Strengths and Limitations of Measurement Tools

As indicated above, each of these approaches entails trade-offs. The rigorous adaptation process we employed with the BDI and BAI can effectively balance the goals of cross-cultural comparison and ethnographic validity, especially when used in tandem with a locally developed tool like the KDI. At the same time, the adaptation process is time-consuming, and ultimately the tools rely on categories of biomedical psychiatry. Development of a purely local screening tool best achieves the goal of ethnographic validity, ensuring that mental distress is assessed based on the concepts, categories, and means of communication that are meaningful and preferred. At the same time, this process is even more time-consuming, relies on in-depth qualitative research, and is less interpretable cross-culturally, including in communications with policymakers and donors. The ZLDSI balances the goals of cross-cultural comparison with ethnographic validity and is the only tool that is clinically validated. At the same time, qualitative data collection and clinical validation are timeconsuming and require the availability of trained specialists. Finally, because clinical validation is in comparison to biomedical psychiatric constructs, categories developed in the West are necessarily privileged. This privileging of universalist over particularist approaches and of Western-derived psychiatric constructs over local categories, as well as potentially pathologizing normal responses to trauma and hardship all carry important implications for GMH research and practice.

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