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Reliability and Validity of the Haitian Creole PHQ-9

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A Capsule Commentary to this article was published on 16 August 2014

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. HIV-positive 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.

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Conflict of Interest

The authors declare that they do not have a conflict of interest.

Contributors

The authors would like to thank the Republic of Haiti’s Programme National de Lutte contre le SIDA (Mme. Nirva Duval, Dr. Edieux Louissaint), Laboratoire National de Santé Publique (Dr. Jacques Boncy), SEROvie (Mr. Reginald Dupont), PSI LAC (Dr. Benjamin Nieto-Andrade), UNAIDS (Ms Kate Spring), FOSREF and POZ for their sustained support to the design and implementation of the study. We also thank Ms. Marie-Andre Pierre Victor (Social Worker, Codman Square Community Health Center, Dorchester, MA) and Mrs. Magalie Laraque (Translator, Port-au-Prince, Haiti) for their participation on the Bilingual/Bicultural Expert Panel; Dr. Charles Lewis (Department of Graduate Psychometrics, Fordham University, Bronx, NY), Dr. Janet St. Lawrence (Mississippi State University, Meridian), Dr. Don Operario (Brown University School of Public Health), Dr. David Williams (Harvard School of Public Health, Boston, MA) and Ms. Isabel Morgan (Mount Holyoke College) for reviewing the final draft of this manuscript.

Funders

The project was supported by funding from PEPFAR/USAID, KfW (Kreditanstalt für Wiederaufbau), the Global Fund to Fight AIDS, Malaria and Tuberculosis, the Elton John AIDS Foundation, PSI and Housing Works, Inc. Manuscript development was funded, in part, by a grant from the National Institutes of Health (L60 MD002421-02) and Fellowship (R25MH083620) awarded to the primary author, LGM.

Prior Presentations

Presented at the 19th International AIDS Conference in Washington, DC, July 26, 2012, ‘HIV in Haiti in the Time of Reconstruction, Epidemiology, Achievements, Challenges and Perspectives,’ Session THSA08.

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Authors and Affiliations

  1. Harvard School of Public Health, Department of Biostatistics, 677 Huntington Avenue, Landmark Center, 401 Park Drive, 3 East Boston, Boston, MA, 02215, USA

    Linda G. Marc MPH, ScD & Marcia A. Testa PhD, MPH

  2. Harvard School of Public Health, Division of Policy, Translation and Leadership Development, Boston, MA, 02215, USA

    Linda G. Marc MPH, ScD, Whitney R. Henderson MSW & Marcia A. Testa PhD, MPH

  3. Harvard Medical School, Department of Psychiatry, Boston, MA, 02115, USA

    Astrid Desrosiers MD

  4. PSI Haiti, Port-au-Prince, Haiti

    Samuel E. Jean BS & Eniko Edit Akom MD

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  1. Linda G. Marc MPH, ScD
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  2. Whitney R. Henderson MSW
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  3. Astrid Desrosiers MD
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  4. Marcia A. Testa PhD, MPH
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  5. Samuel E. Jean BS
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Correspondence to Linda G. Marc MPH, ScD.

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Marc, L.G., Henderson, W.R., Desrosiers, A. et al. Reliability and Validity of the Haitian Creole PHQ-9. J GEN INTERN MED 29, 1679–1686 (2014). https://doi.org/10.1007/s11606-014-2951-5

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