Depression screening among Haitian immigrants: A quality-improvement project

Area of Science:

• Mental Health
• Cross-cultural Psychiatry
• Health Services Research

Background:

• Haitian populations face significant barriers in depression screening.
• Standard depression screening tools like the English PHQ-9 may lack cultural and linguistic appropriateness.
• Quality improvement initiatives are needed to address these disparities.

Purpose of the Study:

• To evaluate the effectiveness of culturally adapted Haitian Creole depression screening tools.
• To compare the diagnostic accuracy and reliability of the Haitian Creole PHQ-9 and ZLDSI against the English PHQ-9.
• To improve depression screening and referral for Haitian adults.

Main Methods:

• A quality improvement project utilized the plan-do-study-act method.
• Compared the English PHQ-9 with the Haitian Creole PHQ-9 and Zanmi Lasante Depression Symptom Inventory (ZLDSI).
• Administered tools to 50 Haitian adults over 3 months during routine clinic visits.

Main Results:

• The Haitian Creole PHQ-9 identified 10% of patients with mild-to-moderate depression, compared to 6% with the English PHQ-9 and ZLDSI.
• Culturally adapted tools demonstrated higher sensitivity in detecting nuanced symptoms and at-risk cases.
• The ZLDSI showed excellent internal consistency (0.905), followed by the Haitian Creole PHQ-9 (0.798).

Conclusions:

• Culturally and linguistically responsive screening tools are essential for Haitian immigrants.
• These tools enhance the capture of depressive symptoms and identification of at-risk individuals.
• Adoption of adapted tools can bridge the diagnostic gap and improve mental health referrals.