Development of a culturally and linguistically specific depression screener for deaf individuals

Background: Screening for depression in primary care has become the standard in combating the debilitating effects of a treatable condition. Primary care is often the access point to mental health services. While written English screeners are appropriate for most US populations, this does not appear to be the case for culturally deaf individuals who use American Sign Language (ASL) as their main mode of communication. Possible reasons include: low literacy skills in this population, cultural and/or linguistic differences in the expression of depression from those used in English screeners, and unique deaf cultural experiences of depression. Objective: Develop and test a culturally and linguistically specific depression screen in ASL for deaf individuals, delivered via computer. Method: Items were selected from existing English screeners or translated directly from DSM-IV criteria. Items were shown on DVD to 2 patient and 1 staff focus groups. Focus group members were asked to comment on clarity of the questions and asked to offer alternative signs to convey depressive symptoms. Probes were added for unique cultural experiences/expressions of depression. Conclusion: Analysis of focus group data reveals new ways to inquire in ASL about some symptoms. It also reveals that anger is a common emotion for deaf persons who are depressed. In this case anger appears to be related to feeling frustrated and misunderstood, perhaps due to lack of cultural competence on the part of health care practitioners. These findings will be further refined through in-depth interviews with a signing psychiatrist and a mental health interpreter.