Objective:

Focusing on concepts from several Patient Reported Outcomes (PROs) aimed at adults with depression and possible suicide ideation, the objective is to analyse the suicide methods localised in over 30 languages and to highlight the need for back translation and cognitive debriefing reviews.

Methodology:

An analysis of several back translation and cognitive debriefing review grids was carried out to determine the challenges in localising suicide methods. Instances of the linguists suggesting updates to culturally appropriate suicide methods during back translation review and participants suggesting updates of the same during the cognitive debriefing interviews were the focus of further analysis. A percentage of suicide methods changed for cultural suitability per language was calculated, and then a sample of 13 suicide methods was cross-referenced to analyse the proportion of changes needed within the languages in the study (2.8% across 27 languages).

Results:

The majority of suicide methods remain the same across the world; however, there are a small amount of methods that differ and are more common in some countries than others. Out of the 13 suicide methods analysed (including ‘freezing’, ‘drowning’ and ‘suffocation/asphyxiation’), edits to the translation of these during back translation or cognitive debriefing review were necessary for 27% of all languages, with 33% of all languages receiving further suggestions from one or more cognitive debriefing participants. The general trend was that suicide involving automobiles caused the most issues in translation; for example, when translating the method ‘auto or similar “accident”’, clarification would be needed in some countries to determine whether ‘auto’ was linked to vehicles or industrial machinery.

Conclusion:

Using a translation methodology that includes back translation and cognitive debriefing reviews helps to facilitate the development of culturally-appropriate PROs to ensure they are fully representative of suicide methods in the target language and country, allowing for optimum PRO data collection.