Responses to Depression Scale items among Mexican-Americans and non-Hispanic whites

Predictors of somatic symptom severity: The role of cumulative history of trauma and adversity in a diverse community sample

OBJECTIVE

Somatic symptoms are often reported among victims of trauma, and place a significant burden on primary care health providers. We examined the relationship between lifetime histories of trauma and adversity, including aspects not previously studied (i.e., perceived discrimination), and somatic symptoms, as well as the mediating role of posttraumatic stress symptoms (PTSS) and depressive symptoms.

METHOD

A multiethnic community sample of 500 male and female participants (230 African American and 270 Latino) completed measures of demographic characteristics, the University of California, Los Angeles Lifetime Adversities Screener (LADS), depressive symptoms, PTSS, and somatic symptoms.

RESULTS

An ordinary least-squares regression analysis controlling for age, gender, and race/ethnicity indicated that higher levels of lifetime adversity and trauma were significantly associated with more severe somatic symptoms (b = 6.95, p < .0001). Formal mediation tests indicated that there was a significant indirect effect of LADS on somatic symptoms via PTSS and depressive symptoms, indirect effect = 2.64 (95% confidence interval [CI] [1.2, 4.1]) and 2.19 (95% CI [1.3, 3.3]), respectively. Even after PTSS and depressive symptoms were taken into account, the LADS remained significantly associated with somatic symptoms (b = 2.13, p < .05), suggesting partial mediation.

CONCLUSION

Exposure to traumatic and adverse events (the LADS) was associated with somatic symptom severity. Furthermore, although PTSS and depressive symptoms partially accounted for the association between the LADS and somatic symptoms, the LADS remained significant, suggesting that both exposure to trauma and adversity and the resultant development of PTSS and depressive symptoms influence the development of somatic symptoms. (PsycINFO Database Record

Dual Ethnicity and Depressive Symptoms: Implications of Being Black and Latino in the United States

This study investigated the expression of depressive symptoms in adolescents who are of Afro-Latino descent. Levels of expression of depressive symptoms were compared for four groups of adolescents in Grades 7 through 12 residing in the United States: European Americans, African Americans, Latinos, and Afro-Latinos. One hypothesis is that Afro-Latinos should exhibit higher levels of depressive symptoms than either African Americans or Latinos by virtue of being double minorities. An alternative hypothesis is that Afro-Latino youth will show lower levels of depressive symptomology because of their access to a broader repertoire of cultural resources when faced with stress and depression-inducing events. Results indicated that Afro-Latino females tended to exhibit higher levels of depressive symptoms than those of the other ethnic groups. Across all ethnic groups, adolescent females tended to show higher levels of depressive symptoms than adolescent males and older adolescents tended to show higher levels of depression than younger adolescents.

Depressive symptoms and responses to cigarette pack warning labels among Mexican smokers

OBJECTIVE

We examine whether having depressive symptoms (DS) is associated with different responses to cigarette package health warning labels (HWLs) before and after the implementation of pictorial HWLs in Mexico.

METHOD

We analyze data from adult smokers from Wave 4 and Wave 5 (n = 1,340) of the International Tobacco Control Policy Evaluation Project in Mexico. Seven Center for Epidemiological Studies Depression Scale (CES-D) items assessed DS, with scores ≥7 indicating elevated DS. Outcomes included: attention to HWLs, cognitive responses to HWLs, tobacco constituents awareness, putting off smoking due to HWLs, avoidance of HWLs, and awareness of telephone support for cessation (i.e., quitlines). Mixed effects models were used to assess main and interactive effects of DS and time (i.e., survey wave) on each outcome.

RESULTS

All HWL responses increased over time, except putting off smoking. Statistically significant interactions were found between DS and time for models of tobacco constituents awareness (b = -0.36, SE = 0.15, p = .022), putting off smoking (OR = 0.41, 95% CI [0.25, 0.66]), avoidance of HWLs (OR = 1.84, 95% CI [1.03, 3.29]), and quitline awareness (OR = 0.35, 95% CI [0.21, 0.56]). Compared to smokers with low DS, smokers with elevated DS reported stronger HWL responses at baseline; however, HWL responses increased over time among smokers with low DS, whereas HWL responses showed little or no change among smokers with elevated DS.

DISCUSSION

Population-level increases in HWL responses after pictorial HWLs were introduced in Mexico appeared mostly limited to smokers with low DS. In general, however, smokers with elevated DS reported equivalent or stronger HWL responses than smokers with low DS.

Caregiver burden as a predictor of depression among family and friends who provide care for persons with bipolar disorder

OBJECTIVES

Over one-third of caregivers of people with bipolar disorder report clinically significant levels of depressive symptoms. This study examined the causal relationship between depression and caregiver burden in a large sample of caregivers of adult patients with bipolar disorder.

METHODS

Participants were 500 primary caregivers of persons with bipolar disorder enrolled in the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD).This study evaluates the strength and direction of the associations between caregiver burden and depressive symptoms at baseline and at six- and 12-month follow-up using cross-lagged panel analyses, controlling for the clinical status of patients and sociodemographic variables.

RESULTS

Higher levels of overall caregiver burden at baseline were associated with increased levels of depressive symptoms among caregivers at follow-up (F = 8.70, df = 1,290, p < 0.001), after controlling for baseline caregiver depression, gender, race, age, social support, and patients' clinical status. By contrast, caregiver depression at baseline was not significantly associated with caregiver burden at follow-up (F = 1.65, p = 0.20).

CONCLUSIONS

Caregiver burden is a stronger predictor of caregiver depressive symptoms over time than the reverse. Interventions that help alleviate caregiver burden may decrease depressive symptoms.

