoken languages in India. Moreover, there is a dearth of research on the subject of peripartum psychiatry in India, and studies conducted using the Hindi translation of the UBPMHST may help to fill this void. Materials and Methods This study, conducted at a tertiary care centre with Institutional Ethics Committee approval, employed a cross-sectional design and involved 194 participants selected through convenient sampling. Enrolments occurred from March 2021, with participants being pregnant or postpartum women who provided written consent. Participants completed questionnaires as required, and results of screen positivity in each of the scales (UBPMHST and EPDS) were compared. They completed either Hindi or English versions of the scales on two occasions within 3–7 days and they were asked to complete either the Hindi version again (n = 10) or the English version (n = 10). Sample size was determined based on respondent to item ratio for the 9-item UBPMHST questionnaire, which was then translated and validated in Hindi for use with Indian women. EPDS, a screening tool which has been validated in India was used for evaluating concurrent validity. Methodological tools and details of the translation process About the UBPMHST UBPMHST (Ultra brief peripartum mental health Screening tool) ( 15 ) is a novel, ultra-brief screening tool developed in 2019 by T. van Heyningen et al in South Africa. This simple, binary-scoring instrument assesses symptoms of depressed mood, anxiety, and suicidal ideation, designed to be feasible and acceptable for non-specialist health workers in busy, low-resource primary care settings. Participants are expected to respond with either ‘yes’ or ‘no’ to questions concerning symptoms of common mental health problems (Part A) and associated psychosocial risk factors (Part B), from a 9item self rated/ clinician facilitated questionnaire with two subparts: Part A scores each item with one point, while Part B screens for psychosocial factors. A positive screen is indicated by affirmative responses to more than 2 questions. The tool returned a sensitivity of 78% and specificity of 82% when evaluated against diagnostic criteria (15). Table 1 UBPMHST items (English) Part A UBPMHST items During the past month, have you often been bothered by feeling down, depressed or hopeless? During the past month, have you often been bothered by having little interest or pleasure in doing things? During the past month, have you often been bothered by not being able to stop or control worrying? During the past month, has the thought of committing suicide often occurred to you? Part B (Psychosocial Risk factors) You have had problems with depression and or anxiety in the past? You have had some very difficult things happen to you in the last year? You have experienced some kind of abuse in the past (e.g. physical, emotional, sexual abuse or rape)? You have a special person who is a real source of comfort to you? Process of translation and adaptation The scale's translation followed the methodology recommended by the World Health Organization ( 16 ) and was conducted by mental health professionals proficient in both Hindi and English. Initially, the scale was translated into Hindi and then independently back-translated by two different mental health professionals unfamiliar with the scales. These back-translations were compared with the original English version to ensure consistent meaning. A panel of two mental health professionals then reviewed both the Hindi and English versions, selecting the translation that best maintained the original meaning while simplifying it. Any inadequate translations were adjusted based on feedback from the experts, with modifications made to suit Indian culture. Efforts were made to keep the language simple while retaining the scale's intended meaning, addressing semantic and cultural factors. Discrepancies and ambiguities were resolved through consensus meetings involving translators, language experts, and mental health professionals, resulting in a draft Hindi version of the scale. Pilot Testing The draft Hindi version was distributed to 20 peripartum women from various socio-demographic backgrounds, proficient in Hindi, for evaluation. They assessed the language, cultural appropriateness, comprehension, and feasibility of the scale, providing suggestions for improvement ( 17 ). These inputs guided final adjustments to the draft Hindi translated tool before its psychometric validation. Psychometric Validation and reliability The translated Hindi peripartum mental health screening tool was assessed for reliability, validity, and clinical usefulness using a sample of 194 women from a tertiary healthcare centre. They completed both the translated tool and the established Edinburgh Postnatal Depression Scale for assessment of concurrent validity ( 18 ). Data analysis During the validation phase, data were analyzed using SPSS-20. Simple descriptive statistics involved calculation of mean and Standard Deviation for continuous variables and percentages for categorical variables. Test-retest reliability of the Hindi version and cross-language agreement were assessed using the intraclass correlation coefficient (ICC). Validity was tested through exploratory factor analysis to examine factor structure and construct validity. Internal consistency was assessed using Cronbach’s alpha and item-total correlation. Concurrent validity was evaluated through correlation analyses with the EPDS ( 19 ). Sensitivity and specificity analyses were conducted to determine the accuracy of the translated tool in identifying individuals at risk of peripartum mental health disorders ( 20 ). Results The study included 194 antenatal and postnatal women, averaging 26.5 years (SD: 4.2) and 26.8 years (SD: 4.1) respectively. The majority, 89.4% of antenatal and 94.4% of postnatal patients, were homemakers from joint families (83% and 76.9% respectively) of urban areas (84.6% and 94.4% respectively). Regarding religion, most were Hindus (65.38% and 68%), followed by Muslims (29.8% and 27%), with smaller proportions identifying as Sikhs (2.8% and 2.2%) and Christians (0.9% and 1.1%) among antenatal and postnatal women respectively. Psychometric Properties Concurrence Between Hindi and English Versions Table 2 displays intra-class correlation coefficients ≥ 0.7 for various items of UBPMHST, indicating strong cross-language equivalence between the Hindi and English versions of the questionnaire. Top of Form Test–Retest Reliability Test-retest reliability for the total score of the Hindi version showed an ICC value of 0.952 (P < 0.001), indicating high consistency over time. Comparable ICC values were observed for individual items of the scales (see Table 3 ). Table 2 Cross language concordance matrices for UBPMHST Questions Intraclass Correlation Coefficient-cross language Cronbach's alpha 95% CI 1 0.86 0.93 (0.687, 0.944) 2 0.86 0.93 (0.687, 0.944) 3 0.835 0.91 (0.629, 0.931) 4 `--- `--- `--- 5 0.78 0.88 (0.527,0.907) 6 1.00 1.00 ( 1 , 1 ) 7 0.791 0.655 (0.309, 0.847) 8 1.00 1.00 ( 1 , 1 ) 9 -0.05 -0.11 (-0.475, 0.389) Total Score 0.908 0.952 (0.782, 0.962) Table 3 Test-retest reliability matrices for UBPMHST tool Question Correlation Coefficient-test and retest Cronbach's alpha 95% CI 1 1.00 1.00 ( 1 , 1 ) 2 0.891 0.943 (0.747, 0.956) 3 0.783 0.878 (0.530, 0.908) 4 `--- `--- `--- 5 1.00 1.00 ( 1 , 1 ) 6 1.00 1.00 ( 1 , 1 ) 7 0 (-0.433, 0.433) 8 0.655 0.791 (0.309, 0.847) 9 `--- `--- `--- Total Score 0.908 0.952 (0.782, 0.962) Content validation by experts and target audience Content validation assessed relevance, clarity, and simplicity, with an average Content Validation Index (CVI) of 0.911. Face validation by 20 target audience members indicated that UBPMHST items were easily understood and clear, with no significant revisions needed. Construct validity: Convergent validity Exploratory Factor analysis Table 4 illustrates that all composite reliability values exceeded 0.7, and mean variance values were higher than 0.5 (except for component factor three), meeting the criteria for correlation of structures (21). Even though the AVE for component factor