PURPOSETo make decisions about implementing systematic depression screening, primary care physicians who serve Spanish-speaking populations need to know whether Spanish language depression-screening instruments are accurate. We aimed to review systematically the evidence regarding diagnostic accuracy of depression-screening instruments in Spanish-speaking primary care populations.
METHODSWe searched PubMed, PsycINFO, CINAHL, EMBASE, and Cochrane Libraries from inception to May 28, 2008, for studies examining the diagnostic accuracy of Spanish language depression case-fi nding instrument(s) administered to primary-care outpatients. Two authors independently assessed studies for inclusion and quality.RESULTS Twelve studies met inclusion criteria. In general primary care screening, the Spanish language version of the Center for Epidemiologic Studies-Depression scale (CES-D) had sensitivities ranging from 76% to 92% and specifi cities ranging from 70% to 74%. We found no US study reporting the accuracy of the Primary Care Evaluation of Mental Disorders (PRIME-MD-9) or the Patient Health Questionnaire (PHQ-9) depression module in Spanish-speakers. One fair-quality European study and 1 poor-quality study conducted in Honduras found the 9-item PRIME-MD had sensitivities ranging from 72% to 77% and specifi cities ranging from 86% to 100%. The 2-item PRIME-MD was 92% sensitive, but only 44% specifi c for depression in 1 US study. In geriatric outpatients, the 15-item Spanish language version of the Geriatric Depression Scale (GDS) had sensitivities ranging from 76% to 82%, and specifi cities ranging from 64% to 98%. In postpartum women, the Spanish language version of the Edinburgh Postnatal Depression Scale (EPDS) was 72% to 89% sensitive and 86% to 95% specifi c for major depression (2 non-US studies). The Spanish language version of the Postpartum Depression Screening Scale (PDSS) was 78% sensitive and 85% specifi c for combined major/minor depression (1 US study).CONCLUSIONS For depression screening in Spanish-speaking outpatients, fair evidence supports the diagnostic accuracy of the CES-D and PRIME-MD-9 in general primary care, the GDS-15-Spanish for geriatric patients, and the Spanish language versions of the EPDS or PDSS for postpartum patients. The ultrashort 2-item version of PRIME-MD may lack specifi city in US Spanish-speakers.
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SPA NISH L A NGU AGE DEPR ES SION SCR EENINGAlthough legal and economic barriers contribute to these disparities, language and cultural barriers also play an important role. 8 In recent years, the number of US residents who are Spanish speakers has risen dramatically. More than 31 million US residents now speak Spanish at home.9 Within this changing sociocultural context, those who provide primary care to Spanish-speaking populations must make decisions about implementing systematic depression screening in their clinics and health centers. Among the key pieces of information clinicians and clinical leaders need in order to make these decisions is how the various available...