Gender and the children's depression inventory's (CDI) ‘crying’ question

Objectives: Following disruption from students, particularly boys, during the administration of item 10, the ‘feel like crying’ question, of the Children's Depression Inventory (CDI), this study sought to explore the issue of non-response to this question. It was decided that particular attention should be given to gender differences in responses and non-responses, based on the experiences of researchers administering this measure.

Method: Chi-square analysis of non-responses was conducted on CDI items collected from a total sample of 2,297 second year and pre-leaving certificate students from 23 randomly selected schools in the Mid-West region of Ireland.

Results: Analysis identified item 10 as being significantly less likely to be completed than any other item. Further analysis revealed that boys were significantly less likely to respond to this question than girls.

Conclusion: A modification of the wording to item 10 is suggested to ameliorate this difficulty.

Depressive symptoms of midlife Latinas: effect of immigration and sociodemographic factors

Immigrant Latinas may have different cultural attitudes toward menopause and aging, and may experience higher levels of distress associated with adaptation to their new environment. The purpose of this secondary analysis was to describe the frequency of depressive symptoms experienced by premenopausal Latinas (40-50 years of age) living in the United States and compare Latinas born in the US with immigrant Latinas on stress and sociodemographic factors that influence depressive symptom experience. Analysis was conducted on a subsample of 94 self-identified Latinas who participated in a longitudinal study and completed the Center for Epidemiological Studies-Depression (CES-D) scale at enrollment and 6 months. Immigrant Latinas had a significantly higher CES-D (14.4 ± 11.1) than US-born Latinas (10.0 ± 7.9) and the difference remained at 6 months. There was no difference in age, body mass index (BMI), self-report of general health, or perceived stress. Higher BMI, work-related stress, and insufficient income for essential daily needs were associated with depressive symptom scores in immigrant Latinas. High BMI and less education were associated with depressive symptom scores in the US-born Latinas.

Correlates of mental health among Latino farmworkers in North Carolina

PURPOSE

Latino farmworkers are a vulnerable population who confront multiple threats to their mental health. Informed by the stress-process model of psychiatric disorder, the goal of this paper is to determine primary and context-specific stressors of poor mental health among Latino farmworkers.

METHODS

Structured interview data were obtained from farmworkers (N = 69) in 6 counties in eastern and western North Carolina.

FINDINGS

Results indicated that a substantial number of farmworkers have poor mental health, as indicated by elevated depressive symptoms (52.2%) and anxiety (16.4%). Results also indicated that each mental health outcome had different predictors.

CONCLUSION

Addressing the mental health issues of farmworkers requires a comprehensive, multifaceted approach.

Psychometric value of the Center for Epidemiologic Studies Depression (CES-D) scale for screening of depressive symptoms in Armenian population

BACKGROUND

This study examined the psychometric value of the Center for Epidemiologic Studies Depression Scale (CES-D) translated for use with an Armenian population.

METHODS

Using data obtained from a country-wide health survey of 2310 households involving female and male respondents aged 18 and over, we investigated the response pattern to the CES-D items, the factor structure, internal consistency, inter-item correlations of the total scale and its negatively and positively formulated subscales. We used logistic regression analysis to relate the constructs measured by the CES-D and its subscales to known determinants of depression.

RESULTS

Armenian respondents of both genders significantly suppressed their positive emotions, thus over-endorsing positively formulated (reverse-coded) items, therefore producing artificially high depression scores. Factor analysis of the scale yielded a three-factor structure (combined Depressed/Somatic, Positive Affect, and Interpersonal). The Positive Affect factor correlated weakly with the other two factors, and its inclusion reduced the internal consistency of the whole scale. Unlike the 16-item subscale of negatively formulated items, Positive Affect was not related to several known determinants of depression and did not reflect known depression-specific differences between genders. The set of determinants of Positive Affect included mainly lifestyle and attitudinal variables.

LIMITATIONS

This study did not assess the concurrent and discriminate validity of the Armenian CES-D.

CONCLUSIONS

For Armenians, the construct measured by the four Positive Affect items of CES-D is not related to depressive symptoms as measured by the other items. It introduces ethnical/cultural response bias in CES-D score and reduces the cross-cultural comparability of the latter.

Cross-cultural considerations in administering the center for epidemiologic studies depression scale

BACKGROUND

Cultural biases may affect the individual responses to questionnaires for depression and thus confound the international or multiethnic researches on depression.

OBJECTIVE

We compared the diagnostic accuracy of the Center for Epidemiologic Studies Depression Scale (CES-D) for major depressive disorder (MDD) in late life between Korean and US Caucasian elderly.

METHODS

This study included 332 US Caucasian MDD patients, 116 Korean MDD patients, 125 US Caucasian nondepressed subjects and 700 Korean nondepressed subjects. Differential item functioning and factor analyses were conducted to examine the differences in the response patterns to the CES-D between the US Caucasian and Korean elderly. Diagnostic accuracy of the CES-D for MDD was compared using the area under the receiver-operating characteristic curves (AUC).

RESULTS

The Korean elderly were more likely to endorse 6 items compared to the US Caucasians, and the US Caucasian elderly were more likely to endorse 5 items compared to the Koreans. The factor solutions from both ethnic groups were not comparable since the congruence coefficient for the second factor was below 0.46 and that for the first factor did not reach 0.90. The AUC of the CES-D for MDD in Koreans (AUC = 0.850, 95% CI = 0.801-0.899) was significantly smaller than that in US Caucasians (AUC = 0.973, 95% CI = 0.960-0.987), and the optimal cutoff score of the CES-D in the Korean elderly (21/22) was 2 times higher than that in the US Caucasian elderly (10/11).