three was less than 0.5, with a composite reliability higher than 0.6, the convergent validity of the construct remains adequate ( 22 ). Table 4 Convergent validity Question ƛ Factor CR (Composite Reliability) AVE (Average variance Extracted) क्या पिचले एक महिने में आप ज़्यादातर कुछ भी अच्छा ना लगने, उदासीनता या निराशा को लेकर परेशान रहे हैं 0.83 1 0.8 0.6 क्या पिचले एक महिने में आप किसी भी काम को करने कम दिलचस्पी या कम खुशी होने के कारण ज़्यादातर परेशान रहे हैं 0.78 1 क्या पिचले एक महिने में आप अत्याधिक चिंता को रोकने के अथवा नियंत्रित ना रख पाने को लेकर ज़्यादातर परेशान रहे हैं 0.69 1 क्या पिछले साल आपको बहुत बड़ी समस्याओं का सामना करना पड़ा है 0.46 2 0.8 0.55 क्या आपके पति पुरुष मित्र या घर में कोई भी आपके साथ किसी प्रकार की हिंसा या मार पिटाई करते हैं 0.84 2 क्या आपके साथ किसी प्रकार का शोषण हुआ है 0.81 2 क्या पिचले एक महिने में आपको आत्महत्या करने के विचार अकसर आए हैं 0.62 3 0.7 0.4 क्या आपको पहले कभी भी उदासी या घबराहट संबंधित परेशानी थी 0.55 3 आपके जिवन में कोई विषेश व्यक्ति है जिसके साथ आप सुरषित या खुश महसुस करें 0.72 3 Criterion validity: Concurrent validity The Pearson’s correlation coefficient between scores of the index tool UBPMHST and the standard screening tool EPDS was 0.67 and 0.71 in the ANC and PNC groups respectively, with a p-value < 0.05, indicating a significant positive correlation between the two tools. Table 5 Key matrices for Concurrent validity UBPMHST VS EPDS total score Pearson’s Correlation coefficient P value ANC 0.67 0.000000000* PNC 0.71 0.000000000* Reliability: Internal Consistency Cronbach’s coefficient α was utilized to assess the internal consistency of the 9 items in the questionnaire, yielding a coefficient of 0.80 (P < 0.001), indicating good internal consistency. Item-total correlations, after correction, were all positive and equal to or greater than 0.3, except for the question "आपके जिवन में कोई जवषेश व्यक्ति है जिसके साथ आप सुरजषत या खुश महसुस करें" in the PNC subgroup (P value 0.7, not significant), supporting the internal reliability of the questionnaire (see Table 6 ). Table 6 Key matrices for Internal consistency Question Item total Correlation (ANC) P-value Item total Correlation (PNC) P-value 1 0.74 0.000* 0.65 0.000* 2 0.68 0.000* 0.61 0.000* 3 0.72 0.000* 0.66 0.000* 4 0.40 0.00002 0.3 0.00502 5 0.52 0.000* 0.42 0.00003 6 0.56 0.000* 0.56 0.000* 7 0.5 0.000* 0.40 0.00009 8 0.3 0.00279 0.41 0.00006 9 0.3 0.00372 0.04 0.70982 Discussion The study highlights the successful translation and validation of an ultra-brief peripartum mental health screening tool into Hindi. It demonstrates the tool's reliability, validity, and clinical relevance among Hindi-speaking women. The translated tool showed robust internal consistency, factor structure, and concurrent validity through rigorous psychometric evaluation, making it valuable for identifying peripartum mental health concerns. Despite one question having a Cronbach’s alpha value slightly below 0.3, all other items were within an acceptable range. Test-retest reliability was also strong, with ICC values exceeding 0.7. Cultural and linguistic adaptations during translation were crucial for the tool's appropriateness and acceptability among Hindi-speaking women, aligning with previous literature emphasizing the importance of linguistic equivalence and cultural relevance in mental health assessment ( 23 , 24 ). Our study emphasizes the importance of customizing screening tools to local contexts to improve their accuracy and usefulness. Clinically, the translated tool has significant implications for delivering peripartum mental health care in Hindi-speaking areas. Comparisons with existing literature on peripartum mental health screening tools underscore both congruent findings and unique cultural considerations. While our study aligns with previous research demonstrating the validity and reliability of screening tools across diverse populations ( 25 , 26 ), cultural variations in symptom expression and help-seeking behaviours warrant continued exploration ( 27 , 28 ). Its integration into routine screening protocols within primary care, obstetric, and community health settings can facilitate early detection and intervention for maternal mental health concerns, ultimately improving outcomes for women and their families. Moving forward, future research should prioritize longitudinal studies to evaluate the translated tool's predictive validity. Cross-cultural comparisons can elucidate cultural variations in peripartum mental health experiences, while qualitative investigations can capture women's narratives within the Hindi-speaking context. Efforts to refine and validate the tool further, including assessing its sensitivity to cultural nuances and expanding its applicability to diverse subpopulations, are also warranted. Continued collaboration between researchers, healthcare providers, and community stakeholders is essential to address the complex challenges surrounding peripartum mental health and promote maternal well-being across diverse populations. Limitations Despite the rigorous methodology employed and the various strengths of this study, several limitations should be acknowledged. These include potential sampling biases, reliance on self-report measures, and the absence of longitudinal follow-up to assess predictive validity. Additionally, while efforts were made to ensure linguistic and cultural equivalence, nuances specific to regional dialects and socio-cultural contexts may not have been fully captured in the translation process. Addressing these limitations through larger sample sizes, longitudinal follow-up, and incorporating complementary methodological approaches in future research will enhance the validity and generalizability of the findings, thus advancing our understanding of peripartum mental health among Hindi-speaking women, underscoring the importance of culturally sensitive approaches in addressing maternal mental health needs. Conclusion There is an urgent need for the translation and adaptation of tools essential for clinical practice, particularly for early identification of issues through appropriate screening tools. Our study marks the first attempt to translate and validate the UBPMHST from its original English version to Hindi. Through collaborative efforts, we successfully developed a translated version of the tool usable by researchers. The Hindi version of the UBPMHST emerges as a reliable and valid screening tool for diagnosing common perinatal mental health disorders, representing a significant advancement in addressing maternal mental health needs among Hindi-speaking populations in India. By embracing a culturally sensitive approach and interdisciplinary collaboration, we can further advance our understanding of peripartum mental health and provide better support to women during this critical life stage. Ultimately, this translated tool could serve as a valuable resource for primary care physicians, aiding in the early diagnosis and treatment of common mental health disorders in peripartum females. Top of Form Declarations Ethical approval This study adhered to ethical guidelines for research involving human participants, including informed consent, confidentiality, and voluntary participation (29). Ethical approval was obtained from the institutional review board (IRB) ie Institutional ethical committee of LHMC before data collection commenced (trial number: LHMC/IEC/2020/PG Thesis/136). Consent for participation and publication The authors confirm that they have obtained all necessary patient consent forms, where patients have provided consent for their images and other clinical information to be reported in the journal. Patients were assured that their names and initials would not be published, and efforts would be made to conceal their identity. However, complete anonymity cannot be guaranteed. Human ethics and consent to participate declaration Not applicable Availability of data and materials The datasets generated or analysed during the current study are available from the corresponding author on reasonable request Competing interests The authors declare no potential conflicts of interest regarding the research, authorship, and publication of this article. Opinions, discussions, views, and recommendations expressed in this article solely reflect those of the authors and do not necessarily represent the organizations they are affiliated with. Funding The authors received no financial support for the research, authorship, and/or publication of this article. Author’s contribution IH interpreted and analysed the patient responses and data for translation and validation procedures along with the conceptualisation of the original draft. PK reviewed and edited the original draft. All authors read and approved the final manuscript. DK, MP, MG, SP reviewed the drafts and supervised the work. Acknowledgements Not applicable References Howard LM, Megnin-Viggars O, Symington I, Pilling S, On behalf of the Guideline Development Group. Antenatal and postnatal mental health: summary of updated NICE guidance. BMJ. 2014 Dec 18;349(dec18 5):g7394–g7394. Stein A, Pearson RM, Goodman SH, Rapa E, Rahman A, McCallum M, et al. