Getting it Right: validating a culturally specific screening tool for depression ( aPHQ ‐9) in Aboriginal and Torres Strait Islander Australians

Abstract

Objectives To determine the validity, sensitivity, specificity and acceptability of the culturally adapted nine‐item Patient Health Questionnaire (aPHQ‐9) as a screening tool for depression in Aboriginal and Torres Strait Islander people. Design Prospective observational validation study, 25 March 2015 – 2 November 2016. Setting, participants 500 adults (18 years or older) who identified as Aboriginal or Torres Strait Islander people and attended one of ten primary health care services or service events in urban, rural and remote Australia that predominantly serve Indigenous Australians, and were able to communicate sufficiently to respond to questionnaire and interview questions. Main outcome measures Criterion validity of the aPHQ‐9, with the depression module of the Mini‐International Neuropsychiatric Interview (MINI) 6.0.0 as the criterion standard. Results 108 of 500 participants (22%; 95% CI, 18–25%) had a current episode of major depression according to the MINI criterion. The sensitivity of the aPHQ‐9 algorithm for diagnosing a current major depressive episode was 54% (95% CI, 40–68%), its specificity was 91% (95% CI, 88–94%), with a positive predictive value of 64%. For screening for a current major depressive episode, the area under the receiver operator characteristic curve was 0.88 (95% CI, 0.85–0.92); with a cut‐point of 10 points its sensitivity was 84% (95% CI, 74–91%) and its specificity 77% (95% CI, 71–83%). The aPHQ‐9 was deemed acceptable by more than 80% of participants. Conclusions Indigenous Australians found the aPHQ‐9 acceptable as a screening tool for depression. Applying a cut‐point of 10 points, the performance characteristics of the aPHQ were good.

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Factors Associated with Thoughts of Self-Harm or Suicide among Aboriginal and Torres Strait Islander People Presenting to Urban Primary Care: An Analysis of De-Identified Clinical Data

“…The adapted Patient Health Questionnaire 9 (aPHQ-9) depression screening tool has formed a part of health assessments at the Inala COE since 2014. The aPHQ-9, based on the Patient Health Questionnaire 9, a reliable clinical and research tool used for diagnosing depressive disorders, has been adapted and validated for use with Aboriginal and Torres Strait Islander populations [ 39 , 40 , 41 ]. Item 9 of the aPHQ-9 questionnaire asks, ‘how often in the last 2 weeks have you been thinking about hurting or killing yourself?’.…”

Co-Designing Health Service Evaluation Tools That Foreground First Nation Worldviews for Better Mental Health and Wellbeing Outcomes

“…In between Workshop One and Workshop Two, Aboriginal research team members undertook a targeted review of pre-existing service experience and mental health and wellbeing measures and survey tools. Instruments validated by Aboriginal people were given priority [56][57][58]. Other instruments not been specifically validated for (nor by) Aboriginal people and used by services were reviewed and also considered [59,60].…”

“…Finally, the design of the survey to capture multiple perspectives of a client's service experience acknowledges the critical role of family and community in understanding and integrating collective experiences of wellbeing and recovery [15,16,[50][51][52][55][56][57][58][64][65][66]. This exemplifies the role relationships play in people's lived experience being shared, connected, and central to a person's sense of belonging and wellness.…”