title: Reliability and validity of the Haitian Creole PHQ-9.
abstract: BACKGROUND
  There is limited information on depression in Haitians and this is partly attributable to the absence of culturally and linguistically adapted measures for depression.
  
  
  OBJECTIVE
  To perform a psychometric evaluation of the Haitian-Creole version of the PHQ-9 administered to men who have sex with men (MSM) in the Republic of Haiti.
  
  
  METHODS
  This study uses a cross-sectional design and data are from the Integrated Behavioral and Biological HIV Survey (IBBS) for MSM in Haiti.
  
  
  METHODS
  Inclusion criteria required that participants be male, ≥ 18 years, report sexual relations with a male partner in the last 12 months, and lived in Haiti during the past 3 months. Respondent Driven Sampling was used for participant recruitment.
  
  
  METHODS
  A structured questionnaire was verbally administered in Haitian-Creole capturing information on sociodemographics, sexual behaviors, human immunodeficiency virus (HIV) status and depressive symptomatology using the PHQ-9. Psychometric analyses of the translated PHQ-9 assessed unidimensionality, factor structure, reliability, construct validity, and differential item functioning (DIF) across subgroups (age, educational level, sexual orientation and HIV status).
  
  
  RESULTS
  In a study population of 1,028 MSM, the Haitian-Creole version of the PHQ-9 is unidimensional, has moderately high internal consistency reliability (α = 0.78), and shows evidence of construct validity where HIV-positive subjects have greater depression (p = 0.002). There is no evidence of DIF across age, education, sexual orientation or HIV status. HIV-positive MSM are twice as likely to screen positive for moderately severe and severe depressive symptoms compared to their HIV-negative counterparts.
  
  
  CONCLUSIONS
  There is strong evidence for the psychometric adequacy of the translated PHQ-9 screening tool as a measure of depression with MSM in Haiti. Future research is necessary to examine the predictive validity of depression for subsequent health behaviors or clinical outcomes among Haitian MSM.
authors.affiliation: Harvard School of Public Health, Department of Biostatistics, 677 Huntington Avenue, Landmark Center, 401 Park Drive, 3 East Boston, Boston, MA, 02215, USA, linda.marc@post.harvard.edu.
authors.forename: Linda G
authors.initials: LG
authors.lastname: Marc
authors.forename: Whitney R
authors.initials: WR
authors.lastname: Henderson
authors.forename: Astrid
authors.initials: A
authors.lastname: Desrosiers
authors.forename: Marcia A
authors.initials: MA
authors.lastname: Testa
authors.forename: Samuel E
authors.initials: SE
authors.lastname: Jean
authors.forename: Eniko Edit
authors.initials: EE
authors.lastname: Akom
mesh_terms: D000293:Adolescent; D000328:Adult; D003430:Cross-Sectional Studies; D003863:Depression / Q000175:diagnosis* / Q000453:epidemiology; D015658:HIV Infections / Q000453:epidemiology / Q000523:psychology; D006205:Haiti / Q000453:epidemiology; D006716:Homosexuality / Q000523:psychology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D011594:Psychometrics; D015203:Reproducibility of Results; D012725:Sexual Behavior; D055815:Young Adult
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