POS-545 Identifying depression in South Asian patients receiving haemodialysis in England: A multi-centre study

Abstract

Depression affects approximately 20-30% of patients receiving haemodialysis (HD). It is problematic because of association with a range of negative outcomes such as lower adherence to treatment and early mortality. This has led to greater effort to identify those experiencing associated symptoms and to offer suitable psychosocial care. The completion of self-report questionnaires is often a first step towards referral for further intervention but in countries with multi-ethnic demographics, language and or cultural barriers act to disadvantage those who cannot or do not want to engage in English. In this study, we assessed the use of culturally adapted and translated versions of commonly-used depression screening questionnaires with patients in England who identified with a South Asian heritage and had language needs or preferences in Gujarati, Punjabi, Urdu or Bengali. Patients completed adapted versions of the Patient Health Questionnaire (PHQ-9), the Centre for Epidemiological Studies Depression Scale Revised (CESD-R), and the Beck Depression Inventory II (BDI-II). A comparative sample of white-Europeans completed the questionnaires in English. The research took place across nine National Health Service (NHS) Trusts in England. Structural validity of translated questionnaires was assessed using confirmatory factor analysis (CFA). Diagnostic accuracy was explored in a subgroup of patients against ICD-10 categories using the Clinical Interview Schedule Revised (CIS-R) with receiver operating curve (ROC) analysis. 229 South Asian and 120 white-European HD patients participated. We found that a single latent depression factor largely accounted for the correlations between items of the PHQ-9, CESD-R and BDI-II. There were issues with measurement equivalence, which implied that scores on the translations may not be comparable with the English language versions. Against CIS-R based ICD-10 diagnosis of depression, sensitivity was modest (50-66.7%) across scales. Specificity was higher (81.3-93.8%). Alternative screening cut-offs did not improve positive predictive values. Culturally adapted translations of depression screening questionnaires are useful to explore symptom endorsement amongst South Asian patients in England. Consent rates and data completeness were excellent, suggesting that the exclusion of South Asians from existing research says more about methodological factors as opposed to patients being ‘hard to reach’. Data did not support the use of standard cut-off scores to classify symptom severity (i.e. mild, moderate, or severe). We also suggest that use of the CIS-R algorithms for optimal case identification requires further exploration in this setting. Taken together our findings raise important questions for how we collect and interpret patient reported outcomes from different patient communities within renal services. The study will be of interest to those working in the area of patient reported experience/ outcome measures, quality improvement, and addressing under-representation of non-indigenous kidney patients in research.