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

Cross-Sectional Associations of Intakes of Starch and Sugars with Depressive Symptoms in Young and Middle-Aged Japanese Women: Three-Generation Study of Women on Diets and Health

The relationship between the intakes of saccharide subtypes and depressive symptoms is unclear in Asian countries. This cross-sectional study aimed to investigate this association among 3963 young (age of 18 years) and 3826 middle-aged (mean age of 47.8 years) Japanese women. The intakes of starch, total sugars, free sugars, sucrose, lactose, glucose, and total fructose were assessed using a validated diet history questionnaire. The prevalence of depressive symptoms was 22.0% and 16.8% among young and middle-aged women, assessed using the Center for Epidemiologic Studies Depression (CES-D) score. After adjusting for potential confounding factors, higher starch intake was associated with a lower prevalence of depressive symptoms in young women with an odds ratio (OR) of the fourth to the first quintiles of 0.75 (95% confidence interval (CI): 0.57, 0.99). Moreover, higher intakes of sugars (except for lactose) were associated with a higher prevalence of depressive symptoms in young women, with ORs (95% CI) of the fifth to the first quintiles ranging from 1.30 (0.995, 1.69) for glucose to 1.47 (1.12, 1.93) for sucrose. These associations were not observed in middle-aged women. Future prospective studies are needed to confirm these findings.

The Effect of Alternative Scoring Procedures on the Measurement Properties of a Self-Administered Depression Scale

Abstract. To investigate the effect of response alternatives/scoring procedures on the measurement properties of the Center for Epidemiologic Studies Depression Scale (CES-D) which has the four response alternatives, a polytomous item response theory (IRT) model was applied to the responses of 2,061 workers and university students (1,640 males, 421 females). Test information functions derived from the polytomous IRT analyses on the CES-D data with various scoring procedures indicated that: (1) the CES-D with its standard (0-1-2-3) scoring procedure should be useful for screening to detect subjects with “at high-risk” of depression if the θ point showing the highest information corresponds to the cut-off point, because of its extremely higher information; (2) the CES-D with the 0-1-1-2 scoring procedure could cover wider range of depressive severity, suggesting that this scoring procedure might be useful in cases where more exhaustive discrimination in symptomatology is of interest; and (3) the revised version of CES-D with replacing original positive items into negatively revised items outperformed the original version. These findings have never been demonstrated by the classical test theory analyses, and thus the utility of this kind of psychometric testing should be warranted to further investigation for the standard measures of psychological assessment.

Dose⁻Response Relationships between Second-Hand Smoke Exposure and Depressive Symptoms among Adolescents in Guangzhou, China

There has been little focus on the possible association between second-hand smoke (SHS) exposure and depressive symptoms among adolescents. Thus, this study aimed to explore the dose–response relationships between SHS exposure and depressive symptoms among adolescents and differentiate these associations in setting-specific exposure and severity-specific outcomes. A cross-sectional study was conducted using a stratified cluster sampling method to obtain a representative sample of high school students in Guangzhou, China. Depressive symptoms were measured using the Center for Epidemiologic Studies Depression Scale. Univariable and multivariable logistic regression models were used to explore the potential associations between SHS exposure and depressive symptoms. Among 3575 nonsmoking students, 29.6% were classified as having probable depressive symptoms and 9.6% had severe depressive symptoms. There were monotonically increasing dose–response relationships between setting-specific (public places, homes, or indoor/outdoor campuses) SHS exposure and severity-specific (probable or severe) depressive symptoms. When examining these relations by source of exposure, we also observed similar dose–response relationships for SHS exposure in campuses from smoking teachers and from smoking classmates. Our findings suggest that regular SHS exposure is associated with a significant, dose-dependent increase in risk of depressive symptoms among adolescents, and highlight the need for smoke-free environments to protect the health of adolescents.

Review on Diagnostic Criteria of Neurasthenia: Suggesting Pathway of Culture-bound dieases

OBJECTIVE

Neurasthenia is a disease which consists of increased fatigue or bodily weakness and exhaustion plus pantalgia, dizziness, headache and other symtoms relevant to autonomic nerve dysfunction. There are plenty of studies investigating the history of diagnostic criteria of neurasthenia, which is influenced by diverse cultural(or social) environment. The obejective of this study is to provide review of the previous studys on the changes of neurasthenia diagnoses in the context of local area to find meanings of these transition and improve health care for psychiatric patient.

METHODS

Literature review was conducted on studies demonstrating diagnostic criteria of neurasthenia with cultural(or social) environment. We investigated the literature reviews or observative studies which described alteration of diagnostic criteria of neurasthenia and assessed its significance. After selecting eligible studies, the authors read the articles and summarized the meaningful contents those were significant in clinical practice.