CONCLUSION

Cross-cultural issues may significantly influence the diagnostic accuracy of depression questionnaires and thus should be considered more carefully than before in both clinical and research settings on multiethnic populations.

Ethnic and Sex Differences in Children's Depressive Symptoms

This study examined ethnic and sex differences in children's depressive symptoms, along with hypothesized mediators of those differences (academic achievement, peer acceptance), in a follow-up of African American (n = 179) and Euro-American (n = 462) children in Grades 3 to 5. African American boys reported more depressive symptoms than African American girls, and Euro-American boys and girls. Also, depressive symptoms of African American boys increased over time whereas depressive symptoms of the other groups decreased or remained stable. Academic and social competence deficits were associated with elevated levels of depressive symptoms across the school year, although only academic achievement scores emerged as a unique predictor of increases in depressive symptoms over time. Neither academic nor social competence mediated the SexA xA ethnicity interaction in changes in children's depressive symptoms.

Differential item responses on CES-D inventory: A comparison of elderly Hispanics and non-Hispanic Whites in the United States and item usage by elderly Hispanics across time

OBJECTIVES

This study examines the differential item functioning (DIF) on both the standard 20-item scale and 10-item and 12-item subsets of the Center for Epidemiological Studies Depression (CES-D) inventory.

METHOD

Two elderly groups in the United States are compared: one composed of Hispanics and the other of non-Hispanic Whites. We also compare item use among the elderly Hispanics over time. Survey data was analyzed from participants (N = 4499) in the Established Populations for Epidemiologic Studies of the Elderly (EPESE) with complete data on the CES-D. Partial correlation analysis was applied to test hypotheses regarding the DIF on the basis of ethnic background and among the elderly Hispanics across time points.

RESULTS

Hispanics appear to express positive affect differently than non-Hispanic Whites. On the 20-item scale, Hispanics under responded to items measuring positive affect. Item bias was also found for one positive affect question in the 10-item subset. Among the Hispanic sub-population, we also observed item response bias for the positive affect items across time. A 12-item subset tested for DIF displays an acceptable amount of item bias across ethnic groups and across time for the Hispanic sample.

CONCLUSIONS

Attempts to make substantive comparisons about the relative prevalence of depression symptoms in elderly Hispanic and non-Hispanic sub-populations appears to be limited by the lack of measurement invariance in the full CES-D. Comparisons across time for elderly Hispanics also appear problematic.

Leaving family for work: ambivalence and mental health among Mexican migrant farmworker men

Men migrating to the United States from Mexico and Central America confront opposing family norms. They need to leave their families to gain family economic security; yet, leaving renders their families vulnerable. We examined the mental health implications of the opposing family norms inherent in migration using an ambivalence framework. We interviewed 60 Latino migrant farmworkers working in North Carolina. Most were from Mexico; each had left a wife and children in his country of origin. Analysis indicated that family ambivalence was common. Ambivalence was associated with anxiety symptoms (but not depression or alcohol dependence), especially among men who were unable to contact their families regularly. Results show the usefulness of the ambivalence framework, and suggest that the origins of poor migrant mental health may reside in circumstances preceding migration. Study recommendations include facilitating family contact by expanding access to telephones among migrant workers.

Diagnostic accuracy of Spanish language depression-screening instruments

PURPOSE

To make decisions about implementing systematic depression screening, primary care physicians who serve Spanish-speaking populations need to know whether Spanish language depression-screening instruments are accurate. We aimed to review systematically the evidence regarding diagnostic accuracy of depression-screening instruments in Spanish-speaking primary care populations.

METHODS

We searched PubMed, PsycINFO, CINAHL, EMBASE, and Cochrane Libraries from inception to May 28, 2008, for studies examining the diagnostic accuracy of Spanish language depression case-finding instrument(s) administered to primary-care outpatients. Two authors independently assessed studies for inclusion and quality.

RESULTS

Twelve studies met inclusion criteria. In general primary care screening, the Spanish language version of the Center for Epidemiologic Studies-Depression scale (CES-D) had sensitivities ranging from 76% to 92% and specificities ranging from 70% to 74%. We found no US study reporting the accuracy of the Primary Care Evaluation of Mental Disorders (PRIME-MD-9) or the Patient Health Questionnaire (PHQ-9) depression module in Spanish-speakers. One fair-quality European study and 1 poor-quality study conducted in Honduras found the 9-item PRIME-MD had sensitivities ranging from 72% to 77% and specificities ranging from 86% to 100%. The 2-item PRIME-MD was 92% sensitive, but only 44% specific for depression in 1 US study. In geriatric outpatients, the 15-item Spanish language version of the Geriatric Depression Scale (GDS) had sensitivities ranging from 76% to 82%, and specificities ranging from 64% to 98%. In postpartum women, the Spanish language version of the Edinburgh Postnatal Depression Scale (EPDS) was 72% to 89% sensitive and 86% to 95% specific for major depression (2 non-US studies). The Spanish language version of the Postpartum Depression Screening Scale (PDSS) was 78% sensitive and 85% specific for combined major/minor depression (1 US study).

CONCLUSIONS

For depression screening in Spanish-speaking outpatients, fair evidence supports the diagnostic accuracy of the CES-D and PRIME-MD-9 in general primary care, the GDS-15-Spanish for geriatric patients, and the Spanish language versions of the EPDS or PDSS for postpartum patients. The ultrashort 2-item version of PRIME-MD may lack specificity in US Spanish-speakers.

Effects of acculturation on the reporting of depressive symptoms among Hispanic pregnant women

BACKGROUND

Significant differences have been reported in the prevalence of depression between Mexicans and Mexican Americans. Whether the differences in prevalence are real or are the results of cultural bias in instrumentation is not known.

