Cultural adaptation, validity and reliability of the Marathi language version of the Patient Health Questionnaire-9 to screen depression in rural Maharashtra, India.

BACKGROUND: Screening is essential to bridge the significant care gap that exists for depression. PHQ-9 is a brief, valid, and reliable questionnaire, making it a valuable tool for detecting depression in both clinical and community settings. However, there is a lack of culturally and contextually appropriate local language versions of the PHQ-9, especially in India. This study aims to culturally adapt the existing Marathi version of the PHQ-9 for a rural Marathi-speaking population and evaluate its diagnostic accuracy and psychometric properties for detecting depression.

METHODS: We followed the World Health Organization's guidelines for the cultural adaptation of the PHQ-9, followed by the assessment of criterion, construct, and convergent and divergent validity, as well as reliability. We compared the performance of the Marathi version of the PHQ-9 with that of the semi-structured diagnostic interview. We also assessed test-retest and inter-rater reliability by estimating the Intraclass Correlation Coefficient (ICC) and internal consistency by calculating Cronbach's alpha.

RESULTS: For the Marathi version of PHQ-9, Area Under the Curve (AUROC) was 0.88 (95%CI: 0.86-0.91). Confirmatory Factor analysis supported a four-factor structure for the full sample (RMSEA = 0.039 (90% CI: 0.024-0.054), CFI = 0.985, TLI = 0.974, and SRMR = 0.024). Cronbach's alpha was 0.81 for the full sample, and the ICC for test-retest was 0.81.

CONCLUSION: Our findings support the use of the adapted Marathi version of the PHQ-9 for screening depression in the Marathi-speaking population. Future research efforts may benefit from adopting the comprehensive approach outlined in this study.