Cultural and Linguistic Issues in Developing an Adaptation of the Geriatric Depression Scale for Laotian Elderly

Objectives. Studies and instruments to measure depression among Laotian elderly are lacking, despite the burden of mental illness among Southeast Asian refugees. Using an iterative process, we adapted the Geriatric Depression Scale (GDS) as a screening instrument for use among Laotian elderly. We will explain how cultural and linguistic factors impacted the process.

Methods. A multilingual outreach worker from a Southeast Asian community organization translated the English GDS into Lao and a separate outreach worker back-translated the Lao translation into English. Despite fairly equivalent translation/back-translation documents, this initial Lao GDS did not result in a valid instrument. Issues in semantic and content equivalence inherent in translation had to be taken into account before validity was achieved. The final version of the Lao GDS was used to screen elderly for depression and one week after the initial screening, the Lao GDS was retested for face validity and reliability.

Results. Simple translation and back translation did not result in a valid Lao GDS. Certain English words such as “helpless” were especially challenging to find Lao equivalents. The yes/no format also resulted in inaccurate interpretation and response to the questions among the elderly. Problems were overcome by engaging research staff and translators in an iterative process to arrive at a valid translation.

Conclusions. In order to produce a valid GDS adapted for Laotian elderly, cultural and linguistic differences should be taken into account in an iterative and collaborative process in which the translators are closely involved. Simple translation/back-translation should be used with caution.