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The SLPDS is a measure of adult psychological distress which has been designed specifically for the Sierra Leone context. It can be used freely by any individual or organisation for assessment of community needs or for the evaluation of mental health and/ or psychosocial services. This webpage provides all the information needed to use the SLPDS safely and effectively, and how to get further information where necessary.

What is the Sierra Leone Psychological Distress Scale (SLPDS)?

The SLPDS is a measure of psychological distress which has been designed specifically for the Sierra Leone context. This means that it includes signs of distress which are common amongst adults in Sierra Leone, and it uses words which are easily understood. It is available in both Krio and English.

The SLPDS consists of two parts:

Part 1 is an 18-item scale designed to measure psychological distress. It consists of three subscales, which relate to high emotional arousal (fear, anxiety, anger etc.), passive signs of distress (specifically hopelessness and feelings of worthlessness and withdrawal) and physical and behavioural issues (including sleep, appetite and engaging with other people).

Part 2 is a 9-item measure of ability to carry out daily tasks as an indication of the severity of distress. There are two versions of this – one for men and one for women.

The SLPDS is not intended as an individual screening tool, but as a measure which can be used at community-level to assess mental health and psychosocial needs.

Why was it developed?

Studies of psychological distress in Sierra Leone have typically used measures which were developed for use in other contexts, and which often have not been adapted or validated for use in Sierra Leone. This has resulted in a lack of reliable information about the patterns of psychological distress within the population, which is a barrier to the development of effective and appropriate mental health services.

How was it developed?

The measure is based on research conducted to understand how psychological distress is expressed by adult men and women in Sierra Leone. This involved interviews with community members in five districts of the country, and interviews with community leaders and other key informants in four districts.

A draft measure was developed based on the signs of distress identified through this process. These initial questions were tested, reviewed, revised and tested again with community members in different parts of the country.

Finally, the revised version of the SLPDS was used to collect information from a sample of 904 men and women in five districts. Statistical analysis was conducted to assess the reliability and validity of the measure. Some further revisions were made at this stage before the SLPDS was finalised.

What can it be used for?

The SLPDS is designed to be used at community or group level, rather than to assess individual wellbeing. It can be used to:

• Assess the nature of psychological distress within a community or group, to support the planning of services or projects which will meet their needs.
• Evaluate the effectiveness of an initiative designed to strengthen psychosocial wellbeing and/ or reduce distress.

What can it not be used for?

The SLPDS is not a clinical screening tool. It cannot be used to:

• Diagnose mental health disorders
• Screen individuals for mental health problems

It was developed and tested for use with adult populations (age 18 and over). It has not yet been tested with adolescents and children, so we do not know how appropriate it is for these groups.

Who can use it?

The SLPDS can be used by individuals and groups who want to better understand the psychosocial wellbeing of the communities they work with. This can include community groups, non-governmental organisations (NGOs), government bodies and others.

No background in mental health or psychosocial support is needed to use the SLPDS.

It can be used by those involved in planning, implementing and evaluating programmes, and by those conducting research.

Where can I find out more about the SLPDS?

You can read about the development of the SLPDS and its psychometric properties here:

Horn, R., Jailobaeva, K., Arakelyan, S. & Ager, A. (2021). The development of a contextually appropriate measure of psychological distress in Sierra Leone. BMC Psychology, 9, 108. .

This guidance is intended to provide information to support the use of the SLPD to gather information from community members. This guidance does not include:

• The general skills required for a person to conduct a structured interview
• How to decide on a sampling strategy

Who can use the SLPD?

The SLPD is designed to be used by interviewers with:

a) secondary school or higher level of education
b) skills and experience in conducting structured interviews

The process should be supervised by a person with a strong background in research and/ or evaluation. This lead person will be responsible for training the interviewers; monitoring the quality of their work and providing support where necessary; managing any ethical issues which arise.

Links to downloadable material:

What are the ethical issues involved in using the SLPD?

Detailed information about ethical issues involved in this type of information-gathering exercise can be found elsewhere, for example the following resources which are available online:

Some key ethical issues are outlined below

1. Safety of interviewer and respondent must be prioritised

Systems must be in place to ensure that the location of interviewers is known to supervisors and that communication is possible in case of any difficulties. It is often advisable for interviewers to work in pairs.

2. Respondents must freely consent to participating in the interview, with full knowledge of what is involved

Before the interview begins, the process should be explained to each potential participant, fully informing them of all that is involved, including the purpose of the interview, how and what information will be collected, how the information will be used, and potential risks and benefits to respondents. The potential outcomes of the data collection must be described honestly, even if it is likely that it may lead to no specific benefits to the community. Care must be taken to avoid raising unrealistic expectations during assessments. People must be free to decline or end participation without any negative consequences.

For children, people experiencing severe mental disorder and those who are unable to consent for themselves, alternative mechanisms should be used to obtain consent.

Informed consent may be taken either verbally or in writing, depending on the context.

