The methods of improving cultural sensitivity of depression scales for use among global indigenous populations: a systematic scoping review

Abstract

Cultural adaptation of psychometric measures has become a process aimed at increasing acceptance, reliability, and validity among specific Indigenous populations. We present a systematic scoping review to: (1) identify the depression scales that have been culturally adapted for use among Indigenous populations worldwide, (2) globally report on the methods used in the cultural adaptation of those scales, and (3) describe the main features of those cultural adaptation methods. We included articles published from inception to April 2021, including 3 levels of search terms: Psychometrics, Indigenous, and Depression. The search was carried out in the Ovid Medline, PubMed, Embase, Global Health, PsycINFO, and CINAHL databases, following PRISMA guidelines. We identified 34 reports on processes of cultural adaptation that met the criteria. The scales were adapted for use among Indigenous populations from Africa, Australia, Asia, North America, and Latin America. The most common scales that underwent adaptation were the Patient Health Questionnaire (PHQ-9), the Center for Epidemiologic Studies Depression Scale (CES-D), and the Edinburgh Postnatal Depression Scale (EPDS). Methods of adaptation involved a revision of the measures’ cultural appropriateness, standard/transcultural translation, revision of the administration process, and inclusion of visual supports. Culturally safe administration of scales was reported in some studies. To come to a consensus on most appropriate methods of improving cultural safety of psychometric measurement, most studies utilized qualitative methods or mixed methods to understand the specific community’s needs. Revision of linguistic equivalence and cultural relevance of content, culturally safe administration procedures, qualitative methods, and participatory research were key features of developing safe culturally adapted measures for depressive symptoms among Indigenous populations. While for comparability, uniform scales would be ideal as mental health evaluations, an understanding of the cultural impact of measurements and local depression expressions would benefit the process of developing culturally sensitive psychometric scales. PROSPERO registration ID: CRD42023391439.

Safe and valid? A systematic review of the psychometric properties of culturally adapted depression scales for use among Indigenous populations

“…As an alternative to cultural adaptation, methods of administration could also increase cultural safety. This includes at least considering the setting, language, use of community members at administration, and visual elements (Gomez Cardona et al, Submitted ).…”

“…In the future, studies should include a needs assessment prior to developing new screening tools. If modifications are warranted, qualitative methods may be beneficial to understand the community’s needs which can be addressed by a novel or adapted scale (Gomez Cardona et al, Submitted ). Concurrently, there must be emphasis on ensuring adaptation processes yield stable and clinically useful tools.…”

“…The methods for the systematic search, including the search strategy, were reported previously (Gomez Cardona et al, Submitted ). This study followed the outline set forth by the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA; Figure 1 ).…”

“…These considerations are especially important in mental health care for Indigenous peoples, as Indigenous peoples share cultural backgrounds and ideas about health and concern that are unique from other ethnic groups (Mayberry et al, 2000 ). As a response to these unique perspectives, cultural adaptation of psychometric tools has become a commonly used method to increase cultural safety of psychometric evaluation and to reduce communication problems (Gomez Cardona et al, Submitted ). As a consequence, it is hoped to lead to reduced risk of harm, and to improved access of Indigenous peoples to psychiatric treatment for depression.…”

“…Recently, more studies have explored different methods of culturally adapting and developing measures that reflect mental health conditions (Haswell et al, 2010 ). We recently reviewed the methods of cultural adaptation of measures for depression, identifying the modifications and adaptations made and evaluating their acceptability by target Indigenous populations (Gomez Cardona et al, Submitted ). Here, we continue the work and investigate the psychometric properties of the previously identified culturally adapted psychometric measures.…”