Translation and validation of brief patient health questionnaire against DSM IV as a tool to diagnose major depressive disorder in Indian patients

Context: Depression is frequently encountered in the primary care setting but is often unrecognized and hence untreated. There is a need for a uniform user-friendly screening instrument for depression for primary healthcare personnel in India.
Aims: Translation and validation of the brief patient health questionnaire (BPHQ) as a screening tool for depression in major Indian languages.
Materials and Methods: This was a prospective study conducted at 18 sites, in psychiatric and general clinics. The English version of the BPHQ was translated into 11 Indian languages. The translations were reviewed by experts and volunteers and proofread for the final translated BPHQ. The validation exercise included more than 3000 subjects. A psychiatrist and a psychiatry social worker / coordinator conducted the study under the supervision of the principal investigator. For each language, the presence or absence of major depressive disorder (MDD) as diagnosed with the help of a patient-completed BPHQ and the psychiatrist DSM-IV diagnosis was matched. The kappa coefficient was used as a measure of inter-observer agreement between the two diagnostic methods.
Results: Seven languages failed the primary validation exercise. These translations were reviewed and the updated versions, after proofreading were re-run for validation. The self-administered BPHQ was successfully translated and validated for diagnosis of MDD against DSM-IV diagnosis made by a psychiatrist, in English, Hindi, Marathi, Oriya, Malayalam, Assamese, Gujarati, Kannada, Telugu, Bengali and Tamil.
Conclusions: BPHQ is a simple, quick and reliable instrument, which facilitates rapid and accurate diagnosis of depression in the primary care setting in our country.

Keywords
Brief patient health questionnaire, depression, primary care, PRIME MD Today