OBJECTIVES

To examine the association between acculturation and the responses to the individual depressive symptom item of the Center for Epidemiologic Studies Depression Scale (CES-D).

METHODS

The CES-D was administered to 395 Hispanic women during their 22-24 weeks' pregnancy clinic visit. Acculturation was defined by a subject's language preference of English or Spanish when completing the CES-D. Those who preferred English belong to the acculturated group and those who preferred Spanish are considered nonacculturated. Logistic regression was used to conduct differential item functioning (DIF) analysis for each of the 20 CES-D items to determine whether they operated differently between the acculturated Hispanic group and the nonacculturated Hispanic group.

RESULTS

Reliability of the CES-D total score was .86 and .88 for the nonacculturated and acculturated groups, respectively. None of the items of the Depressed Affect Subscale showed DIF. However, DIF was found in four out of the seven items in the Somatic Activity Subscale and in three out of the four items in the Positive Affect Subscale.

DISCUSSION

The results suggest that even within a homogenous Hispanic group of mostly Mexican Americans, responses to the CES-D differ by acculturation. The nonacculturated group are less likely to endorse somatic symptoms but more likely to endorse positive items than the acculturated group. Depression screening in this population needs to account for acculturation differences within the Hispanic group.

Effect of immigrant status on risk of depressive symptoms associated with spouse's chronic conditions

The aim of this prospective cohort study was to assess whether the prevalence of chronic disease of one spouse would be associated with a change in depressive symptoms of the other spouse and whether this relationship varies by immigrant status. Negative binomial regression was used to calculate risk ratios from a matched sample of 553 husbands and 553 wives aged 65 years or older of Mexican Americans. Overall, prevalence of chronic disease of one spouse was associated with change in high depressive symptoms for the other spouse. When the results were stratified by immigrant status, respondents born in the US exhibited higher risk of depressive symptoms associated with the chronic conditions of their spouse, while foreign born respondents did not exhibit higher risk for depressive symptoms. These findings highlight how immigrant status and the marital relationship may be related to chronic disease and depression.

Epidemiology of major depression in four cities in Mexico

Analyses were conducted to estimate lifetime and current prevalence of major depressive disorder (MDD) for four representative cities of Mexico, to identify variables that influence the probability of MDD, and to further describe depression in Mexican culture. A multistage probability sampling design was used to draw a sample of 2,509 adults in four different regions of Mexico. MDD was assessed according to DSM-IV criteria by using the Composite International Diagnostic Interview collected by trained lay interviewers. The prevalence of MDD in these four cities averaged 12.8% for lifetime and 6.1% for the previous 12 months. MDD was highly comorbid with other mental disorders. Women were more likely to have lifetime MDD than were men. Being divorced, separated, or widowed (compared to married or never married) and having experienced childhood trauma were related to higher lifetime prevalence but not to current prevalence. In addition, age and education level were related to current 12-month MDD. Data on the profile of MDD in urban Mexico are provided. This research expands our understanding of MDD across cultures.

Acculturative stress, anxiety, and depression among Mexican immigrant farmworkers in the midwest United States

No previous studies have examined the psychological functioning of immigrant farmworkers in the midwest United States. The purposes of the present study were threefold: (1) to assess the prevalence levels of anxiety and depression in a sample of Mexican immigrant farmworkers in the midwest United States; (2) to explore the relationships among acculturative stress, anxiety, and depression; and (3) to examine the variables that best predict anxiety and depression. The overall sample revealed elevated levels of anxiety and depression. Immigrant farmworkers with heightened levels of acculturative stress reported high levels of anxiety and depression. Family dysfunction, ineffective social support, low self-esteem, lack of choice in the decision to immigrate and live a migrant farmworker lifestyle, high education levels, and low levels of religiosity were significantly associated with high levels of anxiety and depression. The overall findings suggest that Mexican immigrant farmworkers who experience elevated levels of acculturative stress may be "at risk" for experiencing high levels of anxiety and depression. The findings highlight the importance of establishing prevention and treatment services for migrant farmworkers that aim to increase levels of emotional support, self-esteem, and coping skills.

The validation of the Texas revised inventory of grief on an older Latino sample

PURPOSE

Bereavement is considered to be one of the most profound experiences in older adulthood. However, assessments of emotional reactions to grief and loss have often been based on measures tested on primarily Anglo samples. This study examined the validity and factor structure of a commonly used bereavement measure on an older Latino sample.

DESIGN AND METHODS

Using convergent and discriminant validation procedures, this instrument was tested using a purposive sample of 134 older, recently bereaved Latinos.

RESULTS

While the instrument was originally designed to measure two domains of grief: Past Behaviors and Present Feelings, confirmatory and exploratory factor analysis revealed a three-factor solution for this sample which included also Disbelief of the loss. Items within this domain included anger, rejection, and a sense of injustice.

IMPLICATIONS

This study underscores the need for improved measures in research on grief and bereavement to capture the intensity and severity of grief in a cross-cultural context.

Gender Differences in Anxiety and Depression Among Immigrant Latinos

This study determines elements of a social history that could assist primary care providers in identifying and treating anxiety and depression among immigrant Mexicans. Cross-sectional data were obtained through interviewer-administered survey questionnaires from immigrant Latinos in the United States fewer than 5 years (N = 150). Interviews were conducted by native Spanish-speakers in community settings. Mental health was measured with the Center for Epidemiologic Studies-Depression Scale (CES-D) and the Personality Assessment Inventory (PAI). Mental health in this sample was poor with nearly 40% indicating levels of anxiety and depression that may impair functioning. Social marginalization was associated with higher depression symptoms in men, and separation from family stress was associated with more depressive symptoms among women. When caring for immigrant Latinos, questions about social isolation and separation from family may provide insight into stress and its contribution to clinically significant anxiety and depression. These characteristics should also be considered when offering a treatment plan for anxiety and depression.

