title: Depression in Aboriginal men in central Australia: adaptation of the Patient Health Questionnaire 9.
abstract: BACKGROUND
  While Indigenous Australians are believed to be at a high risk of psychological illness, few screening instruments have been designed to accurately measure this burden. Rather than simply transposing western labels of symptoms, this paper describes the process by which a screening tool for depression was specifically adapted for use across multiple Indigenous Australian communities.
  
  
  METHODS
  Potential depression screening instruments were identified and interrogated according to a set of pre-defined criteria. A structured process was then developed which relied on the expertise of five focus groups comprising of members from primary Indigenous language groups in central Australia. First, focus group participants were asked to review and select a screening measure for adaptation. Bi-lingual experts then translated and back translated the language within the selected measure. Focus group participants re-visited the difficult items, explored their meaning and identified potential ways to achieve equivalence of meaning.
  
  
  RESULTS
  All five focus groups independently selected the Primary Health Questionnaire 9, several key conceptual differences were exposed, largely related to the construction of hopelessness. Together with translated versions of each instrument for each of the five languages, a single, simplified English version for use across heterogeneous settings was negotiated. Importantly, the 'code' and specific conceptually equivalent words that could be used for other Indigenous language groups were also developed.
  
  
  CONCLUSIONS
  The extensive process of adaptation used in this study has demonstrated that within the context of Indigenous Australian communities, across multiple language groups, where English is often a third or fourth language, conceptual and linguistic equivalence of psychological constructs can be negotiated. A validation study is now required to assess the adapted instrument's potential for measuring the burden of disease across all Indigenous Australian populations.
authors.forename: Alex D H
authors.initials: AD
authors.lastname: Brown
authors.forename: Ricky
authors.initials: R
authors.lastname: Mentha
authors.forename: Kevin G
authors.initials: KG
authors.lastname: Rowley
authors.forename: Timothy
authors.initials: T
authors.lastname: Skinner
authors.affiliation: Wardliparingga Aboriginal Research Unit, South Australian Health and Medical Research Institute, PO Box 11060, 5001, Adelaide, South Australia, Australia. carol.davy@sahmri.com.
authors.forename: Carol
authors.initials: C
authors.lastname: Davy
authors.forename: Kerin
authors.initials: K
authors.lastname: O'Dea
mesh_terms: D000328:Adult; D000368:Aged; D001315:Australia / Q000453:epidemiology; D017281:Cost of Illness; D003469:Culture; D003866:Depressive Disorder / Q000208:ethnology*; D005006:Ethnicity; D017144:Focus Groups; D006801:Humans; D007802:Language; D008297:Male; D008403:Mass Screening; D008571:Men; D059020:Suicidal Ideation; D011795:Surveys and Questionnaires; D014175:Translating