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4306591","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":300336840,"identity":"2d7e8d86-4b81-41f9-84ee-759e23b9ff83","order_by":0,"name":"Dr. Ishita Harit","email":"","orcid":"","institution":"Lady Hardinge Medical College","correspondingAuthor":false,"prefix":"Dr.","firstName":"Ishita","middleName":"","lastName":"Harit","suffix":""},{"id":300336841,"identity":"64a4a9f8-d2ab-4911-93b8-e500efa59ec6","order_by":1,"name":"Dr. Prerna Kukreti","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA2klEQVRIiWNgGAWjYDCCA0BcwSDBwMDeAGQZWBCp5QxICw+IZSBBtBYgkEgAk4R18B1vfvbh4B4LOXPJ51c3/CiQYOBv707Aq0XyzDHjGQeeSRhbzs4pu9kDdJjEmbMb8GoxuJFgzPzhgETihts5aTd4gFoMJHIJaLn//DPDgQMS9Rtunkm7+YcoLTd4jEFaEgxusB+7TZQtkmdyikFaDDecyWG7LWMgwUPQL3zHj28GaqmTNzh+/NnNN39s5Pjbe/FrQQI8BmCSWOUgwP6AFNWjYBSMglEwggAAldJN61+Vxx0AAAAASUVORK5CYII=","orcid":"","institution":"Lady Hardinge Medical College","correspondingAuthor":true,"prefix":"Dr.","firstName":"Prerna","middleName":"","lastName":"Kukreti","suffix":""},{"id":300336842,"identity":"38bef6c1-170a-4f7a-b63b-6f5f7e3450af","order_by":2,"name":"Dr. Dinesh Kataria","email":"","orcid":"","institution":"Lady Hardinge Medical College","correspondingAuthor":false,"prefix":"Dr.","firstName":"Dinesh","middleName":"","lastName":"Kataria","suffix":""},{"id":300336843,"identity":"2b261ab8-497c-48db-908d-836caf7bb07b","order_by":3,"name":"Dr. Manju Puri","email":"","orcid":"","institution":"Lady Hardinge Medical College","correspondingAuthor":false,"prefix":"Dr.","firstName":"Manju","middleName":"","lastName":"Puri","suffix":""},{"id":300336844,"identity":"4fc795c8-f22a-4fb6-9ff8-602f98cc440e","order_by":4,"name":"Dr. Manish Kumar Goel","email":"","orcid":"","institution":"Lady Hardinge Medical College","correspondingAuthor":false,"prefix":"Dr.","firstName":"Manish","middleName":"Kumar","lastName":"Goel","suffix":""},{"id":300336846,"identity":"bec54ffd-967c-4780-a70b-1653ce69ed19","order_by":5,"name":"Dr. Shiv Prasad","email":"","orcid":"","institution":"Lady Hardinge Medical College","correspondingAuthor":false,"prefix":"Dr.","firstName":"Shiv","middleName":"","lastName":"Prasad","suffix":""}],"badges":[],"createdAt":"2024-04-22 14:37:34","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4306591/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4306591/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":56174492,"identity":"df9ccf69-c72c-40a3-9d91-06d52416b1c5","added_by":"auto","created_at":"2024-05-09 12:44:06","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":735219,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4306591/v1/10d8ec71-31fb-48b7-995c-10c2f4bbf1a4.pdf"},{"id":56174372,"identity":"0046cfa3-1245-42b2-88e2-53357f66a4b6","added_by":"auto","created_at":"2024-05-09 12:42:32","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":14309,"visible":true,"origin":"","legend":"","description":"","filename":"Supplementarymaterial.docx","url":"https://assets-eu.researchsquare.com/files/rs-4306591/v1/dbfc78c5e382d492ab1b74c9.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Hindi translation and validation of Ultra Brief peripartum Mental Health Screening Tool (UBPMHST)","fulltext":[{"header":"Key messages","content":"\u003cp\u003eThe Hindi translated version of UBPMHST has adequate reliability, validity and clinical utility for screening for common mental health disorders among Hindi speaking peripartum females.\u0026nbsp;\u003c/p\u003e"},{"header":"Background","content":"\u003cp\u003eThe peripartum period, encompassing pregnancy and the postpartum phase, represents a critical juncture in a woman's life, characterized by profound physiological, psychological, and social changes. For majority of women, pregnancy and motherhood is a positive psychological life event, however, for a few, this life-changing process might result in a mental health problem. It is estimated that about 15\u0026ndash;25% of women will experience a mental health problem either during pregnancy or in the first-year post pregnancy which might present either as a new problem altogether or as a reoccurrence of a pre-existing mental health problem which can contribute to adverse outcomes for women, their infants, partners as well as other family members (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Specific impacts of perinatal common mental health disorders like depression and anxiety on the mother and baby include poor birth outcomes, substandard attachment and bonding between mother and baby, ongoing emotional and cognitive difficulties for children, and enduring mental health disorders for the woman (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eRates for PND range between 13% in the first few weeks to 20% in the first year postpartum in industrialised countries with higher rates reported in some developing countries (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). The rate of anxiety disorders is estimated to be between 14\u0026ndash;15%, while approximately two-thirds of women who experience perinatal depression have co-morbid anxiety (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). Perinatal mental health problems, once known to be rare in lower middle-income countries (LMICs) due to protective role of traditional care and support system, have grown substantially in recent times with their prevalence being much higher in LMICs than in high-income nations. Meta-analyses from LMIC have reported pooled prevalence estimates of 19% for perinatal depression (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e), and 34 and 26% for antenatal and postnatal anxiety respectively (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). In India, an estimated 18 and 22% of women experience antenatal and postnatal depression, respectively (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e), while perinatal anxiety has not been systematically studied.\u003c/p\u003e \u003cp\u003eIdentification and management of perinatal CMDs must not be side lined. It is now widely accepted, screening during pregnancy is crucial in its own right as many women might show symptoms, potentially amenable to early intervention and treatment. Perinatal period provide for an ideal framework for psychosocial screening and early intervention strategies if adequately trained staff are available to screen and provide follow-up services to those identified as being at risk (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e) while a lack of such mental health screening creates a significant lost opportunity for diagnosis and management. WHO also recommends integration of mental health services into primary care, with increasing advocacy for universal, routine screening at primary antenatal care level by nonspecialist health workers (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e) which has the potential to catalyse the process of further assessment and referral for treatment and follow up care. A stepped care approach, where initial screening is followed by more in-depth screening or assessment may mitigate the burden of false positives also by reducing the number of incorrectly diagnosed patients referred for further treatment.