Measuring psychological well-being in South Asians with diabetes: a qualitative investigation of the PHQ-9 and the WHO-5 as potential screening tools for measuring symptoms of depression

Background: People from South Asian backgrounds living in the UK have a greatly increased risk of developing type 2 diabetes. Whether or not this patient group also experience high rates of depressive symptoms (known to be the case in Caucasian populations with diabetes) remains unknown, partly because it is unclear whether the screening tools used are culturally relevant. The aim of this study was to develop culturally competent translations (in both written and audio formats) of two screening tools used to measure symptoms of depression in languages with no written form and establish their face validity. Methods: adults with type 2 diabetes from two South Asian minority ethnic groups (from Bangladesh and Pakistan) whose main language is only spoken (Sylheti and Mirpuri) were recruited via the Birmingham Heartlands Hospital Diabetes Centre. Participants attended 2 focus group meetings to consider the content and method of delivery of two questionnaires measuring symptoms of depression, the Patient Health Questionnaire (PHQ-9) and the World Health Organisation Well-being Index (WHO-5). Results: culturally equivalent content was achieved for both questionnaires in both languages. The Mirpuri men and women groups did not indicate a clear preference for either mode of questionnaire delivery; however the Sylheti groups’ preference was for independent audio-delivery in their spoken language. Conclusions: the face validity of the PHQ-9 and the WHO-5 was established for Sylheti and Mirpuri in an audio delivery format. Psychometric testing is now needed amongst minority ethnic populations so that the feasibility of wider use can be determined