Moroccan colloquial Arabic version of the Mini International Neuropsychiatric Interview (MINI): Qualitative and quantitative validation

Short communication

Moroccan colloquial Arabic version of the Mini International

Neuropsychiatric Interview (MINI): qualitative and quantitative validation

N. Kadri ^a, *, M. Agoub ^a , S. El Gnaoui ^a , Kh. Mchichi Alami ^a , T. Hergueta ^b , D. Moussaoui ^a

a

University Psychiatric Center Ibn Rushd, Rue Tarik Ibnou Ziad, 20000 Casablanca, Morocco

b

Inserm, La Salpêtrière Hospital, Paris, France

Received 10 December 2002; received in revised form 8 November 2004; accepted 15 November 2004

Abstract

The validation of mini international neuropsychiatric interview (MINI) into Moroccan Colloquial Arabic language demonstrated good psychometric properties. The concordance between translated MINI’s and expert diagnoses was good with kappa values greater than 0.80.

The reliability inter-rater and test–retest were excellent with kappa values above 0.80 and 0.90, respectively.

© 2005 Elsevier SAS. All rights reserved.

Keywords: Colloquial Arabic MINI version; Qualitative validation; Concordance expert; Inter-rater reliability; Test–retest reliability

1. Introduction

In Morocco and despite a long history in treating mental ill people, till now no official data on the epidemiology of mental disorders are available.

To be able to conduct an epidemiological survey, there is a need of reliable and valid instrument. For this, we have cho- sen the mini international neuropsychiatric interview (MINI) [2,3] to conduct such surveys in Morocco.

This instrument was translated into many languages, and two classical Arabic versions were produced. Our group tested these versions among Moroccan population (patients and healthy volunteers). However, we noticed that they were not suitable to our context. The official language is Arabic. But, this most widely spoken language, Moroccan colloquial Ara- bic, is quite different from the classical Arabic. It is not used in medical settings in its written form. On the other hand, in Morocco medical sciences are taught in French. In practice, health professional make their work from French version of medical documentations and translate as they speak into the patient’s preferred tongue.

2. Methods

2.1. Translation procedures

The group in charge of the translation, from French to Col- loquial Arabic language, was a trilingual group (Arabic, French and English), composed by psychiatrists.

The part of the translation procedure was divided into four distinct steps. First, the group had agreement meeting and worked and discussed comprehensibility, acceptability and cultural applicability of the questions, appropriateness of for- mat, wording and phrasing. Second, each member of the group was in charge of a number of modules. Third, the members reviewed individually the translation of the modules done by the other members. Finally, a concordance meeting with the whole team was held after completion of each module, in the aim to read the chapter in Arabic, to compare it to the original French version and to work on the cultural and social weight of the words and sentences.

2.2. Back-translation procedures

An independent group proceeded to the back-translation into French of the full revised translated version. Then, a com- parison of the back-translation with the original version for semantic and conceptual equivalence was conducted.

* Corresponding author.

E-mail address: n.kadri@casanet.net.ma (N. Kadri).

European Psychiatry 20 (2005) 193–195

http://france.elsevier.com/direct/EURPSY/

0924-9338/$ - see front matter © 2005 Elsevier SAS. All rights reserved.

doi:10.1016/j.eurpsy.2004.11.007

2.3. Quantitative validation

2.3.1. Study population

The following minimum recruitment quotas were set:

30 cases of depressive disorders, 20 cases of manic episodes, 30 cases of anxiety disorders, 40 cases of psychotic disor- ders, and 30 patients with substance-related disorders. Fifty healthy non-psychiatric volunteers were recruited in a pri- mary health care center.

2.4. Validity and reliability procedures

As in Morocco, there was no validated instrument to be compared with; it was chosen to test the validity of the Moroc- can MINI against an expert opinion. The “MINI interviewer”

was psychiatrist (M.A.), and had received by the authors a half-day training session. The expert (N.K.) was professor of psychiatry and used to use DSM-IV classification and clini- cal rating scales as well as diagnostic interviews. She pro- vided DSM-IV diagnoses using whatever source of informa- tion she considered to be the most appropriate. Each patient was seen the same day by the two interviewers. Both “MINI interviewer” and expert were blind towards the other diagno- sis.

The inter-rater and test–retest reliability were assessed in a subgroup of 50 patients of the whole patient’s population.

For the first one the MINI was administered by two distinct interviewers and for the latter; subsequently by one of them 2 days after the initial rating.

2.4.1. Data analysis

For each axis-I disorders generated by the Moroccan MINI diagnostic concordance against expert opinion was assessed using Cohen’s kappa values, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV).

