The effect of language of administration, experimentally induced symptom exaggeration, and criterion grouping method on self-reported depression and anxiety in Cuba: a cross-cultural study.

BACKGROUND

Despite increasing linguistic diversity in the US, little is known about the effects of limited English proficiency on psychiatric symptom report.

METHOD: Cuban university students were randomly assigned to control (n = 51) or experimental malingering (expMAL) condition (n = 25). The Patient Health Questionnaire (PHQ)-9 and Generalized Anxiety Disorder (GAD)-7 were administered in both English and Spanish. Classification accuracy was calculated using expMAL status and psychometrically defined symptom/performance validity as criteria.

RESULTS

PHQ-9 and GAD-7 scores did not differ as a function of language. Test-retest reliability/cross-language equivalence was high (0.89-0.95). Extreme scores (≥15 to ≥18) were sensitive (0.40-0.70) and specific (0.90-0.98) to invalid symptom report, but insensitive (0.11-0.26) to invalid performance.

CONCLUSIONS

Basic English proficiency may be sufficient to measure anxiety and depression in culturally diverse examinees. The PHQ-9 and GAD-7 have potential for dual use: they simultaneously measure anxiety/depression and non-credible symptom report. However, their symptom validity test function is limited by relatively low sensitivity. Symptom and performance validity were psychometrically distinct constructs.