Mental Health of Women in Afghanistan—Reply

In Reply: Dr Westermeyer suggests that the high response frequencies among Afghan women for depression and PTSD and the number of family members reported killed in war "do not ring true." The finding that 97% of Afghan women reported symptoms of major depression is indeed striking. However, high rates of depression have been observed in other populations. For example, Carlson and Rosser-Hogan¹ have demonstrated rates of depression of 80% among a random sample of Cambodian refugees who resettled in the United States. Since the participants in our study continue to experience considerable hardships, it does not seem that the rates of depression in our study are so high as to "ring untrue." The symptom checklist we used to predict MDD was the Hopkins Symptom Checklist-25 (HSCL-25), an instrument that has been demonstrated to be 86% sensitive and 93% specific in identifying the diagnosis of MDD.² We disagree that the depressive symptoms identified by the HSCL-25 fall "well short of MDD."