Title: Screening for depression in South Asian patients with End Stage Renal Disease: An evaluation of the Beck Depression Inventory-II and the Patient Health Questionnaire-9
Funder: Department of Health (England)

Abstract: Background: The treatment regimen for End Stage Renal Disease (ESRD) is taxing for patients. In addition to dialysis itself, there is strain associated with medication effects, hospital attendance, and changes in lifestyle, fluid and diet intake [1]. Consequently, depression is the most common comorbidity in ESRD affecting approximately 20- 30% of patients [1-2]. It is associated with negative outcomes such as reduced compliance with treatment and higher morbidity and mortality [3-5]. Given the impact of depression on health related quality of life, it is essential that patients are helped in managing the psychological impact of living with a chronic illness (NICE, 2009)[6]. Depression is typically measured using self-complete questionnaires developed primarily with white, English speaking populations [1]. Research suggests that such measures accurately identify distress in patients with ESRD and there are now emerging trials of suitable interventions [7]. Indeed, we are exploring the efficacy of medication in helping patients manage depression on dialysis. A large proportion of patients living with ESRD are from South Asian backgrounds [8-11]. South Asian is defined here as a diverse group including the following ethnic subgroups: Indian, Pakistani, Bangladeshi, Sri Lankan, Nepalese, Bhutanese, and Mauritian [12]. Due to language barriers and a lack of clarity on suitable screening methods, it has been difficult to establish the prevalence of depression in the UK South Asian dialysis population [13]. This is a significant barrier to offering all patients equal access to treatment. Although some translated scales for measuring depression exist, studies of validity and reliability are lacking [6,13]. Due to cultural variations in the understanding and experience of distress, it is also unclear whether measures developed with one cultural group are applicable to another [6,13]. Research that does exist suggests that at least in the UK, translated scales may work as well as culture specific measures of depression [6,14], although more research is needed, particularly with people affected by a chronic illness. Depression may be more difficult to measure in patients due to the overlap of symptoms related to depression versus the chronic illness itself [1]. Research Aims: This proposal aims to improve screening for depression in South Asian ethnic groups by undertaking the translation of two gold standard English language questionnaires - The Beck Depression Inventory (BDI-II) and the Patient Health Questionnaire (PHQ-9) - into 5 South Asian languages that meet the needs of the majority of ESRD patients (Punjabi, Bengali, Sylheti, Gujarati and Urdu). Plan of Investigation: The translated scales will be: Administered to a cross-sectional sample of patients. A subset of patients will be followed up with a clinical diagnostic interview to identify the sensitivity and specificity of the scales. Patients will also be asked about if they would be willing to engage with different types of treatment to establish the feasibility of intervention in this group. Benefits to Patients: Improved diagnosis of distress. Access to treatment. Understanding of the size of the problem in the target group relative to other renal service users. Care that is individualised to patient needs. Benefits to the NHS: Better knowledge on the utility of different screening measures as applied to ethnic minorities affected by a chronic illness (priority identified by NICE). This could help, for example, update NICE guidelines so that the outcomes have greater impact across different services where South Asians dominate (e.g. Diabetes and Cardio). Equalizing access to services for members of ethnic minorities. Reducing disparities in health care is a key NHS priority that this proposal directly addresses, particularly in the remit of psychological care. Commissioning research that is responsive to the preferences, values and needs of different people.


Research activity codes: 4.4 POPULATION SCREENING
Health categories: MENTAL HEALTH;RENAL AND UROGENITAL