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Screening for major depression in Vietnamese refugees: a validation and comparison of two instruments in a health
1Department of Social Medicine, Harvard Medical School, Boston, Massachusetts.
Objectives:
1) Using standard cutoffs, to determine the accuracy of two Vietnamese-language depression screening instruments for major depression in a nonpsychiatric setting, 2) to examine the utility of other cutoffs, and 3) to compare the instruments' overall accuracies.
Design:
1) A research assistant administered the Vietnamese Depression Scale (VDS) and the Indochinese Hopkins Symptom Checklist Depression Subscale (HSCL-D) to all subjects. 2) The "gold standard" was determined by a native Vietnamese-speaking psychiatrist using a written translation of a standard semistructured clinical interview.
Setting:
A health screening clinic at a large public hospital.
Patients:
A convenience sample of 206 newly arrived adult Vietnamese refugees undergoing routine, mandatory health screening.
Results:
The psychiatrist diagnosed 7% of the refugees as having major depression. At standard cutoffs, the VDS had a 64% sensitivity, a 98% specificity, a 75% positive predictive value, and a 97% negative predictive value. Corresponding results for the HSCL-D were 86%, 93%, 48%, and 99%. More than half of the patients who had false-positive results had other clinical disorders. For each instrument, adjusting the cutoff improved sensitivity and positive predictive value. Receiver operating characteristic (ROC) curve analysis showed no difference in accuracy between the two instruments. Each instrument took approximately 5-10 minutes to administer.
Conclusions:
These instruments accurately identified Vietnamese refugees with major depression and should be of use to clinicians in primary care settings. Standard cutoffs may need to be adjusted in nonpsychiatric settings.