Reliability and Validity of the Haitian Creole PHQ-9

Abstract

BACKGROUND: There is limited information on depression in Haitians and this is partly attributable to the absence of culturally and linguistically adapted measures for depression. OBJECTIVE: To perform a psychometric evaluation of the Haitian-Creole version of the PHQ-9 administered to men who have sex with men (MSM) in the Republic of Haiti. DESIGN: This study uses a cross-sectional design and data are from the Integrated Behavioral and Biological HIV Survey (IBBS) for MSM in Haiti. PARTICIPANTS: Inclusion criteria required that participants be male, ≥ 18 years, report sexual relations with a male partner in the last 12 months, and lived in Haiti during the past 3 months. Respondent Driven Sampling was used for participant recruitment. MAIN MEASURES: A structured questionnaire was verbally administered in Haitian-Creole capturing information on sociodemographics, sexual behaviors, human immunodeficiency virus (HIV) status and depressive symptomatology using the PHQ-9. Psychometric analyses of the translated PHQ-9 assessed unidimensionality, factor structure, reliability, construct validity, and differential item functioning (DIF) across subgroups (age, educational level, sexual orientation and HIV status). KEY RESULTS: In a study population of 1,028 MSM, the Haitian-Creole version of the PHQ-9 is unidimensional, has moderately high internal consistency reliability (α = 0.78), and shows evidence of construct validity where HIV-positive subjects have greater depression (p=0.002). There is no evidence of DIF across age, education, sexual orientation or HIV status. HIVpositive MSM are twice as likely to screen positive for moderately severe and severe depressive symptoms compared to their HIV-negative counterparts. CONCLUSIONS: There is strong evidence for the psychometric adequacy of the translated PHQ-9 screening tool as a measure of depression with MSM in Haiti. Future research is necessary to examine the predictive validity of depression for subsequent health behaviors or clinical outcomes among Haitian MSM.KEYWORDS: Depression; Haiti; HIV/AIDS; International health; men who have sex with men.

Temporal Trends in Age at HIV Diagnosis in Cohorts in the United States, the Caribbean, and Central and South America

“…The differences between the proportion of patients who report being MSM across different sites within CCASAnet are also noteworthy, and may reflect important differences between countries, clinic settings, and cultures, in regards to HIV stigma, access to HIV testing and treatment, and education levels. Alternatively, it may be that due to the self-report of sexual orientation (and perhaps varying willingness to do this depending on the country of origin and associated stigma 22,23 ) that our data on MSM must be interpreted with caution. Importantly, a substantial number of study subjects, including all patients at our site in Haiti, had an unknown route of transmission.…”

“…24 However, more recent data showed the majority of Haitian MSM reported bisexual activity, and 30% reported male-to-male intercourse as their risk factor for HIV acquisition. This ongoing interplay between homosexual/bisexual/heterosexual subgroups may serve to drive the spread of HIV by creating connections between epidemics 22 .…”

Development of a Sexual Dysfunction Scale for Women With Inflammatory Bowel Disease

“…18 In a meta-analysis, the PHQ-9 was found to be satisfactory for screening for depression in a range of locations and populations. [19][20][21][22][23] The instrument uses a Likert-type response format ranging from 0 (not at all) to 3 (every day), and the total score ranges from 0 to 27, with 5 severity categories: minimal (0-4), mild (5-9), moderate (10)(11)(12)(13)(14), moderately severe (15)(16)(17)(18)(19), and severe (20-27). 18 A higher score indicates increased depressive symptoms.…”

Evaluation of smartphone APP-based case-management services among antiretroviral treatment-naïve HIV-positive men who have sex with men: a randomized controlled trial protocol

“…Both instruments comprise four-point Likert scales with the responses based on occurrence of symptoms during the last week. In each scale, the sum of all items will be calculated and categorized into different levels of mental health disorder: normal (0-4), mild (5)(6)(7)(8)(9), moderate (10)(11)(12)(13)(14), and moderate to severe (≥15) [50,51].…”