Study of the integrated cognitive model of depression among Latin-Americans

OBJECTIVE

The objective of the present study is to test the validity of the integrated cognitive model (ICM) of depression proposed by Kwon and Oei with a Latin-American sample. The ICM of depression postulates that the interaction between negative life events with dysfunctional attitudes increases the frequency of negative automatic thoughts, which in turns affects the depressive symptomatology of a person. This model was developed for Western Europeans such as Americans and Australians and the validity of this model has not been tested on Latin-Americans.

METHOD

Participants were 101 Latin-American migrants living permanently in Brisbane, including people from Chile, El Salvador, Nicaragua, Argentina and Guatemala. Participants completed the Beck Depression Inventory, the Dysfunctional Attitudes Scale, the Automatic Thoughts Questionnaire and the Life Events Inventory. Alternative or competing models of depression were examined, including the alternative aetiologies model, the linear mediational model and the symptom model.

RESULTS

Six models were tested and the results of the structural equation modelling analysis indicated that the symptom model only fits the Latin-American data.

CONCLUSIONS

Results show that in the Latin-American sample depression symptoms can have an impact on negative cognitions. This finding adds to growing evidence in the literature that the relationship between cognitions and depression is bidirectional, rather than unidirectional from cognitions to symptoms.

Reliability and factor structure of the Brazilian version of the Center for Epidemiologic Studies-Depression

The Center for Epidemiologic Studies-Depression scale is a screening test designed by the National Institute of Mental Health (USA) to screen for 'depressed' individuals in the community. It has been widely used in different settings and cultures displaying variable psychometric properties. The present article describes coefficients of internal consistency and factor analysis of the CES-Depression version adapted for use in Brazil. In a sample of 523 college students internal consistency measured by Cronbach alpha was .85. Structure analysis evidenced that two questions were poorly correlated with the remaining questions. Factor analysis resulted in a four-dimension solution accounting for 53.8% of the total item variance. The scale is adequate for use in this different cultural setting.

Race/ethnicity and depressive symptoms: a cross-cultural/ethnic comparison among university students in East Asia, North and South America

To examine manifestations of depressive symptomatology among undergraduate students in East Asia, North and South America, responses to the Center for Epidemiologic Studies Depression Scale (CES-D) were compared across Japanese (n = 310), Anglo-American (n = 377), Native American (n = 353), and Argentinean (n = 110) undergraduate students. Japanese reported a significantly higher level of low positive affect, leading to significantly higher total CES-D scores, whereas their negative symptoms score was comparable to scores of Anglo-Americans and Argentineans. Although Native Americans were more likely to endorse negative symptoms, their low positive affect score was comparable to those of Argentineans. Argentineans appear to suffer less from depressive symptoms. Results from a Differential Item Functioning analysis, using Anglo-Americans as the reference group, indicated that: (1) the manifestation of depressive symptoms seemed to be similar for Anglo-Americans and Argentineans, except for low positive affect; (2) Native Americans tended to favor somatic symptoms over affective (depressive) symptoms; (3) responses to positive affect questions could possibly be biased not only for Japanese but also for people in North America; i.e., the expression of positive affect might be enhanced in North American culture, while inhibited in Japanese culture.

Exploring the mental health of Mexican migrant farm workers in the Midwest: psychosocial predictors of psychological distress and suggestions for prevention and treatment

The purposes of the present study were threefold: (a) to assess the prevalence levels of anxiety and depression in a sample of Mexican migrant farm workers in the midwestern United States; (b) to explore the relationships among acculturative stress, anxiety, and depression; and (c) to examine the variables that best predict anxiety and depression. The overall sample revealed elevated levels of anxiety and depression. Migrant farm workers with heightened levels of acculturative stress were more likely to report high levels of anxiety and depression. Family dysfunction, ineffective social support, low self-esteem, lack of agreement with the decision to migrate, high education levels, high levels of acculturative stress, and high levels of anxiety were significantly associated with high depression levels. The overall findings suggest that migrant farm workers who experience elevated levels of acculturative stress may be at risk for experiencing high levels of anxiety and depression. The findings highlight the importance of establishing prevention and treatment services for migrant farm workers that aim to increase levels of emotional support, self-esteem, and coping skills.

Race/ethnicity and depressive symptoms in community-dwelling young adults: a differential item functioning analysis

To examine variations in the manifestation of depressive symptomatology across racial/ethnic groups, analyses of differential item functioning (DIF) on the Center for Epidemiologic Studies Depression Scale (CES-D) were separately conducted for representative samples of young adults in the following groups: African-Americans (n = 434), Hispanics born in the US (n = 493), and Hispanics born outside the US (n = 395). Non-Hispanic whites (n = 463) were employed as the reference group in all analyses. The effects of gender and age were controlled. DIF analyses indicated that: (1) about half of the CES-D items functioned differently among non-Hispanic whites compared to each of the other racial/ethnic groups; (2) the manifestation of symptoms seemed to be similar for both Hispanic groups, except for low positive affect; (3) African-Americans tended to favor somatic symptoms over affective (depressive) symptoms; (4) Immigrant Hispanics appeared to inhibit the expression of positive affect, and thus more high scorers on the total CES-D were observed within this subgroup. In contrast, no differences were observed when only negative items were considered. The use of positive affect items might artifactually induce spurious differences among people who were born outside the United States or North America.

