Not all depressive symptoms matter equally: Ratings of the relative importance of nine DSM symptoms in a sample of Indian adolescents
Background: There is widespread debate about the extent to which western diagnostic criteria for depression are appropriate cross-culturally. A key aspect of this debate involves the extent to which individual symptoms are considered important, impairing, and concerning by individuals in low- and middle-income countries. Here, we describe a novel method to understand the degree to which symptoms of depression are most important to individuals, and we illustrate its application in a non-western sample.Methods: We surveyed 1,237 Indian adolescents (47.8% female, Mage= 14.11). Adolescents received the Patient Health Questionnaire-9, a measure of nine DSM-derived depressive symptoms. For each symptom, participants answered three questions designed to assess the degree to which they perceive the symptom as distressing and impairing. The three scores were averaged to form a Subjective Importance Rating (SIR) for each symptom.Results: Anhedonia received the highest SIR, followed by Sad Mood, Suicidal Ideation, and Feeling like a Failure; Psychomotor Problems received the lowest SIRs. Females reported greater SIRs than males, and older students reported greater SIRs than younger students. There was a non-linear relationship between participants' own depressive symptoms and SIRs.Limitations: Participants were recruited from the general population; findings may not generalize to patients or individuals in other countries.Conclusion: Not all symptoms of depression were viewed as equally important. We discuss how the SIR approach can help global mental health researchers identify specific symptoms that are considered most concerning, evaluate the cross-cultural relevance of western diagnostic criteria, and inform the validation of measurement tools.