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Validation of the Recent Life Changes Questionnaire (RLCQ) for stress measurement among adults residing in urban communities in Pakistan

  • Artani, Azmina1, 2
  • Kamal, Ayeesha K.1, 2
  • Azam, Syed Iqbal3
  • Artani, Moiz4
  • Bhamani, Shireen Shehzad5
  • Saif, Mehreen6
  • Khan, Fariha Afzal6
  • Alam, Nazir7
  • 1 Aga Khan University, Stroke Service, Section of Neurology, Department of Medicine, Karachi, Pakistan , Karachi (Pakistan)
  • 2 Aga Khan University, Stroke Fellowship Program, International Cerebrovascular Translational Clinical Research Training Program, Fogarty International Center and the National Institute of Neurologic Disorders and Stroke, Stadium Road, Karachi, 74800, Pakistan , Karachi (Pakistan)
  • 3 Aga Khan University, Biostatistics and Epidemiology, Department of Community Health Sciences, Karachi, Pakistan , Karachi (Pakistan)
  • 4 Jinnah Medical and Dental College, MBBS Program, Karachi, Pakistan , Karachi (Pakistan)
  • 5 Aga Khan University School of Nursing & Midwifery, Karachi, Pakistan , Karachi (Pakistan)
  • 6 Bahria University, Karachi, Pakistan , Karachi (Pakistan)
  • 7 University of Karachi, Karachi, Pakistan , Karachi (Pakistan)
Published Article
BMC Psychology
BioMed Central
Publication Date
Oct 21, 2019
DOI: 10.1186/s40359-019-0341-9
Springer Nature


BackgroundRecent Life Changes Questionnaire (RLCQ) developed by Richard Rahe has enabled quantification of stress by analyzing life events. The overall aim of the study was to create a reliable version of the Rahe’s RLCQ for measuring stress in individuals living in developing countries and assess its validity. This paper discusses criterion validation of the adapted RLCQ in urban communities in Pakistan.MethodsThis is a criterion validation study. Four urban communities of Karachi, Pakistan were selected for the study in which households were randomly chosen. Two data collectors were assigned to administer the adapted RLCQ to eligible participants after obtaining written informed consent. Following this interaction, two psychologists interviewed the same participants with a diagnostic gold standard of Mini International Neuropsychiatric Interview (MINI) which is utilized in usual practice within Pakistan to confirm the presence of stress related mental disorders such as Depression, Anxiety, Dysthymia, Suicide, Phobia, OCD, Panic Disorder, PTSD, Drug abuse and dependence, Alcohol abuse and dependence, Eating Disorders and Antisocial Personality Disorder to validate the accuracy of the adapted RLCQ. We generated the ROC curves for the adapted RLCQ with suggested cut-offs, and analyzed the sensitivity and specificity of the adapted RLCQ.ResultsThe area under the receiver operating characteristic curve (ROC) of common mental disorders such as depression and anxiety was 0.64, where sensitivity was 66%, specificity was 56% and the corresponding cut off from the adapted RLCQ was 750. Individuals scoring ≥750 were classified as high stress and vice versa. In contrast, the area under the ROC curve for serious mental disorder and adverse outcomes such as suicide, bipolar and dysthymia was 0.75, where sensitivity was 72% and specificity was 60% at the cut off of 800 on the adapted RLCQ. Individuals scoring ≥800 were classified as high stress and vice versa. The rate of agreement between the two psychologists was 94.32% (Kappa = 0.84).ConclusionThe adapted and validated RLCQ characterizes common mental disorders such as depression and anxiety with moderate accuracy and severe mental disorders such as suicide, bipolar and dysthymia with high accuracy.Trial NCT02356263. Registered January 28, 2015. (Observational Study Only).

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