Reliability, validity and psychometric properties of the Greek translation of the Center for Epidemiological Studies-Depression (CES-D) Scale

INTRODUCTION

The aim of the current study was to assess the reliability, validity and psychometric properties of the Greek translation of the Center for Epidemiological Studies- Depression Scale (CES-D).

METHODS

40 depressed patients 29.65 +/- 9.38 years old, and 120 normal controls 27.23 +/- 10.62 years old entered the study. In 20 of them (12 patients and 8 controls) the instrument was re-applied 1-2 days later. Translation and Back Translation was made. Clinical Diagnosis was reached by consensus of two examiners with the use of the SCAN v.2.0 and the IPDE. Statistical Analysis included ANOVA, the Pearson Product Moment Correlation Coefficient, Principal Components Analysis and Discriminant Function Analysis and the calculation of Cronbach's alpha (alpha)

RESULTS

Both Sensitivity and specificity exceed 90.00 at 23/24, Chronbach's alpha for the total scale was equal to 0.95. Factor analysis revealed three factors (positive affect, irritability and interpersonal relationships, depressed affect and somatic complains). The test-retest reliability was satisfactory (Pearson's R between 0.45 and 0.95 for individual items and 0.71 for total score).

CONCLUSION

The Greek translation of the CES-D scale is both reliable and valid and is suitable for clinical and research use with satisfactory properties. Its properties are similar to those reported in the international literature. However one should always have in mind the limitations inherent in the use of self-report scales.

Differential item functioning in a Spanish translation of the Beck Depression Inventory

Brief and culturally compatible measures of depression are necessary, yet most depression scales are translated without regard for cultural biases. In this study, 292 medical outpatients completed an English or a Spanish-translated and back-translated version of the Beck Depression Inventory (BDI). The BDI items were analyzed for bias between Spanish and English-speaking patients to determine the equivalence of the scale. A Differential Item Function (DIF) using a Mantel Haenszel Approach for Ordered Response Categories was used to analyze how likely subjects in the two ethnic groups were to endorse each response category. The results suggest that regardless of level of depression, Latinos are more likely to endorse items reflecting tearfulness and punishment, and less likely to endorse inability to work. Cultural interpretations and recommendations for use of the BDI are discussed.

Trends in the rate of depressive illness and use of antidepressant pharmacotherapy by ethnicity/race: an assessment of office-based visits in the United States, 1992-1997

OBJECTIVE

This study was undertaken to determine ethnicity/race-specific (white, black, and Hispanic) population-adjusted rates of US office-based physician visits in which a diagnosis of a depressive disorder was recorded or in which a diagnosis of a depressive disorder was recorded and antidepressant pharmacotherapy was prescribed.

METHODS

Data from the National Ambulatory Medical Care Survey for 1992 through 1997 were partitioned into three 2-year periods: 1992-1993, 1994-1995, and 1996-1997. For each 2-year period, data from office-based physician visits for patients aged 20 to 79 years were extracted to assess, by ethnicity/race, (1) the number of visits in which a diagnosis of a depressive illness was recorded (International Classification of Diseases, Ninth Revision, Clinical Modification codes 296.2-296.36, 300.4, or 311) and (2) the number of visits in which a diagnosis of a depressive illness was recorded and antidepressant pharmacotherapy was prescribed. We calculated ethnicity/race-specific rates (per 100 US population aged 20 to 79 years) of office-based visits in which a diagnosis of a depressive disorder was recorded and in which a diagnosis of a depressive disorder was recorded and antidepressant pharmacotherapy was prescribed. The specialty of the reporting physician and the proportion of patients receiving a selective serotonin reuptake inhibitor (SSRI) were also discerned.

RESULTS

From 1992-1993 to 1996-1997, the rate of office-based visits (per 100 US population aged 20 to 79 years) in which a diagnosis of a depressive disorder was recorded increased 3.7% for whites (from 10.9 to 11.3; P = 0.001), 31.0% for blacks (from 4.2 to 5.5; P = 0.001), and 72.9% for Hispanics (from 4.8 to 8.3; P = 0.001). The rate of office-based visits in which a diagnosis of a depressive disorder was recorded and antidepressant pharmacotherapy was prescribed increased 18.5% for whites (from 6.5 to 7.7 per 100; P = 0.001), 38.5% for blacks (from 2.6 to 3.6 per 100; P = 0.001). and 106.7% for Hispanics (from 3.0 to 6.2 per 100; P = 0.001). Between 1992-1993 and 1996-1997, use of an SSRI increased among whites and blacks (from 50.0% to 65.8% and from 40.5% to 58.2%, respectively), but declined among Hispanics (from 51.4% to 48.6%; all comparisons P = 0.001).

CONCLUSION

By 1996-1997, the population-adjusted rates for Hispanics were within a quartile of those observed for whites, whereas the rates for blacks remained at less than half those observed in whites. The observed divergence in population-adjusted rates by ethnicity/race may reflect the nature of the patient-physician relationship, sensitivity and specificity of diagnostic techniques and instruments, and the wider social context in which an office-based visit occurs, including access to and type of health insurance and coverage for mental health services.

The relationship between body image discrepancy and body mass index across ethnic groups

OBJECTIVE

This study sought to examine at what body mass index (BMI) body image discrepancy (BD) was reported in a community sample of 389 white, Hispanic, and black women. In addition, we assessed the trajectory of the BMI-BD relationship as BMI increases by ethnic group.

RESEARCH METHODS AND PROCEDURES

All participants were assessed on height and weight and completed the Figure Rating Scale.

RESULTS

We found no difference in the proportion of women in each ethnic group reporting BD. However, white women experienced BD at a lower BMI level (BMI = 24.6), and below the criterion for overweight (BMI = 25). In contrast, black and Hispanic women did not report BD until they were overweight (BMIs of 29.2 and 28.5, respectively). Compared with black and white women, Hispanic women registered increases in BD at smaller increases in BMI.

