Patient Mania Questionnaire-9: Spanish Language and Cultural Adaptation

Monitoring treatment using patient-reported outcomes such as depressive and manic symptom measures can inform clinical decisions. Outpatient consultation liaison psychiatry settings commonly use such measures in clinical care. However, Spanish-speaking patients often lack access to culturally and linguistically adapted tools for assessing manic symptoms, which may contribute to inequities in mental health care.

The Patient Mania Questionnaire-9 (PMQ-9) is an established measure used to monitor manic symptoms in patients with bipolar disorder but has not been systematically adapted for Spanish-speaking populations. This study sought to develop and assess the acceptability and cultural appropriateness of a Spanish-language adaptation of the PMQ-9.

We conducted a two-phase mixed-methods study in collaboration with the Hispano-American Special Interest Group of the Academy of Consultation-Liaison Psychiatry. The PMQ-9 underwent translation using established cross-cultural adaptation guidelines. Phase I surveyed Spanish-speaking mental health clinicians across 10 countries regarding translation accuracy, usability, and cultural relevance. Phase II involved structured video interviews with Spanish-speaking adults with clinician-diagnosed bipolar disorder to assess clarity, acceptability, emotional impact, and cultural resonance. Qualitative data were analyzed using inductive thematic analysis; quantitative survey data were summarized descriptively. All participants provided informed consent, and the protocol received institutional review board approval.

Seventy-one clinicians participated in Phase I. Most endorsed usability (n = 62, 87.1%) and would recommend the measure (n = 68, 96%). Cultural relevance ratings were high (mean 4.1/5 ± 1.4), with feedback highlighting regional linguistic nuances and suggesting minor wording refinements. In Phase II, eleven patients from five Latin American countries participated. Themes included high clarity and readability, regional language preferences, varied emotional responses to symptom recall, and suggestions for improving specific terms and response options.

The Spanish-language PMQ-9 demonstrated preliminary acceptability, usability, and cultural relevance for both clinicians and patients. Engaging end-users in the adaptation process strengthened linguistic accuracy and cultural fit beyond translation alone. The Spanish-language PMQ-9 may help support more equitable access to symptom monitoring for Spanish-speaking individuals with bipolar disorder in integrated care settings. Further psychometric validation and implementation studies are warranted.