In Zimbabwe, we use the Shona Symptom Questionnaire (SSQ) to find out if someone is suffering from common mental disorders, it has been developed and normalised for Zimbabwe. The SSQ can also be used to find out if someone is getting better and problem solving therapy (PST) is actually helping.
All the questions can be answered with ‘yes’ or ‘no’. Every ‘yes’ answer counts one point. To score the questionnaire result, we simply add the ‘yes’ answers. If someone has more than 9 points, we know that this person is very likely to suffer from Kufungisisa and needs treatment.
SSQ question number 11 reads ‘At times I felt like committing suicide’. It is a very important question addressing the risk for suicidality. If a client answers this question with ‘yes’, we call this a red flag. This means that the person is even more at risk of suffering from CMD. We refer this person immediately to higher level care.
The PHQ 9 is a questionnaire that can be used to assess the severity of depression. If a person scored high (>12) and/or answers 'Yes' to question 11 on the SSQ (At times I feel like committing suicide), we need to know how severe the patients depression is. The district health promoter officer will therefore administer the PHQ-9. The 9th question of the PHQ-9 also asks for suicidal intent. The patient will be asked to answer the questions regarding the past 2 weeks. There is an added question 10 asking for the impact depression is having on a person's functioning at work/home and with other people.
All questions can be answered on a scale with four points:
0- Kwete/not at all
1- Mamwe Mazuva/several days
2- Zviri pakati nepakati/more than half the days
3- Zuva rega rega/nearly every day.
For the total score the individual scores are added up, so a total of 27 points can be reached.
The PHQ-9 cut-off score is 20. If a person scores 20 and has at least 1 point on question 9, it is necessary for the DHPO to refer to the nurse for further assessment and possible prescription of anti-depressant medication.
The Friendship Bench card is a way of taking summarized notes. They are necessary for consecutive sessions. Only the most important facts go on the Friendship Bench card. In each session, we might add something to the FB cards. Our client will have her or his own card. The card will help the client to remember what she or he learned and agreed to do between sessions.