Cross-cultural adaptation of mental health screening instruments for Samoan adolescents

Mental health problems appear common among Pacific Islander adolescents. The lack of culturally adapted mental health screening instruments is a barrier to establishing prevalence estimates needed to inform resource allocation and health system budgeting. Following the Gjersing et al. (2010) guidelines, we adapted five clinical mental health screening instruments to measure symptoms of depression, anxiety, post-traumatic stress, and suicide-related indicators for Samoan adolescents. In collaboration with clinical experts and American Samoan adolescents, we employed a four-stage incremental approach: (1) establishing expert team consensus to modify items for conceptual equivalence; (2) an iterative process of group-based forward- and back-translations; (3) adolescent piloting testing using an online survey; and (4) an adolescent focus group to finalize instruments and to develop administrative guidelines. We adapted the Patient Health Questionnaire-9 Modified for Teens (PHQ-9M), the Generalized Anxiety Disorder 7 (GAD-7), Child PTSD Symptom Scale Self-Report for the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (CPSS-5), and the CPSS-5 Trauma Screener. We also developed a deliberate self-harm questionnaire based on the Avon Longitudinal Study of Parents and Children (ALSPAC) questionnaire and the Self-Injurious Thoughts and Behaviors Interview (SITBI). The adult expert committee modified the English-language wordings in each tool to improve local relevance and comprehension; adolescent pretesting led to two minor changes to the CPSS-5. Participants reported concerns about honesty in responding to highly sensitive questions; to address this, the focus group provided additional administrative guidelines. We provide the first cross-culturally adapted mental health screening instruments for use among Samoan adolescents. These instruments provide an opportunity to measure prevalence and inform public health policy through future population-based surveys. Further research should evaluate cross-cultural validity, measurement equivalence, and concordance with clinical screening to aid in clinical diagnostics for screening programs in Samoan healthcare settings.