title: Diagnostic accuracy of Spanish language depression-screening instruments.
abstract: OBJECTIVE
  To make decisions about implementing systematic depression screening, primary care physicians who serve Spanish-speaking populations need to know whether Spanish language depression-screening instruments are accurate. We aimed to review systematically the evidence regarding diagnostic accuracy of depression-screening instruments in Spanish-speaking primary care populations.
  
  
  METHODS
  We searched PubMed, PsycINFO, CINAHL, EMBASE, and Cochrane Libraries from inception to May 28, 2008, for studies examining the diagnostic accuracy of Spanish language depression case-finding instrument(s) administered to primary-care outpatients. Two authors independently assessed studies for inclusion and quality.
  
  
  RESULTS
  Twelve studies met inclusion criteria. In general primary care screening, the Spanish language version of the Center for Epidemiologic Studies-Depression scale (CES-D) had sensitivities ranging from 76% to 92% and specificities ranging from 70% to 74%. We found no US study reporting the accuracy of the Primary Care Evaluation of Mental Disorders (PRIME-MD-9) or the Patient Health Questionnaire (PHQ-9) depression module in Spanish-speakers. One fair-quality European study and 1 poor-quality study conducted in Honduras found the 9-item PRIME-MD had sensitivities ranging from 72% to 77% and specificities ranging from 86% to 100%. The 2-item PRIME-MD was 92% sensitive, but only 44% specific for depression in 1 US study. In geriatric outpatients, the 15-item Spanish language version of the Geriatric Depression Scale (GDS) had sensitivities ranging from 76% to 82%, and specificities ranging from 64% to 98%. In postpartum women, the Spanish language version of the Edinburgh Postnatal Depression Scale (EPDS) was 72% to 89% sensitive and 86% to 95% specific for major depression (2 non-US studies). The Spanish language version of the Postpartum Depression Screening Scale (PDSS) was 78% sensitive and 85% specific for combined major/minor depression (1 US study).
  
  
  CONCLUSIONS
  For depression screening in Spanish-speaking outpatients, fair evidence supports the diagnostic accuracy of the CES-D and PRIME-MD-9 in general primary care, the GDS-15-Spanish for geriatric patients, and the Spanish language versions of the EPDS or PDSS for postpartum patients. The ultrashort 2-item version of PRIME-MD may lack specificity in US Spanish-speakers.
authors.affiliation: Department of Medicine, Division of General Medicine and Clinical Epidemiology, and the Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, North Carolina 27599 - 7110, USA. dreuland@med.unc.edu
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Reuland
authors.forename: Andrea
authors.initials: A
authors.lastname: Cherrington
authors.forename: Garth S
authors.initials: GS
authors.lastname: Watkins
authors.forename: Daniel W
authors.initials: DW
authors.lastname: Bradford
authors.forename: Roberto A
authors.initials: RA
authors.lastname: Blanco
authors.forename: Bradley N
authors.initials: BN
authors.lastname: Gaynes
mesh_terms: D000367:Age Factors; D003431:Cross-Cultural Comparison; D003863:Depression / Q000175:diagnosis*; D003866:Depressive Disorder / Q000175:diagnosis*; D006801:Humans; D007802:Language; D008403:Mass Screening / Q000379:methods* / Q000706:statistics & numerical data; D011320:Primary Health Care / Q000379:methods; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013030:Spain