7 The PHQ‐9 text has been re‐worded in “Aboriginal English”, and the adapted instrument (aPHQ‐9) was found to be internally consistent in a study with a community sample of 78 Aboriginal men (Cronbach α = 0.776) and women (α = 0.767) from central Australia. The nine‐item Patient Health Questionnaire (PHQ‐9) 6 has been used for nearly two decades as a screening tool for depression and for assessing symptom severity in a wide range of cultural settings, but lacked face validity for use in Indigenous Australian communities. 5 To rectify the paucity of Indigenous Australian‐specific depression research, a culturally adapted depression screening tool validated in multiple Australian states and territories is needed. 4 High quality primary care investigations of this problem have been undertaken in the United Kingdom and the United States, 3 but detection of depression in Aboriginal and Torres Strait Islander people (Indigenous Australians) in primary care has been little investigated.Ī recent systematic review of diagnostic psychiatric instruments found that none had been formally validated for Indigenous Australians. 2 Evidence‐based management of people with depression in primary care is beneficial for their health, 3 but the rates of detection, diagnosis and effective intervention are inadequate. 1 Major depression, a chronic and relapsing disorder, impairs cognitive and emotional functioning, has substantial social and economic impacts, and increases the risk of premature death. The burden of disease for mental and substance use disorders, in terms of disability‐adjusted life years (DALYs), was the third highest of all diseases in Australia in 2011. We must ensure that those applying the aPHQ‐9 have the skills and resources to confidently assess and identify depression, provide effective treatment, and implement effective prevention strategies. The implications: We have an evidence‐based tool for screening for depression in Indigenous Australians. The aPHQ‐9 was regarded as acceptable by more than 80% of participants. The new: The adapted nine‐item Patient Health Questionnaire (aPHQ‐9) is an effective screening tool for depression a cut‐point score of 10 points provides 84% sensitivity and 77% specificity. The known: Screening tools for depression have not been formally validated for Aboriginal and Torres Strait Island people across multiple states and territories in Australia. Applying a cut‐point of 10 points, the performance characteristics of the aPHQ were good. The aPHQ‐9 was deemed acceptable by more than 80% of participants.Ĭonclusions: Indigenous Australians found the aPHQ‐9 acceptable as a screening tool for depression. For screening for a current major depressive episode, the area under the receiver operator characteristic curve was 0.88 (95% CI, 0.85–0.92) with a cut‐point of 10 points its sensitivity was 84% (95% CI, 74–91%) and its specificity 77% (95% CI, 71–83%). The sensitivity of the aPHQ‐9 algorithm for diagnosing a current major depressive episode was 54% (95% CI, 40–68%), its specificity was 91% (95% CI, 88–94%), with a positive predictive value of 64%. Results: 108 of 500 participants (22% 95% CI, 18–25%) had a current episode of major depression according to the MINI criterion. Main outcome measures: Criterion validity of the aPHQ‐9, with the depression module of the Mini‐International Neuropsychiatric Interview (MINI) 6.0.0 as the criterion standard. Setting, participants: 500 adults (18 years or older) who identified as Aboriginal or Torres Strait Islander people and attended one of ten primary health care services or service events in urban, rural and remote Australia that predominantly serve Indigenous Australians, and were able to communicate sufficiently to respond to questionnaire and interview questions. Objectives: To determine the validity, sensitivity, specificity and acceptability of the culturally adapted nine‐item Patient Health Questionnaire (aPHQ‐9) as a screening tool for depression in Aboriginal and Torres Strait Islander people.ĭesign: Prospective observational validation study, 25 March 2015 – 2 November 2016. Statistics,epidemiology and research design.Statistics, epidemiology and research design.