Translation, cultural adaption, and validation of the PHQ-9 and GAD-7 in Kinyarwanda for primary care in the United States

BackgroundDepression and anxiety are significant health burdens that greatly impact the quality of life of refugees and migrants. In this study, we have translated and culturally adapted the Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder Screener (GAD-7) into Kinyarwanda and performed a validation study in a United States (US) primary care setting. MethodsA committee of experts translated and culturally adapted the PHQ-9 and GAD-7, incorporating feedback from cognitive interviews with bilingual participants. The translated instruments were then tested in a cross-sectional validation study. Analyses include internal consistency, discriminative validity, principal component analyses, and confirmatory factor analyses. ResultsAnalyses of 119 responses indicated overall good internal consistency with Cronbachs of 0.85 (PHQ-9) and 0.92 (GAD-7). Both scales showed acceptable factor loadings between 0.44 and 0.90 in the principal component analyses and showed strong correlations with health-related quality of life and depression/anxiety symptoms measured with visual analog scales. Significantly higher scores for PHQ-9 and GAD-7 were shown among participants with known psychiatric conditions. DiscussionPHQ-9 and GAD-7 demonstrated commendable applicability for Kinyarwanda-speaking patients in primary healthcare settings in the US. Culturally adapted translations of these tools may aid in mitigating health disparities among refugee and migrant populations. Future research should further validate these tools against gold-standard diagnostics in larger, geographically diverse samples.