The methods of improving cultural sensitivity of depression scales for use among global indigenous populations: a systematic scoping review

Liliana Gomez Cardona; Michelle Yang; Quinta Seon; Maharshee Karia; Gajanan Velupillai; Valérie Noel; Outi Linnaranta

doi:10.1017/gmh.2023.75

The methods of improving cultural sensitivity of depression scales for use among global indigenous populations: a systematic scoping review

Glob Ment Health (Camb). 2023 Nov 23:10:e83. doi: 10.1017/gmh.2023.75. eCollection 2023.

Authors

Liliana Gomez Cardona^{1

2}, Michelle Yang³, Quinta Seon^{1

2}, Maharshee Karia¹, Gajanan Velupillai², Valérie Noel^{1

4}, Outi Linnaranta^{1

2

5}

Affiliations

¹ Douglas Mental Health University Institute, McGill University, Montreal, QC, Canada.
² Department of Psychiatry, McGill University, Montreal, QC, Canada.
³ École interdisciplinaire des sciences de la santé/Interdisciplinary School of Health Sciences, Université d'Ottawa/University of Ottawa, Ottawa, ON, Canada.
⁴ ACCESS Open Minds, Douglas Mental Health University Institute, McGill University, Montreal, QC, Canada.
⁵ Equality Unit, Finnish Institute for Health and Welfare, Helsinki, Finland.

Abstract

Cultural adaptation of psychometric measures has become a process aimed at increasing acceptance, reliability, and validity among specific Indigenous populations. We present a systematic scoping review to: (1) identify the depression scales that have been culturally adapted for use among Indigenous populations worldwide, (2) globally report on the methods used in the cultural adaptation of those scales, and (3) describe the main features of those cultural adaptation methods. We included articles published from inception to April 2021, including 3 levels of search terms: Psychometrics, Indigenous, and Depression. The search was carried out in the Ovid Medline, PubMed, Embase, Global Health, PsycINFO, and CINAHL databases, following PRISMA guidelines. We identified 34 reports on processes of cultural adaptation that met the criteria. The scales were adapted for use among Indigenous populations from Africa, Australia, Asia, North America, and Latin America. The most common scales that underwent adaptation were the Patient Health Questionnaire (PHQ-9), the Center for Epidemiologic Studies Depression Scale (CES-D), and the Edinburgh Postnatal Depression Scale (EPDS). Methods of adaptation involved a revision of the measures' cultural appropriateness, standard/transcultural translation, revision of the administration process, and inclusion of visual supports. Culturally safe administration of scales was reported in some studies. To come to a consensus on most appropriate methods of improving cultural safety of psychometric measurement, most studies utilized qualitative methods or mixed methods to understand the specific community's needs. Revision of linguistic equivalence and cultural relevance of content, culturally safe administration procedures, qualitative methods, and participatory research were key features of developing safe culturally adapted measures for depressive symptoms among Indigenous populations. While for comparability, uniform scales would be ideal as mental health evaluations, an understanding of the cultural impact of measurements and local depression expressions would benefit the process of developing culturally sensitive psychometric scales. PROSPERO registration ID: CRD42023391439.

Keywords: Indigenous; cross-cultural psychiatry; culturally competent care; depression; psychometrics.

Publication types

Review