Depression screening among Haitian immigrants: A quality-improvement project

ABSTRACT Background: Haitians frequently encounter barriers during screening for depression. This quality-improvement project evaluated the effectiveness of depression screening tools specifically adapted for Haitian Creole-speaking populations. Local Problem: The English version of the Patient Health Questionnaire-9 (PHQ-9), widely used to screen for depressive symptoms, may not accurately assess depression due to cultural and linguistic nuances. Methods: The plan-do-study-act method was used to evaluate the effectiveness of the culturally adapted Haitian Creole PHQ-9 and Zanmi Lasante Depression Symptom Inventory (ZLDSI) in comparison to the English PHQ-9 among 50 Haitian adults who had completed the English PHQ-9 six months before implementing this quality-improvement project. Interventions: The Haitian Creole PHQ-9 and ZLDSI were administered over 3 months during routine clinic visits to screen Haitians for depression. Patients who met diagnostic criteria for depression were identified and referred for further mental health services. Results: Diagnostic accuracy was comparable across the three tools: 6% scored mild-to-moderate depression on the English PHQ-9 and the ZLDSI, whereas 10% did so on the Haitian Creole PHQ-9 and were referred to mental health services. The Haitian Creole PHQ-9 and ZLDSI were more sensitive in detecting culturally nuanced symptoms, flagging near-threshold cases at higher risk of depression. Internal consistency reliability was 0.905 for the ZLDSI, 0.798 for the Haitian Creole PHQ-9, and 0.710 for the English PHQ-9. Conclusions: Nurse practitioners should use culturally and linguistically responsive screening tools for Haitian immigrants to better capture depressive symptoms, identify those at risk, bridge the diagnostic gap, and ensure appropriate referrals.