Kappa values were also used to test inter-rater and test–retest reliabilities.

3. Results

A total of 175 psychiatric patients and 50 normal controls agreed to participate in the study.

3.1. Concordance between Moroccan MINI and expert diagnosis

Table 1 shows the psychometric properties of the Moroc- can MINI regarding the validity. General anxiety disorder and eating disorders were not included because of the small num- ber of patients in our sample.

3.2. Inter-rater and test–retest reliability

All of the kappa values were above 0.80 and the majority, nine out of 11, was 0.90 or higher, indicating an excellent inter-rater reliability.

4. Discussion

Overall, the results of the quantitative validity study were satisfactory. The data suggest that the Moroccan version of the MINI succeeded in validity in eliciting symptom criteria used in making DSM-IV diagnoses.

As it is often the case in such instruments, inter-rater and test–retest reliability results were very good. These results might be partially explained by the fact that most of the popu- lation tested was satisfying the diagnostic criteria of mental disorders according to DSM-IV criteria and was followed up in psychiatric facilities.

Nevertheless, the study had several limitations such as the low number of cases for some diagnoses such as dysthymia, PTSD, generalized anxiety disorder and eating disorders, we did not include patients from other facilities than mental health institutions and the MINI is in large part devoted to the screen- ing of psychiatric disorders especially in primary care set-

Table 1

Concordance between Moroccan MINI and expert diagnoses

Disorder (n = 225) TP TN FP FN Kappa Sensitivity Specificity PPV NPV

Major depressive disorder 29 194 1 1 0.95 0.96 0.99 0.96 0.99

Dysthymia 4 220 1 0 0.88 1.00 0.99 0.80 1.00

Current manic disorder 19 203 1 2 0.91 0.90 0.99 0.95 0.98

Panic disorder 9 215 1 0 0.94 1.00 0.99 0.90 1.00

Agoraphobia 12 211 1 0 0.91 1.00 0.99 0.85 1.00

Social phobia 12 211 2 0 0.91 1.00 0.99 0.85 1.00

Obsessive compulsive disorder 9 215 1 0 0.94 1.00 0.99 0.90 1.00

Posttraumatic disorder 2 222 0 1 0.79 0.66 1.00 1.00 0.99

Current alcohol dependence 14 209 0 2 0.92 0.87 1.00 1.00 0.99

Lifetime alcohol dependence 14 208 0 3 0.89 0.82 1.00 1.00 0.98

Current drug dependence 16 207 0 2 0.93 0.88 1.00 1.00 0.99

Lifetime drug dependence 18 204 0 3 0.91 0.85 1.00 1.00 0.98

Current psychotic disorder 40 182 0 3 0.95 0.93 1.00 1.00 0.98

PPV = positive predictive value; NPV = negative predictive value; TP = true positive; TN = true negative; FP = false positive; FN = false negative.

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tings, and the comparisons with an expert’s diagnosis instead of using another structured diagnostic interview because of the lack of valid Moroccan Arabic instruments to be com- pared with. But this method was widely used before and we think we take all dispositions to keep the blindness of each interviewer, which can be the most important.

Because of the simplicity, ease of use and its brevity the Moroccan Arabic version of the MINI can be incorporated into routine psychiatric evaluation or in the general practitio- ner consultations. The MINI was used in multicenter clinical trials and epidemiology studies [1]. For research matters, this instrument will be used soon in a Moroccan national epide- miological survey, which will allow us, for the first time, to have prevalence rates of mental disorders in a representative sample of the general population of Morocco.

References

[1] Duburq A, Blin P, Charpak Y, Blachier C, Allicar MP, Bouhassira M, et al. Use of a structured diagnostic interview to identify depressive episodes in an epidemiologic study: a posteriori internal validation.

Rev Epidemiol Santé Publ 1999;47:455–63.

[2] Lecrubier Y, Sheehan DV, Weiller E, Amorim P, Bonora I, Harnett Sheehan K, et al. The Mini International Neuropsychiatric Interview (MINI). A short diagnostic structured interview: reliability and valid- ity according to the CIDI. Eur Psychiatry 1997;12:224–31.

[3] Sheehan DV, Lecrubier Y, Harnett Sheehan K, Janavs J, Weiller E, Keskiner A, et al. The validity of the Mini International Neuropsychi- atric Interview according to the SCID-P and its reliability. Eur Psy- chiatry 1997;12:232–41.

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N. Kadri et al. / European Psychiatry 20 (2005) 193–195