3. Interviewers should be trained to respond appropriately if the respondent becomes distressed

As part of preventing distress, it is important to make clear during the consent process that respondents may decline to discuss particular topics at any point. However, regardless of the steps taken to make the interviews as safe an experience as possible for respondents, it is possible that some may become distressed during interviews. The training of data collectors should include guidance on how to respond if this occurs, which can include:

• You are not trained to assist the person directly
• Provide compassionate listening and accompaniment to someone who is distressed. Give her/ him the option to have a break or discontinue the interview. If they do not wish to continue, thank them for their participation and ask whether they want to be put in touch with someone who they can talk to.
• If they do, make that referral before the respondent leaves, and tell the respondent what will happen next.

Some respondents may need to be referred to services which can provide more ongoing support. Before the data collection begins, individuals and/ or organisations who are able to provide mental health and psychosocial support should be identified, and systems put in place for referrals to be made in an appropriate, safe way. Once systems have been established, all those involved in the data collection must be trained in when and how to make referrals for further support when needed.

4. Keep information obtained during interviews confidential

Put systems in place to make sure that information given by a respondent cannot become known by people outside the data-collection team. Interviewers’ training and codes of conduct should require them not to discuss respondents’ answers or personal details with people outside of the data collection team, even once the exercise is finished. However, if a respondent is discovered to be at risk of harm (or of harming others), confidentiality must be breached in order to protect safety. The limits to confidentiality should be included in the informed consent process. In addition, steps must be taken to ensure that data is made anonymous and stored securely.

Where should the SLPD interview take place?

The SLPD interview should take place in a community setting ideally (rather than a clinical setting), in a place which is private enough for the questions and responses not to be overheard by others.

The location can be chosen by the respondent, and should be a place where both the respondent and the interviewer are safe.

Locations may include: an open space, under a tree; a community centre; a private home.

Who should be interviewed?

The SLPD is designed to be used with ordinary adult community members. It has not been tested or validated with children and young people under 18 years. We do not cover sampling strategies in this guidance, but you can find useful information in the following resource (freely available online):

How should information be recorded?

The information gathered during interviews can be recorded:

• On paper. This requires one copy of the questionnaire to be printed for each respondent.
• Electronically. Software packages (e.g. Kobo) can be used to record interview information on tablets and mobile phones, and uploaded when the interviewer has an internet connection.

If possible, there are significant advantages to recording the information electronically.

How to introduce the SLPD

When a potential respondent is identified and approached, the first thing to do is to introduce yourself and explain why you would like to talk to them. Your explanation will depend on the reason you are conducting the assessment (e.g. whether it is a project evaluation, an interest in understanding community wellbeing, or some other reason). However, you might want to include the following points:

• Your name and who you are working for
• The reason you are gathering information in this community
• Why you have chosen this particular individual as a potential respondent
• What the interview will involve (e.g. length, types of questions)
• Confidentiality
• Any benefits or risks involved in participation in the interview.

The information to be provided should be written down so that every interviewer explains it in the same way to all potential participants. This avoids any confusion, misunderstandings or rumours when people in the community later tell others about what they participated in, or were asked to participate in.

If the person agrees to the interview, then you may want to record some background information (e.g. age, gender, village). The background information to be gathered should be agreed in advance, and should not include more than is necessary for the assessment/evaluation. Keep confidentiality in mind and do not record names on the interview form.

How to introduce the measure of psychological distress

The ‘measure of psychological distress’ is the part of the SLPD that asks about signs of distress over the last one week (18 questions). It is important to explain this well, and to check that the respondent understands what the questions are about and how they should indicate their response.

In our experience, respondents can find this difficult to understand initially, and if the interviewer does not ensure that they understand before proceeding then there is a risk that respondent’s answers to the questions that follow will be meaningless.

The instructions for this section are below:

The key elements that interviewers should focus on are:

• Explaining the frame (the last one week, including today). It can be helpful to ask the respondent to identify an event that occurred one week ago, to help them focus on the appropriate timeframe. For example: ‘is there something you can remember that happened a week ago’, ‘yes, the market always happens on a Thursday’, ‘OK, so then think about how much you’ve had these experiences since the last market day’.
• Explaining the response options (not at all, a little, quite a lot, very much), and how to use the jerry cans to indicate how much the respondent has experienced something.
• Checking whether a respondent understands how to use the jerry cans to respond. It can be helpful to ask a simple question which has an easy answer, and asking the respondent to indicate which jerry can they would choose to show their response. For example: ‘If I asked you how cold you’re feeling today, which of the jerry cans best shows this?’. If the respondent does not choose a jerry can which reflects the current temperature, the interviewer can clarify with them and ask them to choose again, or ask a different question.

You can see a demonstration of this introduction in the videos below, one in English and one in Krio.

Asking the 'measure of psychological distress' questions

There are 18 questions in this section of the SLPD scale. For each one, read out the question as it is (in English or in Krio). Do not change the wording of the question at all – ask it exactly as it is.

