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BACKGROUND: There is limited information on depression in Haitians and this is partly attributable to the absence of culturally and linguistically adapted measures for depression. OBJECTIVE: To perform a psychometric evaluation of the Haitian-Creole version of the PHQ-9 administered to men who have sex with men (MSM) in the Republic of Haiti. DESIGN: This study uses a cross-sectional design and data are from the Integrated Behavioral and Biological HIV Survey (IBBS) for MSM in Haiti. PARTICIPANTS: Inclusion criteria required that participants be male, ≥ 18 years, report sexual relations with a male partner in the last 12 months, and lived in Haiti during the past 3 months. Respondent Driven Sampling was used for participant recruitment. MAIN MEASURES: A structured questionnaire was verbally administered in Haitian-Creole capturing information on sociodemographics, sexual behaviors, human immunodeficiency virus (HIV) status and depressive symptomatology using the PHQ-9. Psychometric analyses of the translated PHQ-9 assessed unidimensionality, factor structure, reliability, construct validity, and differential item functioning (DIF) across subgroups (age, educational level, sexual orientation and HIV status). KEY RESULTS: In a study population of 1,028 MSM, the Haitian-Creole version of the PHQ-9 is unidimensional, has moderately high internal consistency reliability (α = 0.78), and shows evidence of construct validity where HIV-positive subjects have greater depression ( p = 0.002). There is no evidence of DIF across age, education, sexual orientation or HIV status. HIV-positive MSM are twice as likely to screen positive for moderately severe and severe depressive symptoms compared to their HIV-negative counterparts. CONCLUSIONS: There is strong evidence for the psychometric adequacy of the translated PHQ-9 screening tool as a measure of depression with MSM in Haiti. Future research is necessary to examine the predictive validity of depression for subsequent health behaviors or clinical outcomes among Haitian MSM. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article "Reliability and validity of the Haitian Creole PHQ-9" by Linda G. Marc, Whitney R. Henderson, Astrid Desrosiers, Marcia A. Testa, Samuel E. Jean and Eniko Edit Akom published in the same issue.