DISCUSSION

These findings could have unhealthful implications for weight control behavior. The results encourage a closer look at ethnicity and BD, and their relationship to obesity and weight control.

Psychometric properties of the State-Trait Anxiety Inventory among Japanese clinical outpatients

The factor structure and internal consistency of the Japanese adaptation of the State-Trait Anxiety Inventory Form Y (STAI-JY) were examined for 218 Japanese clinical outpatients (86 males, 132 females) with psychiatric and/or psychosomatic complaints. An initial principal-component analysis revealed that the first three components were considered to reflect the "overall anxiety" component, the "presence-absence of anxiety (positive-negative)" component, and the "state-trait anxiety" component. The component related to presence or absence of anxiety was larger than the state-trait anxiety component. Factors followed by an oblique (promax) rotation were labeled "Anxiety-absent" and "Anxiety-present" factors for a two-factor structure, and "Anxiety-present," "Anxiety-absent/state," and "Anxiety-absent/trait" factors for a three-factor structure that was suggested by the scree test. The internal consistencies for both the state and trait anxiety subscales of the STAI-JY were at a satisfactory level, whereas slightly higher Cronbach's as were obtained from separate calculation for anxiety-present and anxiety-absent items. Similarities and differences in the factor structure of the STAI-JY were discussed in comparison with those reported earlier for the general population in Japan and for individuals in Western countries.

Acculturative stress, depression, and suicidal ideation in Mexican immigrants

This study examined the relationship among acculturative stress, depression, and suicidal ideation in a sample of Mexican immigrants. Also examined were variables that predict depression and suicidal ideation. Multiple regression analyses revealed that acculturative stress significantly predicted depression and suicidal ideation and that family support, social support, religiosity, agreement with the decision to migrate, and expectations for the future were significant predictors of depression and suicidal ideation. The overall findings suggest that adult Mexican immigrants who experience elevated levels of acculturative stress may be at risk for experiencing critical levels of depression and suicidal ideation. The findings highlight the importance of using culturally relevant clinical methods when assessing and treating the depressed and potentially suicidal acculturating individual.

Responses of Japanese and American university students to the STAI items that assess the presence or absence of anxiety

Symptom endorsements and item response patterns on the anxiety-present and anxiety-absent items of the State-Trait Anxiety Inventory Form Y (Spielberger, 1983) for 149 Japanese (99 living in Japan and 50 studying in the United States) and 76 American university students were compared. Although mean scores for the state and trait anxiety-absent items were comparable for Japanese students living in Japan and Japanese international students studying in the United States, the scores of both Japanese groups were significantly higher than those of American students. These differences were attributable to much higher scores of Japanese students on anxiety-absent items that corresponded to a lack of positive feelings. Japanese students had a tendency to inhibit positive (anxiety-absent) feelings, resulting in higher anxiety scores. Responses to anxiety-present and anxiety-absent items should be considered independently in scoring anxiety scales.

The role of acculturation in explaining ethnic differences in the prenatal health-risk behaviors, mental health, and parenting beliefs of Mexican American and European American at-risk women

OBJECTIVE

To assess: (1) ethnic differences in the health-risk behaviors, mental health problems, and adverse parenting beliefs during pregnancy of low-income Mexican American and European American women; and, (2) the extent to which these risks varied with levels of acculturation among low-income Mexican American women.

METHOD

Participants were 594 primiparous, low-income, urban women. A cross-sectional design was used to compare the 331 Mexican American women to the 263 European American. Language was used to assess the level of acculturation of the Mexican American women. Interviews were used to evaluate health-risk behaviors, mental health problems, and adverse parenting beliefs.

RESULTS

In comparison to European American women, Mexican American women were at lower risk for cigarette smoking during pregnancy and higher risk for adverse parenting beliefs. Among Mexican American women, Spanish speakers were at lower risk for cigarette smoking and mental health problems during pregnancy, and higher risk for adverse parenting beliefs than bilingual and English speakers.

CONCLUSIONS

The findings indicate that ethnic differences in cigarette smoking and parenting beliefs during pregnancy were concentrated on the less acculturated, low-income, and primarily unmarried Spanish speaking Mexican American women. Moreover, acculturation is differentially related to cigarette smoking and parenting beliefs. Therefore, acculturation needs to be considered in the development of preventive interventions in order to appropriately target the specific needs of different sub-populations of Mexican Americans.

Positive and negative affect in the factor structure of the State-Trait Anxiety Inventory for Japanese workers

The factor structure of Form Y of the State-Trait Anxiety Inventory (STAI-Y) was examined with 1,862 Japanese adult workers (1,509 men, 353 women). The initial principal component analysis extracted three factors based on the scree test. All 20 state (S-Anxiety) and 20 trait (T-Anxiety) items had dominant salient loadings on the first factor, which reflected "over-all anxiety." The three factors identified by an oblique (promax) rotation were labeled "anxiety-absent," "state anxiety-present," and "trait anxiety-present." All 20 items with dominant salient loadings on the first oblique factor were clearly grouped on the basis of their content, indicating the absence of anxiety. The second and third oblique factors, defined almost entirely by the STAI-Y anxiety-present items, clearly reflected the state-trait distinction in this sample of Japanese workers.