When the respondent chooses one of the four options, either by giving their answer verbally (e.g. ‘a little’) or by pointing to one of the jerry cans, record their answer and move on to the next question. There is no discussion of their answer in this section.

You can see a demonstration of how to ask the questions in the ‘psychological distress’ part of the SLPD in the videos below, one in English and one in Krio.

We found that respondents often forget that we have asked them to focus only on the last one week, and they start thinking about how they feel right now or how they have felt recently (e.g. the last few months). For this reason, it is helpful to keep reminding them that you want them to think only about how things have been for them over the last one week.

You can see an example of how to encourage respondents to focus on the last one week in the videos below, one in English and one in Krio.

How to introduce the assessment of ability

The purpose of this part of the SLPD is to understand the effects that a respondent’s level of psychological distress is having on their ability to carry out the ordinary tasks that they are expected to complete for themselves, their families and their communities.

In order to achieve this, the SLPD includes a list of nine tasks that are often expected of women, and nine tasks that are often expected of men. Depending on the gender of the respondent, you will ask about one of these sets of tasks.

However, the instructions for both men and women are the same. They are asked about each task, and asked to tell the interviewer how much difficulty they have with this task compared to most other men/women of their age. We have found that these instructions can be difficult for respondents to understand, so the interviewer has to be very careful with the explanation.

The instructions for this section are below:

The key elements that interviewers should focus on in explaining this are:

• Explaining that the respondent should think about how much difficulty they have doing a task compared to another man/ woman of their age. This is quite difficult for people to do; instead they tend to just report how much difficulty they have doing the task, without considering whether others of their age also have the same amount of difficulty.
• Explaining the response options (no more difficulty; a little more; a moderate amount more; a lot more; you cannot do the task), and how to use the pictures to indicate how much difficulty a person has compared to another man/ woman of their age.
• Checking whether a respondent understands how to respond by using one or more ‘test questions’, in the same way as when introducing the ‘measure of psychological distress’. It is important to continue to explain and check understanding until the respondent grasps what is required.

You can see a demonstration of this introduction in the video below, which is in available only in Krio.

Asking the 'assessment of ability' questions

There are nine questions in both the female and the male version of the ‘assessment of ability’. For each one, the interviewer needs to ask a series of questions, depending on how the respondent answers. An example is shown below, for the first task for women, which is ‘cooking for the family’.

The interviewer should read out the task and then say:

Are you having no more difficulty than most other men/ women of your age, a little more, a moderate amount more, a lot more, or you often cannot do the task?

When the respondent answers, either verbally (e.g. ‘a little’) or by pointing to one of the pictures, the interviewer should record their answer.

If the respondent indicates no more difficulty in doing a task, the interviewer goes to the next task and repeats the process.

However - if the respondent indicates at least a little more difficulty (responses 1, 2, 3 or 4), the interviewer should ask the following question before going on to the next task:

What causes this difficulty?

The interviewer should then decide whether the cause is a result of a physical problem, an emotional problem or something else (e.g. lack of money). This can sometimes be a challenging judgement to make, so we suggest that the interviewer also writes a brief description of the cause of the difficulty, so that the supervisor can review the responses and give feedback to enable interviewers to judge more easily whether a cause should be categorised as physical, emotional or ‘other’.

The interviewer then moves onto the next task on the list and repeats the process.

You can see a demonstration of how to ask the questions in the ‘assessment of ability’ part of the SLPD in the videos below, one in English and one in Krio.

Learning from experience

Some of the research assistants who were part of the process of developing and testing the SLPD scale have shared some tips that they found helpful when asking the questions of respondents. You can learn from their experiences in the videos below, one in English and one in Krio.

RUHF researchers, the Ministry of Health (MoH) and other relevant stakeholders have finalised a desk guide, for uncomplicated non-communicable diseases (NCDs) and mental health (MH) cases. This deskguide is designed for qualified clinicians, such as doctors, community health officers (CHO) and mental health nurses in Sierra Leone. It is a concise ‘quick reference’ to identify, diagnose and treat NCDs, such as hypertension and diabetes, and MH issues, such as depression. The deskguide has been adapted to the Sierra Leone population and context, and is complemented with a facilitator course guide.

View the Sierra Leone NCD clinical desk guide: 

View the facilitator course guide: Facilitator Course Guide: Non-Communicable Diseases desk guide Training

View the treatment cards: 

View the participant module on NCDs: 

Training videos have been developed in Nigeria in order to assist with the implementation of their NCD desk guide. View the NCD training videos in Nigeria on our YouTube channel: 

An example of salt reduction and stroke prevention in Sierra Leone from the RUHF programme.

See the health facility COVID deskguide: 

See the module for rural health facilities during COVID:

View the Clinic Ethnography protocol, for the assessment of patient experience and service provision culture: A Guide to Clinic Ethnography ( March 2019) – ( Full report available on request via IGHD Email AddressÌý)

View the

View the Guide for Participatory Systems Analysis: