External validity was shown by good sensitivity (0.95) and specificity (0.94) to differentiate depression from absence of depression. Reliability coefficients above 0.92 indicated strong internal consistency. In the confirmatory factor analysis, HDRS had good factor loadings of 0.32–0.80. We enrolled 105 healthy volunteers and 105 patients with confirmed mild to severe depression. Results: The translated version demonstrated a kappa of 0.93. Maximized Youden’s index was used for determining diagnostic cut-off. Psychometric properties, namely internal structure, reliability, and external validity were assessed using confirmatory factor analysis, three reliability calculations, and correlation analysis, respectively. We validated the translation against expert assessment in a comparative study on a sample of patients living with depression and of healthy volunteers. Methods: The HDRS-21 was translated by a multi-group taskforce. We describe the translation, validity, and reliability assessment of the Hamilton Depression Rating Scale (HDRS) as a diagnostic tool for moderate to severe depression in Rwanda. Increasing the ability and capacity to diagnose and treat mental disorders is considered important to close this gap. Mental health services remain underutilized due to stigma and lack of awareness. Introduction: In Rwanda, major depressive disorder affects 11.9% of the population and up to 35% of genocide survivors. 6Department of Neurology and Psychiatry, University of Rwanda, Kigali, Rwanda.5Department of Neurology, Neuropsychiatric Hospital, CARAES Ndera, Kigali, Rwanda.4Division of Emergency Medicine, Department of Surgery, Duke Global Health Institute, Duke University, Durham, NC, United States.3Department of Neurology, Ghent University Hospital, Ghent, Belgium.2Corporate Societal Responsibility, UCB Pharma, Brussels, Belgium.1Department of Neurology, Heilig Hart Hospital, Lier, Belgium.Peter Dedeken 1,2,3 *, Joao Ricardo Nickenig Vissoci 4, Fidele Sebera 3,5,6, Paul A.
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