\u003c/p\u003e \u003cp\u003eNumerous screening tools have already been developed over the last two decades, but the applicability of these tools across diverse linguistic and cultural contexts remains limited because primarily, these have been designed and developed in HICs and their application to LMIC populations and contexts is questionable as only few have been translated from English into other languages for use in resource-constrained countries. A major barrier to screening and evaluating interventions is a lack of cross-culturally validated mental health assessment instruments. The use of metaphors and culturally-specific terms are quite common by women while describing their feelings (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e) and a strict translation of screening instruments would then be insufficient (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e) making linguistic and semantic equivalence equally important in preparing assessment instruments in a country as culturally, linguistically and socially varied as the Indian subcontinent. Screening tools must be locally validated against a \u0026lsquo;gold standard\u0026rsquo; diagnostic interview prior to use, in order to assess their validity, establish appropriate diagnostic thresholds and ensure their cultural appropriateness and acceptability (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). Furthermore, lack of local validation brings into question of reliability of prevalence estimates from different settings, as most prevalence studies rely on the use of screening tools to determine cases.\u003c/p\u003e \u003cp\u003eAlthough there have been efforts towards developing simple and easily administered screening instruments for various common mental health disorders (CMD) in primary care, there is a dire need for a uniform user-friendly screening instrument to be made available to primary healthcare personnel across most regions in India especially for use during the perinatal period (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). UBPMHST (Ultra brief peripartum mental health Screening tool) (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e) is one such ultra-short, novel, simple, binary scoring screening tool, developed in South Africa to include symptoms of depressed mood, anxiety symptoms and suicidal ideation that could be possibly more feasible and acceptable for use by non-specialist health workers in busy, low-resource primary care setting. However, it\u0026rsquo;s translation and subsequent validation for use in Indian population has not yet been undertaken. This study addresses this existing gap by focusing on the translation and validation of UBPMHST into Hindi language, one of the most widely spoken languages in India. Moreover, there is a dearth of research on the subject of peripartum psychiatry in India, and studies conducted using the Hindi translation of the UBPMHST may help to fill this void.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003e This study, conducted at a tertiary care centre with Institutional Ethics Committee approval, employed a cross-sectional design and involved 194 participants selected through convenient sampling. Enrolments occurred from March 2021, with participants being pregnant or postpartum women who provided written consent. Participants completed questionnaires as required, and results of screen positivity in each of the scales (UBPMHST and EPDS) were compared. They completed either Hindi or English versions of the scales on two occasions within 3\u0026ndash;7 days and they were asked to complete either the Hindi version again (n\u0026thinsp;=\u0026thinsp;10) or the English version (n\u0026thinsp;=\u0026thinsp;10). Sample size was determined based on respondent to item ratio for the 9-item UBPMHST questionnaire, which was then translated and validated in Hindi for use with Indian women. EPDS, a screening tool which has been validated in India was used for evaluating concurrent validity.\u003c/p\u003e\n\u003ch3\u003eMethodological tools and details of the translation process\u003c/h3\u003e\n\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eAbout the UBPMHST\u003c/h2\u003e \u003cp\u003eUBPMHST (Ultra brief peripartum mental health Screening tool) (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e) is a novel, ultra-brief screening tool developed in 2019 by T. van Heyningen et al in South Africa. This simple, binary-scoring instrument assesses symptoms of depressed mood, anxiety, and suicidal ideation, designed to be feasible and acceptable for non-specialist health workers in busy, low-resource primary care settings. Participants are expected to respond with either \u0026lsquo;yes\u0026rsquo; or \u0026lsquo;no\u0026rsquo; to questions concerning symptoms of common mental health problems (Part A) and associated psychosocial risk factors (Part B), from a 9item self rated/ clinician facilitated questionnaire with two subparts: Part A scores each item with one point, while Part B screens for psychosocial factors. A positive screen is indicated by affirmative responses to more than 2 questions. The tool returned a sensitivity of 78% and specificity of 82% when evaluated against diagnostic criteria (15).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eUBPMHST items (English)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePart A\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUBPMHST items\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDuring the past month, have you often been bothered by feeling down, depressed or hopeless?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDuring the past month, have you often been bothered by having little interest or pleasure in doing things?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDuring the past month, have you often been bothered by not being able to stop or control worrying?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDuring the past month, has the thought of committing suicide often occurred to you?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePart B (Psychosocial Risk factors)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYou have had problems with depression and or anxiety in the past?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYou have had some very difficult things happen to you in the last year?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYou have experienced some kind of abuse in the past (e.g. physical, emotional, sexual abuse or rape)?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYou have a special person who is a real source of comfort to you?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eProcess of translation and adaptation\u003c/h2\u003e \u003cp\u003eThe scale's translation followed the methodology recommended by the World Health Organization (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e) and was conducted by mental health professionals proficient in both Hindi and English. Initially, the scale was translated into Hindi and then independently back-translated by two different mental health professionals unfamiliar with the scales. These back-translations were compared with the original English version to ensure consistent meaning. A panel of two mental health professionals then reviewed both the Hindi and English versions, selecting the translation that best maintained the original meaning while simplifying it. Any inadequate translations were adjusted based on feedback from the experts, with modifications made to suit Indian culture. Efforts were made to keep the language simple while retaining the scale's intended meaning, addressing semantic and cultural factors. Discrepancies and ambiguities were resolved through consensus meetings involving translators, language experts, and mental health professionals, resulting in a draft Hindi version of the scale.