A Linguistically and Culturally Specific Web-based Deaf Depression Screener: Validity and Reliability

Background: Screening, treatment and referral for depression has become standard in primary care. Many deaf persons cannot be screened using written instruments due to cultural and linguistic differences in their expression of depressive symptoms and low reading levels. While published reports suggest that deaf individuals experience depression more frequently than do hearing persons, deaf individuals may be less likely to be diagnosed and treated due to lack of a valid and reliable screening measure in American Sign Language (ASL).

Objective: Develop and test a web-based, self-administered, culturally and linguistically specific Deaf Depression Screener (DDS), keyed to DSM criteria, in ASL for deaf individuals.

Method: A translation team approach to creating the DDS included interviewing a signing psychiatrist and a mental health interpreter, and conducting focus groups for clarity of language and usability of the prototype screener.

Results: Thus far 272 Deaf persons have recruited. Current results on validity were obtained by comparing the DDS to remote assessment by a signing mental health clinician. Both DDS and mental health clinician used DSM criteria to determine the presence or absence of probable depression. Sensitivity is estimated at 85%; specificity at 70%.   Symptoms were summed and a Pearson correlation coefficient of .85 between the scores from the first and second test administrations indicates good test-retest reliability.

Conclusion: The DDS shows acceptable levels of validity and reliability. It will allow for patient privacy and cultural specificity while meeting the need for screening for depression, the most common mental health disorder seen in primary care.