Background: There is an increased interest in developing better and more accurate methods to recognize and manage mental health problems in primary care settings. Abbreviated screening instruments for mental distress are useful tools for research and clinical practice. The present study seeks to investigate whether only a few questionnaire items from the Self-Reporting- Questionnaire-10 (SRQ-10) can be a robust method in the screening for Mental Distress in Primary Health care. Methods: We compared the screening accuracy of a short, five-item (SRQ-5) version of the SRQ-10 with that of the SRQ-20, General Health Questionnaire 12 (GHQ-12) using the DSM-IV axis as a gold standard and analyzed its performance in different diagnostic entities. We also assessed the correlation, sensitivity and specificity between the 4 instruments. All the instruments were administered to 400 primary health care attendees. Results: The estimated prevalence of mental distress was 13.6% in the study sample (Depression 11%, anxiety disorders 1.8%). The SRQ-5 was highly correlated to SRQ-10 (0.923, p < 0.001), SRQ-20 (0.764, p < 0.001) and only moderately correlated to GHQ-12 (0.417, p < 0.001). The SRQ-5 had high properties for identifying mental distress. The AUC for overall mental distress was 0.925 while that for depression and anxiety were 0.915 and 0.849 respectively. Conclusion: This validation showed that in moving from SRQ with 10 or 20 items to one with merely 5 items, we do not seem to lose the screening prowess of the instrument. The SRQ-5 represents a simplified and less time-consuming screening instrument with strong performance characteristics. We therefore recommend it for inclusion into existing patient assessment protocols, thus enhancing case finding at primary health care level.
 Williams, D.R., Herman, A., Stein, D.J., Heeringa, S.G., Jackson, P.B., Moomal, H., et al. (2008) Twelve-month mental disorders in South Africa: Prevalence, service use and demographic correlates in the population-based South African Stress and Health survey. Pschological Medicine, 38, 211-220. doi:10.1017/S0033291707001420
 Kabede, D., Alem, A. and Rashid, E. (1999) The prevalence and socio-demographic correlates of mental distress in Addis Ababa, Ethiopia. Acta Psychiatr Scand, 100, 5- 10. doi:10.1111/j.1600-0447.1999.tb10687.x
 Tesfaye, A. (2009) Prevalence and correlates of mental distress among regular undergraduate students of Hawassa University: A cross sectional survey. East African Journal of Public Health, 6, 1. doi:10.4314/eajph.v6i1.45755
 Abbo, C., Ekblad, S., Waako, P., Okello, E. and Muhwezi, W.S.M. (2008) Psychological distress and associated factors among attendees of traditional healing practices in Jinja and Iganga districts, Eastern Uganda: A cross-sectional study. International journal of Mental Health Systems, 2, 1-9.
 Ngoma, M.C. and Prince, M.A.M. (2003) Common mental disorders among those attending primary health clinics and traditional healers in urban Tanzania. The British Journal of Psychiatry, 183, 349-355. doi:10.1192/bjp.183.4.349
 Ciesla, J.A. and Robert, J.E. (2001) Meta-analysis of the relationship between HIV infection and the risk for depressive disorders. American Journal of Psychiatry, 158, 725-730. doi:10.1176/appi.ajp.158.5.725
 Jacob, K.S. (2001) Community care for people with mental disorders in developing countries: Problems and possible solutions. The British Journal of Psychiatry, 178, 296-298. doi:10.1192/bjp.178.4.296
 Chipimo, P.J. and Fylkesnes, K. (2010) Comparative validity of screening instruments for mental distress in Zam-bia. Clinical Practice & Epidemiology in Mental Health, 6, 4-15. doi:10.2174/1745017901006010004
 Goldberg, D.P., Gater, R., Sartorious, N., et al. (1997) The validity of two versions of GHQ in the WHO study of mental illness in general health care. Psychological Medicine, 27, 191-197. doi:10.1017/S0033291796004242
 Rumpf, H., Meyer, C., Hapke, U. and Ulrich, J. (2001) Screening for mental health: Validity of the MHI-5 using DSM-IV Axis I psychiatric disorders as gold standard. Psychiatry Research, 105, 243-253. doi:10.1016/S0165-1781(01)00329-8
 Jacobsen, B.K., Hasvold, G., Hansen, H. and Hansen, V. (1995) The general health questionnaire: How many items are really necessary in population surveys? Psychological Medicine, 25, 957-961. doi:10.1017/S0033291700037442
 Friedman, B., Heisel, M. and Delavan, R. (2005) Validity of the SF-36 five-item mental health index for major depression in functionally im-paired, community-dwelling elderly patients. Journal of Amer-ican Geriatrics Society, 53, 1978-1985. doi:10.1111/j.1532-5415.2005.00469.x
 Berwick, D.M., Murphy, J.M., Goldman, A., Ware, J.E., Barsky, A.J. and Weinsten, M.C. (1991) Performance of a five-item mental health screening test. Medical Care, 29, 169-176. doi:10.1097/00005650-199102000-00008
 Cleary, P.D., Bush, B.T. and Kessler, L.G. (1987) Evaluating the use of mental health screening scales in primary care setting using receiver operating characteristics curves. Medical Care, 25, S90-S98. doi:10.1097/00005650-198712001-00009
 Mari, J. and Williams, P.A. (1986) Validity study of a psychiatric screening questionnaire (SRQ-20) in primary care in the city of Sao Paulo. British Journal of Psychiatry, 148, 23-26.doi:10.1192/bjp.148.1.23