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003ePilot Testing\u003c/h2\u003e \u003cp\u003eThe draft Hindi version was distributed to 20 peripartum women from various socio-demographic backgrounds, proficient in Hindi, for evaluation. They assessed the language, cultural appropriateness, comprehension, and feasibility of the scale, providing suggestions for improvement (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). These inputs guided final adjustments to the draft Hindi translated tool before its psychometric validation.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003ePsychometric Validation and reliability\u003c/h2\u003e \u003cp\u003eThe translated Hindi peripartum mental health screening tool was assessed for reliability, validity, and clinical usefulness using a sample of 194 women from a tertiary healthcare centre. They completed both the translated tool and the established Edinburgh Postnatal Depression Scale for assessment of concurrent validity (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eData analysis\u003c/h2\u003e \u003cp\u003eDuring the validation phase, data were analyzed using SPSS-20. Simple descriptive statistics involved calculation of mean and Standard Deviation for continuous variables and percentages for categorical variables. Test-retest reliability of the Hindi version and cross-language agreement were assessed using the intraclass correlation coefficient (ICC). Validity was tested through exploratory factor analysis to examine factor structure and construct validity. Internal consistency was assessed using Cronbach\u0026rsquo;s alpha and item-total correlation. Concurrent validity was evaluated through correlation analyses with the EPDS (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). Sensitivity and specificity analyses were conducted to determine the accuracy of the translated tool in identifying individuals at risk of peripartum mental health disorders (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eThe study included 194 antenatal and postnatal women, averaging 26.5 years (SD: 4.2) and 26.8 years (SD: 4.1) respectively. The majority, 89.4% of antenatal and 94.4% of postnatal patients, were homemakers from joint families (83% and 76.9% respectively) of urban areas (84.6% and 94.4% respectively). Regarding religion, most were Hindus (65.38% and 68%), followed by Muslims (29.8% and 27%), with smaller proportions identifying as Sikhs (2.8% and 2.2%) and Christians (0.9% and 1.1%) among antenatal and postnatal women respectively.\u003c/p\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003ePsychometric Properties\u003c/h2\u003e \u003cdiv id=\"Sec11\" class=\"Section3\"\u003e \u003ch2\u003eConcurrence Between Hindi and English Versions\u003c/h2\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e displays intra-class correlation coefficients\u0026thinsp;\u0026ge;\u0026thinsp;0.7 for various items of UBPMHST, indicating strong cross-language equivalence between the Hindi and English versions of the questionnaire.\u003c/p\u003e \u003cp\u003eTop of Form\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eTest\u0026ndash;Retest Reliability\u003c/h2\u003e \u003cp\u003eTest-retest reliability for the total score of the Hindi version showed an ICC value of 0.952 (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001), indicating high consistency over time. Comparable ICC values were observed for individual items of the scales (see Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCross language concordance matrices for UBPMHST\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQuestions\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIntraclass Correlation Coefficient-cross language\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCronbach's alpha\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e1\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(0.687, 0.944)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e2\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(0.687, 0.944)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e3\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.835\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(0.629, 0.931)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e4\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e`---\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e`---\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e`---\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e5\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(0.527,0.907)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e6\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e7\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.791\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.655\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(0.309, 0.847)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e8\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e9\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(-0.475, 0.389)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTotal Score\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.908\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.952\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(0.782, 0.962)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eTest-retest reliability matrices for UBPMHST tool\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQuestion\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCorrelation Coefficient-test and retest\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCronbach's alpha\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e1\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e2\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.891\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.943\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(0.747, 0.956)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e3\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.783\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.878\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(0.530, 0.908)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e4\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e`---\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e`---\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e`---\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e5\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e6\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e7\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(-0.433, 0.433)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e8\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.655\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.791\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(0.309, 0.847)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e9\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e`---\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e`---\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e`---\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTotal Score\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.908\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.952\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(0.782, 0.962)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eContent validation by experts and target audience\u003c/h2\u003e \u003cp\u003eContent validation assessed relevance, clarity, and simplicity, with an average Content Validation Index (CVI) of 0.911. Face validation by 20 target audience members indicated that UBPMHST items were easily understood and clear, with no significant revisions needed.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eConstruct validity: Convergent validity\u003c/h2\u003e \u003cp\u003eExploratory Factor analysis\u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e illustrates that all composite reliability values exceeded 0.7, and mean variance values were higher than 0.5 (except for component factor three), meeting the criteria for correlation of structures (21). Even though the AVE for component factor three was less than 0.5, with a composite reliability higher than 0.6, the convergent validity of the construct remains adequate (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eConvergent validity\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQuestion\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eƛ\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFactor\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCR (Composite Reliability)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAVE (Average variance Extracted)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eक्या पिचले एक महिने में आप ज़्यादातर कुछ भी अच्छा ना लगने, उदासीनता या निराशा को लेकर परेशान रहे हैं\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eक्या पिचले एक महिने में आप किसी भी काम को करने कम दिलचस्पी या कम खुशी होने के कारण ज़्यादातर परेशान रहे हैं\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eक्या पिचले एक महिने में आप अत्याधिक चिंता को रोकने के अथवा नियंत्रित ना रख पाने को लेकर ज़्यादातर परेशान रहे हैं\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eक्या पिछले साल आपको बहुत बड़ी समस्याओं का सामना करना पड़ा है\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.55\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eक्या आपके पति पुरुष मित्र या घर में कोई भी आपके साथ किसी प्रकार की हिंसा या मार पिटाई करते हैं\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eक्या आपके साथ किसी प्रकार का शोषण हुआ है\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eक्या पिचले एक महिने में आपको आत्महत्या करने के विचार अकसर आए हैं\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eक्या आपको पहले कभी भी उदासी या घबराहट संबंधित परेशानी थी\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eआपके जिवन में कोई विषेश व्यक्ति है जिसके साथ आप सुरषित या खुश महसुस करें\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eCriterion validity: Concurrent validity\u003c/h2\u003e \u003cp\u003eThe Pearson\u0026rsquo;s correlation coefficient between scores of the index tool UBPMHST and the standard screening tool EPDS was 0.67 and 0.71 in the ANC and PNC groups respectively, with a p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05, indicating a significant positive correlation between the two tools.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eKey matrices for Concurrent validity\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUBPMHST VS EPDS total score\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePearson\u0026rsquo;s Correlation coefficient\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eANC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.000000000*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePNC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.000000000*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eReliability: Internal Consistency\u003c/h2\u003e \u003cp\u003eCronbach\u0026rsquo;s coefficient α was utilized to assess the internal consistency of the 9 items in the questionnaire, yielding a coefficient of 0.80 (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001), indicating good internal consistency. Item-total correlations, after correction, were all positive and equal to or greater than 0.3, except for the question \"आपके जिवन में कोई जवषेश व्यक्ति है जिसके साथ आप सुरजषत या खुश महसुस करें\" in the PNC subgroup (P value 0.7, not significant), supporting the internal reliability of the questionnaire (see Table \u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eKey matrices for Internal consistency\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQuestion\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eItem total Correlation\u003c/p\u003e \u003cp\u003e(ANC)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eItem total Correlation\u003c/p\u003e \u003cp\u003e(PNC)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e1\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.000*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.000*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e2\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.000*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.000*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e3\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.000*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.000*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e4\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.00002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.00502\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e5\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.000*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.00003\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e6\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.000*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.000*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e7\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.000*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.00009\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e8\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.00279\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.00006\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e9\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.00372\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.70982\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe study highlights the successful translation and validation of an ultra-brief peripartum mental health screening tool into Hindi. It demonstrates the tool's reliability, validity, and clinical relevance among Hindi-speaking women. The translated tool showed robust internal consistency, factor structure, and concurrent validity through rigorous psychometric evaluation, making it valuable for identifying peripartum mental health concerns. Despite one question having a Cronbach\u0026rsquo;s alpha value slightly below 0.3, all other items were within an acceptable range. Test-retest reliability was also strong, with ICC values exceeding 0.7. Cultural and linguistic adaptations during translation were crucial for the tool's appropriateness and acceptability among Hindi-speaking women, aligning with previous literature emphasizing the importance of linguistic equivalence and cultural relevance in mental health assessment (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). Our study emphasizes the importance of customizing screening tools to local contexts to improve their accuracy and usefulness. Clinically, the translated tool has significant implications for delivering peripartum mental health care in Hindi-speaking areas.\u003c/p\u003e \u003cp\u003eComparisons with existing literature on peripartum mental health screening tools underscore both congruent findings and unique cultural considerations. While our study aligns with previous research demonstrating the validity and reliability of screening tools across diverse populations (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e), cultural variations in symptom expression and help-seeking behaviours warrant continued exploration (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). Its integration into routine screening protocols within primary care, obstetric, and community health settings can facilitate early detection and intervention for maternal mental health concerns, ultimately improving outcomes for women and their families.\u003c/p\u003e \u003cp\u003eMoving forward, future research should prioritize longitudinal studies to evaluate the translated tool's predictive validity. Cross-cultural comparisons can elucidate cultural variations in peripartum mental health experiences, while qualitative investigations can capture women's narratives within the Hindi-speaking context. Efforts to refine and validate the tool further, including assessing its sensitivity to cultural nuances and expanding its applicability to diverse subpopulations, are also warranted. Continued collaboration between researchers, healthcare providers, and community stakeholders is essential to address the complex challenges surrounding peripartum mental health and promote maternal well-being across diverse populations.