Validation of the EQ-5D-5L Shona version for screening anxiety and depression in people living with HIV/AIDS

Anxiety and depression commonly co-occur among people living with HIV (PLHIV), creating a need for brief tools that can support routine mental health screening. This study evaluated the screening performance, construct validity, and test-retest reliability of the Shona EQ-5D-5L. In this cross-sectional study, 611 PLHIV were recruited in Harare, Zimbabwe. The screening performance of the EQ-5D-5L anxiety/depression item was evaluated against clinician diagnosis and against commonly used screening tools: the Patient Health Questionnaire-9 (PHQ-9) for depression, the Generalised Anxiety Disorder-7 (GAD-7) for anxiety, and the Shona Symptoms Questionnaire-14 (SSQ-14) for comorbid anxiety/depression. Sensitivity, specificity, and area under the receiver operating characteristic curve (AUROC) were calculated. Construct validity was assessed using correlations between EQ-5D-5L scores and PHQ-9, GAD-7, and SSQ-14 scores. Test-retest reliability was assessed using the intraclass correlation coefficient (ICC). Using a cut-off of ≥ 2, the EQ-5D-5L anxiety/depression item showed acceptable screening performance against clinician diagnosis for anxiety (sensitivity 64.6%, specificity 67.8%, AUROC 0.72), depression (sensitivity 64.1%, specificity 65.8%, AUROC 0.71), and comorbid anxiety/depression (sensitivity 65.8%, specificity 66.3%, AUROC 0.71). The EQ-5D-5L showed similar overall performance to the GAD-7 and PHQ-9 for anxiety and depression screening, respectively, while the SSQ-14 performed slightly better for comorbid anxiety/depression screening. EQ-5D-5L scores were negatively correlated with SSQ-14, GAD-7, and PHQ-9 scores, supporting construct validity. Over two weeks, the EQ-5D-5L showed acceptable stability, with an ICC of 0.78 (95% CI: 0.70; 0.84) for the utility score and 0.73 (95% CI: 0.63; 0.80) for the visual analogue scale (VAS). The Shona EQ-5D-5L showed acceptable screening performance for anxiety, depression, and comorbid anxiety/depression among PLHIV, while also providing broader health-related quality-of-life information. These findings support its use as a brief screening and triage tool in routine care and research, alongside rather than in place of condition-specific instruments and clinician assessment.