Validation and Diagnostic Accuracy Evaluation of the EQ-5D-5L Shona Digital Version for Screening Anxiety and Depression

Background Comorbid anxiety and depression are common among people living with HIV (PLHIV). This highlights the need for concise diagnostic tools for routine mental health evaluations. This study assesses the diagnostic accuracy, construct validity and test-retest reliability of the EQ-5D-5L Shona version. Methods This cross-sectional survey recruited 611 PLHIV in Harare, Zimbabwe. The diagnostic accuracy of the EQ-5D-5L anxiety/depression item for screening anxiety and depression were evaluated in comparison with clinician diagnoses as the gold standard, and screening tools, i.e., the Patient Health Questionnaire-9 (PHQ-9) for depression, the Generalised Anxiety Disorders Scale for anxiety (GAD-7), and the Shona Symptoms Questionnaire (SSQ-14) for comorbid anxiety and depression. We calculated sensitivity, specificity, and total area under the receiver operating characteristic curve (AUROC). Construct validity was assessed by evaluating the correlation between EQ-5D scores with PHQ-9, GAD-7 and SSQ-14 scores. Test-retest reliability was assessed using the intra-correlation coefficient (ICC). Results Using the cut-point ≥ 2, a cut point-based criterion, the EQ-5D-5L anxiety/depression item displayed acceptable diagnostic accuracy for anxiety [sensitivity-64.6%, specificity-67.8% and AUROC = 0.72], depression [sensitivity-64.1%, specificity-65.8% and AUROC = 0.71] and comorbid anxiety/depression screening diagnosis [sensitivity-65.8%, specificity-66.3% and AUROC = 0.71] when compared to a clinician diagnosis. The EQ-5D-5L outperformed the GAD-7 and PHQ-9 for screening anxiety and depression, respectively. The SSQ-14 outperformed the EQ-5D in screening comorbid anxiety/depression. EQ-5D-5L scores were negatively correlated to SSQ-14, GAD-7 and PHQ-9 scores, demonstrating construct validity. The EQ-5D-5L exhibited adequate stability at two weeks following baseline administration, as indicated by an ICC of 0.78 (95% CI: 0.70; 0.84) for the utility score and an ICC of 0.73 (95% CI: 0.63; 0.80) for the visual analogue scale (VAS) scores. Conclusion The EQ-5D-5L Shona version demonstrates strong diagnostic accuracy for anxiety, depression and comorbid anxiety/depression screening while also offering valuable health insights beyond that role. Therefore, the EQ-5D-5L Shona is a valid and reliable instrument for use in both routine clinical care and research.