\u003c/p\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eLimitations\u003c/h2\u003e \u003cp\u003eDespite the rigorous methodology employed and the various strengths of this study, several limitations should be acknowledged. These include potential sampling biases, reliance on self-report measures, and the absence of longitudinal follow-up to assess predictive validity. Additionally, while efforts were made to ensure linguistic and cultural equivalence, nuances specific to regional dialects and socio-cultural contexts may not have been fully captured in the translation process. Addressing these limitations through larger sample sizes, longitudinal follow-up, and incorporating complementary methodological approaches in future research will enhance the validity and generalizability of the findings, thus advancing our understanding of peripartum mental health among Hindi-speaking women, underscoring the importance of culturally sensitive approaches in addressing maternal mental health needs.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThere is an urgent need for the translation and adaptation of tools essential for clinical practice, particularly for early identification of issues through appropriate screening tools. Our study marks the first attempt to translate and validate the UBPMHST from its original English version to Hindi. Through collaborative efforts, we successfully developed a translated version of the tool usable by researchers. The Hindi version of the UBPMHST emerges as a reliable and valid screening tool for diagnosing common perinatal mental health disorders, representing a significant advancement in addressing maternal mental health needs among Hindi-speaking populations in India. By embracing a culturally sensitive approach and interdisciplinary collaboration, we can further advance our understanding of peripartum mental health and provide better support to women during this critical life stage. Ultimately, this translated tool could serve as a valuable resource for primary care physicians, aiding in the early diagnosis and treatment of common mental health disorders in peripartum females.\u003c/p\u003e \u003cp\u003eTop of Form\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical approval\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study adhered to ethical guidelines for research involving human participants, including informed consent, confidentiality, and voluntary participation\u0026nbsp;(29). Ethical approval was obtained from the institutional review board (IRB) ie Institutional ethical committee of LHMC before data collection commenced (trial number: LHMC/IEC/2020/PG Thesis/136).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for participation and publication\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors confirm that they have obtained all necessary patient consent forms, where patients have provided consent for their images and other clinical information to be reported in the journal. Patients were assured that their names and initials would not be published, and efforts would be made to conceal their identity. However, complete anonymity cannot be guaranteed.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHuman ethics and consent to participate declaration\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u0026nbsp;\u003c/strong\u003eThe datasets generated or analysed during the current study are available from the corresponding author on reasonable request\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no potential conflicts of interest regarding the research, authorship, and publication of this article. Opinions, discussions, views, and recommendations expressed in this article solely reflect those of the authors and do not necessarily represent the organizations they are affiliated with.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors received no financial support for the research, authorship, and/or publication of this article.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor\u0026rsquo;s contribution\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIH interpreted and analysed the patient responses and data for translation and validation procedures along with the conceptualisation of the original draft. PK reviewed and edited the original draft. All authors read and approved the final manuscript. DK, MP, MG, SP reviewed the drafts and supervised the work.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u0026nbsp;\u003c/strong\u003eNot applicable\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eHoward LM, Megnin-Viggars O, Symington I, Pilling S, On behalf of the Guideline Development Group. Antenatal and postnatal mental health: summary of updated NICE guidance. BMJ. 2014 Dec 18;349(dec18 5):g7394\u0026ndash;g7394. \u003c/li\u003e\n\u003cli\u003eStein A, Pearson RM, Goodman SH, Rapa E, Rahman A, McCallum M, et al. Effects of perinatal mental disorders on the fetus and child. The Lancet. 2014 Nov;384(9956):1800\u0026ndash;19. \u003c/li\u003e\n\u003cli\u003eHay DF, Pawlby S, Waters CS, Sharp D. Antepartum and postpartum exposure to maternal depression: different effects on different adolescent outcomes. J Child Psychol Psychiatry. 2008 Oct;49(10):1079\u0026ndash;88. \u003c/li\u003e\n\u003cli\u003eO\u0026rsquo;hara MW, Swain AM. Rates and risk of postpartum depression\u0026mdash;a meta-analysis. Int Rev Psychiatry. 1996 Jan;8(1):37\u0026ndash;54. \u003c/li\u003e\n\u003cli\u003eWisner KL, Sit DKY, McShea MC, Rizzo DM, Zoretich RA, Hughes CL, et al. Onset Timing, Thoughts of Self-harm, and Diagnoses in Postpartum Women With Screen_Positive Depression Findings. JAMA Psychiatry. 2013 May 1;70(5). \u003c/li\u003e\n\u003cli\u003eWoody CA, Ferrari AJ, Siskind DJ, Whiteford HA, Harris MG. A systematic review and meta-regression of the prevalence and incidence of perinatal depression. J Affect Disord. 2017 Sep;219:86\u0026ndash;92. \u003c/li\u003e\n\u003cli\u003eDennis CL, Falah-Hassani K, Shiri R. Prevalence of antenatal and postnatal anxiety: Systematic review and meta-analysis. Br J Psychiatry. 2017 May;210(5):315\u0026ndash;23. \u003c/li\u003e\n\u003cli\u003eMahendran R, Puthussery S, Amalan M. Prevalence of antenatal depression in South Asia: a systematic review and meta-analysis. J Epidemiol Community Health. 2019 Aug;73(8):768\u0026ndash;77. \u003c/li\u003e\n\u003cli\u003eKagee A, Tsai AC, Lund C, Tomlinson M. Screening for common mental disorders in low resource settings: reasons for caution and a way forward. Int Health. 2013 Mar 1;5(1):11\u0026ndash;4. \u003c/li\u003e\n\u003cli\u003eWorld Mental Health day 2022 [Internet]. World Health Organization. World Health Organization; [cited 2022Aug25]. Available from: https://www.who.int/campaigns /world-mental-health-day/2022. \u003c/li\u003e\n\u003cli\u003eChew-Graham C, Chamberlain E, Turner K, Folkes L, Caulfield L, Sharp D. GPs\u0026rsquo; and health visitors\u0026rsquo; views on the diagnosis and management of postnatal depression: a qualitative study. Br J Gen Pract. 2008 Mar 1;58(548):169\u0026ndash;76. \u003c/li\u003e\n\u003cli\u003eKaiser, B.N.,Kohrt, B.A.,Keys, M.H.,Khoury, M.A.,Brewster, A.R. Strategies for assessing mental health in Haiti. Local instrument development and transcultural translation. Transcultural Psychiatry 2013:50;532. \u003c/li\u003e\n\u003cli\u003eBolton P. Cross-cultural validity and reliability testing of a standard psychiatric assessment instrument without a gold standard. J Nerv Ment Dis. 2001 Apr;189(4):238\u0026ndash;42. \u003c/li\u003e\n\u003cli\u003eAli GC, Ryan G, De Silva MJ. Validated Screening Tools for Common Mental Disorders in Low and Middle Income Countries: A Systematic Review. PloS One. 2016;11(6):e0156939. \u003c/li\u003e\n\u003cli\u003evan Heyningen T, Myer L, Tomlinson M, Field S, Honikman S. The development of an ultra-short, maternal mental health screening tool in South Africa. Glob Ment Health Camb Engl. 2019;6:e24. \u003c/li\u003e\n\u003cli\u003eWHO [Internet]. World Health Organization; [cited 2020 Oct 31]. WHO | Process of translation and adaptation of instruments. Available from: https://www.who.int/substance_abuse/research_tools/translation/en/\u003c/li\u003e\n\u003cli\u003e(Streiner, D. L., \u0026amp; Norman, G. R. (2008). Health measurement scales: A practical guide to their development and use. Oxford University Press). \u003c/li\u003e\n\u003cli\u003eDeVellis, R. F. (2016). Scale development: Theory and applications (4th ed.). Sage Publications. \u003c/li\u003e\n\u003cli\u003eField, A. (2013). Discovering statistics using IBM SPSS statistics. Sage. \u003c/li\u003e\n\u003cli\u003eZweig, M. H., \u0026amp; Campbell, G. (1993). Receiver-operating characteristic (ROC) plots: A fundamental evaluation tool in clinical medicine. Clinical Chemistry, 39(4), 561-577. \u003c/li\u003e\n\u003cli\u003eLin H. Huang CL, Cheng CP, Lin HH, Lu CC. Psychometric testing of the Chinese version of the Hooked on Nicotine Checklist in adolescents. Journal of adolescent health. 