Cultural Equivalence in Depressive Symptoms in Older White, Black, and Mexican‐American Adults

Abstract

OBJECTIVES-To examine cultural equivalence in responses to depressive symptom items of three racial or ethnic elderly groups.DESIGN-Cross-sectional analyses of two national data sets. SETTING-The New Haven Established Populations for Epidemiologic Studies of the Elderly (EPESE) and the five-state Hispanic EPESE (H-EPESE).PARTICIPANTS-Whites (n 5 1,876) and blacks (n 5 464) were drawn from the New Haven EPESE and Mexican Americans (n 5 2,623) were drawn from the H-EPESE. MEASUREMENT-The original 20-item version of the Center for Epidemiologic Studies Depression Scale (CES-D).RESULTS-From differential item functioning analyses, a lack of measurement equivalence was found for 16 depressive symptom items. Mexican Americans were predisposed to endorse 12 depressive symptoms. Blacks were more likely than whites to endorse two interpersonal items (unfriendly and disliked). Mexican Americans were more likely than whites to respond to four positive affect items (good, hopeful, happy, and enjoyed) and more likely than blacks to endorse three positive items (good, happy, and enjoyed). CONCLUSION-Resultssuggested response bias to depressive symptom items in racially and ethnically diverse older adults. Mexican Americans were more likely than whites to endorse the large number of depressive symptom items. Blacks were much more likely to respond in patterns similar to those of the whites. Findings from this study provide a foundation for developing culturally appropriate depression measures in health disparities research. Keywords cultural equivalence; depressive symptoms; CESD; measurement equivalence; differential item functioning A growing body of literature documents racial and ethnic disparities in depressive symptoms. 1,2 A number of cross-cultural and cross-national studies on depressive symptoms have found evidence that prevalence rates of probable depression vary dramatically across diverse racial/ and ethnic groups, with rates ranging from 1.5% to 32.0%. 2-5 Because of such cultural variations, it has become a virtual truism in cross-cultural research that racially

Demographic characteristics do not decrease the utility of depressive symptoms assessments: examining the practical impact of item bias in four heterogeneous samples of older adults

“…Current psychometric literature does not clearly articulate thresholds designating varying degrees of DIF significance (Yang and Jones, 2008). Previously reported definitions of salient DIF differ by study, and have included the following: item-level DIF crossing the threshold α level of .05 (Areán and Miranda, 1997), item-level DIF with Bonferroni-corrected p -values (Kim et al, 2009), a critical ratio of 1.25 SE (Uebelacker et al, 2009), and a critical ratio of 2 SE (Grayson et al, 2000). Given the importance of the overall level of depressive symptoms in research and clinical settings, we focused on a change in total score (rather than on change in individual items), as the most practical approach to detecting salient DIF.…”

“…Several studies investigating sex-based DIF among older adults on the Geriatric Depression Scale (GDS) and the Center for Epidemiologic Studies Depression scale (CES-D) have demonstrated that compared to men with the same level of depressive symptoms, women are less likely to endorse the GDS item “Hopeless” (e.g., Broekman et al, 2008), but more likely to endorse the CES-D item “Crying” (e.g., Cole et al, 2000). Others have shown that compared to Whites with the same level of depressive symptomatology, Blacks or African Americans are more likely to endorse CES-D items “People were unfriendly” and “People disliked me,” (e.g., Yang et al, 2009), and Mexican Americans are more likely to endorse some of the positively worded items, including “Happy” (e.g., Kim et al, 2009). …”

“…This is the case with age-based DIF on GDS items “Dropped activities,” “Stay home,” “Memory problems,” “Worthless,” “Energy”, and CES-D items “Failure,” “Hopeful, “Bothered” (Cole et al, 2000, Grayson et al, 2000, Yang et al, 2009, Broekman et al, 2008, Marc et al, 2008); sex-based DIF on GDS items “Good spirits,” “Memory problems,” “Afraid,” and CES-D items “People were unfriendly,” “People disliked me,” “Failure,” “Talked less,” “Effort,” “Fearful,” “Restless sleep” (Yang et al, 2009, Grayson et al, 2000, Stommel et al, 1993, Marc et al, 2008, Broekman et al, 2008); race-based DIF on the GDS item “Memory problems” (Marc et al, 2008); and race/ethnicity-based DIF on the CES-D items “As good as other people,” “Hopeful,” “Enjoyed life” (Kim et al, 2009). …”

DSM-5 Research: Assessing the Mental Health Needs of Older Adults from Diverse Ethnic Backgrounds

“…They suppress their mood and negative feelings in other forms of behavioral or physiological symptoms. Different ethnic groups define mental health differently, and clinicians often find no evidence to support these differences during the treatment process solely based on their cultural definitions of a particular symptom/illness (Kim, Chiriboga, & Jang, 2009). Consequently, clients who are ethnically different from the providers may not step forward to disclose their needs or receive treatment.…”

Rasch analysis of the Center for Epidemiologic Studies Depression scale used for the assessment of community-residing patients with stroke

“…Because the measurement of depression is affected by socio-demographic factors [13], studies were performed in general [14,15] and clinical [16][17][18] populations, with the expectation that the development of depression is high in stroke patients. Furthermore, although study data were collected in a general population, the psychometric properties of the CES-D scale were examined across races, ethnicities [19,20] and cultures [21]. A few studies have examined the psychometric properties of CES-D in patients with stroke [17,22,23].…”