Age differences among Japanese on the Center for Epidemiologic Studies Depression Scale: an ethnocultural perspective on somatization

The Japanese version of the Center for Epidemiologic Studies Depression Scale (CES-D) was subjected to principal component (PC) analysis with oblique rotation, as well as an examination of internal consistency, using data obtained from 2,016 adult employees aged 19-63 years. Analyses focused on age differences in these psychometric properties of the CES-D. Coefficient-alpha was sufficiently high for all age groups but was lower than reported in U.S. studies. Positive affect items lowered internal consistency. The PC analyses extracted four factors for each age group. Depressive affect items did not group into one factor; some were combined with somatic or interpersonal items, and the remainder constituted the smallest factor. These three main factors, 'somatic+depressed', interpersonal + negative' and 'positive affect' were comparable across age groups except for those aged 50-63 years. For those aged 50-63 years, the first two factors were combined into a large 'general dysphoria' factor, suggesting a more unified conceptualization of depressive mood. Although 'positive affect' was stable cross-culturally, it was not related to depressive symptomatology as measured by the other items, for Japanese. The 'interpersonal + negative' appears unique for Japanese, indicating the association of interpersonal relations with depressive mood in Japanese. The effects of age-specific ethnocultural factors in Japan on depressive symptomatology are discussed.

Pain and depression in acute traumatic spinal cord injury: origins of chronic problematic pain?

OBJECTIVE

To examine the relationship between pain and depression over time during acute phases of traumatic spinal cord injury (SCI). Theoretical models of the pain-depression relationship provided the framework: (1) pain causes depression; (2) depression causes pain; (3) pain and depression are independent sequelae to SCI. Understanding the pain-depression relationship provides treatment implications and hypotheses for origins of chronic pain in SCI.

DESIGN

A repeated measures design assessing subjects at admission and discharge from rehabilitation.

SETTING

Subjects were admitted to a large public hospital in Southern California which is a member of the Model Spinal Cord Injury System. Rehabilitation occurred on two 30-bed units.

PARTICIPANTS

Complete admission and discharge data sets were collected from 68 acute traumatic SCI patients who served as subjects. One hundred twenty-one patients initially agreed to participate in a larger study of adjustments to SCI. Thirty-three did not have pain data at admission, 16 dropped out, and 4 had incomplete discharge data. Subjects volunteered and were paid a fee.

INTERVENTION

A standard rehabilitation program for SCI.

MEASURES

Pain assessment used a 101-point numerical rating scale. Depression assessment used the Center for Epidemiological Studies-Depression Scale(CESD).

RESULTS

Pain and depression were independent at admission. At discharge, they were significantly related. Changes in pain affected depression more than changes in depression affected pain.

CONCLUSIONS

Relationships between pain and depression develop over time. Reduced pain will have a greater effect on reducing depression than reduced depression will have on pain. Pain described as "burning" during the acute phase does not represent difficult to treat dysesthetic pain, as it may in chronic SCI pain.

Japan-U.S. comparison of responses to depression scale items among adult workers

The operating characteristics of the Center for Epidemiologic Studies Depression Scale were compared between Japanese and U.S. adult workers. Data were analyzed from age- and education-matched male white collar workers (n = 368 for each) selected from 2016 workers in Japan and 3059 in the United States. The U.S. data were obtained from the 1974-75 Augmentation Survey of the National Health and Examination Survey I. The Japanese responses to positively worded items markedly differed from those of U.S. workers, whereas responses to negatively worded items were generally comparable in the two groups. Thus, spuriously higher positive subscale and whole scale scores were found among the Japanese workers compared with U.S. workers (mean scores: 6.03 vs. 1.83 for the positive subscale and 9.94 vs. 5.35 for the whole scale, respectively; both differences were statistically significant). Negative subscale scores did not differ significantly in the two samples (3.91 vs. 3.52). The present study confirmed the hypothesis of Iwata et al. that Japanese respondents have a tendency to suppress the expression of positive affect.

Psychometric properties of the 30-item version general health questionnaire in Japanese

Psychometric properties of the 30-item General Health Questionnaire (GHQ-30) were explored using the Japanese data collected in various settings. A six- or seven-factor structure emerged for the entire sample and each gender and age-group divided into a 10-year interval. The factors were highly identical across the subsamples. The main four factors showed a high agreement with those of UK and Hong Kong studies: approximately 80% of the items were similarly allocated to factors. However, the response endorsement of two "loss of positive attitude" items was much common regardless of the score level. These items counted up approximately one-fourths of the score, so that these items made the score spuriously higher. According, a question arose as to whether these items should be included in the scale for its use in Japanese.

Responses to a self-administered depression scale among younger adolescents in Japan

Response patterns on the Center for Epidemiologic Studies Depression Scale (CES-D) items among Japanese adolescents were compared with those of their U.S. counterparts. The data were obtained from approximately 1,500 junior high school students, aged 12-15 years. Japanese responses to positively worded items markedly differed from those of American adolescents, whereas responses to negatively worded items were comparable in the two groups. This resulted in poor psychometric properties for the CES-D and spurious higher positive subscale and whole scale scores among the Japanese sample. It is possible that Japanese respondents tend to suppress positive affect expression and, thus, the positively worded questioning is presumably inappropriate for Japanese samples.

Alcohol use, depressive symptoms, and cultural characteristics in two Mexican-American samples

We modeled associations of quantity and frequency of alcohol use with depressive symptoms (negative affect, lack of positive affect, somatic disturbance, interpersonal problems) in two household surveys of Mexican-Americans (Ns = 1,313 and 3,577). Multivariate analyses controlled cultural (immigration, acculturation) and demographic (age, income, household size, marital status, employment status) characteristics, and assessed interactions of these two classes of predictors. Alcohol use was inconsistently related to depression. In some analyses, cultural characteristics accounted for associations of alcohol use with depression. In others, associations of alcohol use with depression depended on cultural characteristics. Associations of drinking with depression tended not to be robust across samples.