2009 Sep 1;45(3):281-5. \u003c/li\u003e\n\u003cli\u003eFornell C, Larcker DF. Evaluating structural equation models with unobservable variables and measurement error. Journal of marketing research. 1981 Feb;18(1):39-50. \u003c/li\u003e\n\u003cli\u003eBhui, K., Warfa, N., Edonya, P., McKenzie, K., \u0026amp; Bhugra, D. (2020). Cultural competence in mental health care: A review of model evaluations. BMC Health Services Research, 20(1), 1-9. \u003c/li\u003e\n\u003cli\u003eSmith, T. B., Domenech Rodr\u0026iacute;guez, M., \u0026amp; Bernal, G. (2017). Culture. Journal of Clinical Psychology, 73(1), 5-17. \u003c/li\u003e\n\u003cli\u003eHoward, L. M., Molyneaux, E., Dennis, C. L., Rochat, T., Stein, A., \u0026amp; Milgrom, J. (2014). Non-psychotic mental disorders in the perinatal period. The Lancet, 384(9956), 1775-1788. \u003c/li\u003e\n\u003cli\u003eShorey, S., Chee, C. Y. I., Ng, E. D., Chan, Y. H., Tam, W. W. S., \u0026amp; Chong, Y. S. (2018). Prevalence and incidence of postpartum depression among healthy mothers: A systematic review and meta-analysis. Journal of Psychiatric Research, 104, 235-248. \u003c/li\u003e\n\u003cli\u003eGoyal, D., Gay, C., \u0026amp; Lee, K. (2018). How culturally sensitive is the Patient Health Questionnaire-9 for diagnosis of maternal depression? A structural equation modeling investigation. Comprehensive Psychiatry, 85, 16-25. \u003c/li\u003e\n\u003cli\u003ePatel, V., Saxena, S., Lund, C., Thornicroft, G., Baingana, F., Bolton, P., ... \u0026amp; Kigozi, F. (2018). The Lancet Commission on global mental health and sustainable development. The Lancet, 392(10157), 1553-1598. \u003c/li\u003e\n\u003cli\u003eAmerican Psychological Association. (2017). Ethical principles of psychologists and code of conduct. Retrieved from https://www.apa.org/ethics/code/. \u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-psychology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"psyo","sideBox":"Learn more about [BMC Psychology](http://bmcpsychology.biomedcentral.com/)","snPcode":"","submissionUrl":"","title":"BMC Psychology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Translation, validation, Common mental health disorder (CMD), brief screening tool, peripartum females","lastPublishedDoi":"10.21203/rs.3.rs-4306591/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4306591/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eThe peripartum period presents a critical window for identifying and addressing maternal mental health concerns. However, existing screening tools often face linguistic and cultural barriers when applied in diverse populations especially of LMIC\u0026rsquo;s. This study aimed to translate and validate an ultra brief, simple, binary-scoring, novel mental health screening tool into Hindi language, evaluating its psychometric properties and cultural relevance among Hindi-speaking women. The scale developed in 2019, includes symptoms of depressed mood, anxiety symptoms and suicidal ideation, which is possibly more feasible and acceptable for use by non-specialist health workers in busy, low-resource primary care settings. However, a Hindi translated, validated version of the scale is not yet available for use among Indian population.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eAs specified by the World Health organisation, the translation process involved forward and backward translations, expert panel reviews, and pilot testing to ensure linguistic equivalence and cultural appropriateness. Subsequently, the translated tool underwent psychometric validation, including exploratory factor analyses, assessment of internal consistency, concurrent validity against established measures like a widely used screening tool (Edinburgh Postnatal Depression rating scale) in the said population. The study recruited a diverse sample of 194 peripartum women seeking antenatal and postnatal care and treatment from a tertiary care healthcare setting, ensuring representation across socio-demographic variables.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe findings of this study underscore the successful translation and validation of an ultra-brief peripartum mental health screening tool for common mental health disorders into Hindi language, demonstrating its reliability, validity, and clinical relevance among Hindi-speaking women. Through rigorous psychometric evaluation, the translated tool exhibited robust internal consistency (Cronbach\u0026rsquo;s α\u0026thinsp;=\u0026thinsp;0.80; P\u0026thinsp;\u0026lt;\u0026thinsp;0.001), cross language concordance (ICC\u0026thinsp;\u0026ge;\u0026thinsp;0.7), test retest reliability (ICC\u0026thinsp;=\u0026thinsp;0.952; P\u0026thinsp;\u0026lt;\u0026thinsp;0.00), factor structure, content validity (CVI\u0026thinsp;=\u0026thinsp;0.911), and concurrent validity (Pearson\u0026rsquo;s correlation coefficient 0.67 in ANC/ 0.71in PNC; P\u0026thinsp;\u0026lt;\u0026thinsp;0.05), thus providing a valuable instrument for identifying peripartum mental health concerns within this population.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eFindings elucidated the reliability, validity, and clinical utility of the translated screening tool in screening for peripartum common mental health disorders among Hindi-speaking women, thereby facilitating timely identification and support for maternal mental health concerns.\u003c/p\u003e","manuscriptTitle":"Hindi translation and validation of Ultra Brief peripartum Mental Health Screening Tool (UBPMHST)","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-05-09 12:38:52","doi":"10.21203/rs.3.rs-4306591/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-03-10T05:46:15+00:00","index":"","fulltext":""},{"type":"reviewerAgreed","content":"56142142748531159365728345465236597999","date":"2025-02-28T10:01:15+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-02-25T08:05:31+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"98458259432965999186319877314214561171","date":"2025-02-25T07:13:28+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-02-25T05:29:49+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"226072436721494564407568199831637540309","date":"2025-02-20T05:10:50+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"159200484978041417542690390446960413557","date":"2025-02-19T18:30:06+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"89428243622006697103850441310215110970","date":"2025-02-19T16:26:19+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-11-18T12:42:51+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2024-05-06T19:10:20+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-05-04T03:59:14+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-05-04T03:59:14+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Psychology","date":"2024-04-22T14:13:49+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-psychology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"psyo","sideBox":"Learn more about [BMC Psychology](http://bmcpsychology.biomedcentral.com/)","snPcode":"","submissionUrl":"","title":"BMC Psychology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"4b855481-ab22-48a5-aed6-4e6e9f413560","owner":[],"postedDate":"May 9th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-08-05T14:38:47+00:00","versionOfRecord":[],"versionCreatedAt":"2024-05-09 12:38:52","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4306591","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4306591","identity":"rs-4306591","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}