RESULTS

Transformation of Chinese Classification of Mental Disorder(CCMD) integrated with internationally utilized DSM-IV or ICD-10 is controversial about its significance in that it had limited effect on public health care due to the variables of sociocultural context, but primarily differentiated neurasthenia from other disorders. The latter one can be the directing point of the diagnostic criteria of other culture-bound diseases, which is the traits of not outstanding mood(or affect) than other neurotic disorders.

CONCLUSION

As diagnostic criteria of neurasthenia varies, the significance of this variation is controversial, but could be the paragon of other culture-bound diseases.

Food-based diet quality score in relation to depressive symptoms in young and middle-aged Japanese women

Only a few studies have focused on the association between overall diet, rather than intakes of individual nutrients or foods, and depressive symptoms in Japanese. This cross-sectional study examined associations between a diet quality score and depressive symptoms in 3963 young (age 18 years) and 3833 middle-aged (mean age 47·9 (sd 4·2) years) Japanese women. Dietary information was collected using a diet history questionnaire. A previously developed diet quality score was computed mainly based on the Japanese Food Guide Spinning Top. The prevalence of depressive symptoms was 22·0 % for young women and 16·8 % for middle-aged women, assessed as a Center for Epidemiologic Studies Depression (CES-D) score ≥23 and ≥19, respectively. As expected, the diet quality score was associated positively with intakes of ‘grain dishes’, ‘vegetable dishes’, ‘fish and meat dishes’, ‘milk’ and ‘fruits’ and inversely with intakes of energy from ‘snacks, confection and beverages’ and Na from seasonings. After adjustment for potential confounders, OR for depressive symptoms in the highest v. lowest quintiles of the diet quality score was 0·65 (95 % CI 0·50, 0·84) in young women (Pfor trend=0·0005). In middle-aged women, the corresponding value was 0·59 (95 % CI 0·45, 0·78) (Pfor trend<0·0001). Analyses where the diet quality and CES-D scores were treated as continuous variables also showed inverse associations. In conclusion, this cross-sectional study showed that a higher diet quality score was associated with a lower prevalence of depressive symptoms in young and middle-aged Japanese women. Prospective studies are needed to confirm a public health relevance of this finding.

A comparison of Geriatric Depression Scale scores in older Australian and Japanese women

AIMS

The aim of this study was to compare the prevalence of depressive symptoms in Australian and Japanese populations of community-dwelling older women using the Geriatric Depression Scale (GDS-15). In addition, the relationship between lifestyle and health factors and higher ratings of depressive symptoms was also examined to determine if there were culturally consistent risk factors associated with higher depressive symptom scores.

METHODS

A total of 444 community based women aged between 65 and 77 years completed a depressive symptom measure (GDS-15) and provided information on common lifestyle factors. The Australian sample (n = 222) were drawn from the Women's Healthy Ageing Project and the age-matched, Japanese sample from the Kumamoto Ageing Study of Mental Health (n = 222). The GDS was chosen to; (1) reduce the impact of physical symptoms associated with old age and, (2) reduce the inflation in scores that may result from the Japanese tendency to endorse somatic items more often than Western adults.

RESULTS

Mean GDS total scores were significantly higher for the Japanese population 3.97 ± 3.69 compared with 1.73 ± 2.7 for Australian women. The percentages of women scoring in the normal; mild and moderate ranges for depression were 91, 7 and 2% for Australia and 67, 24 and 9% for Japan. Scores remained significantly higher for the Japanese cohort when controlling for lifestyle and health factors associated with depression. The analysis of lifestyle and health characteristics showed that the greatest difference between cohorts was in the area of living status, with more Australian women living with their partner and more than three times as many Japanese women living with their children. When the data for the countries was considered independently employment status affected the likelihood of higher depression scores in the Australian sample while heart disease and poor sleep impacted the risk for the Japanese population.

CONCLUSIONS

Significantly more Japanese women scored within the mild and moderate ranges on the GDS compared with their Australian peers, even when controlling for possible confounding factors. Of the lifestyle and health factors assessed in this analysis no single variable was a common risk factor for higher depressive scores for both countries. The presence of cultural influences that may impact the risk of experiencing depressive symptoms, and culture specific patterns of item endorsement on depressive symptom measures, needs to be explored in more detail.

Reports of Attempted Suicide among Brazilian Addicts

Both substance dependence and depressive mood seem to be associated with increased suicide risk. Clinical information on suicide attempts and depressive symptoms were obtained from a sample of 211 psychoactive substance dependents attending a university clinic program for addicts in Brazil. 49 subjects (23.4%) had attempted suicide at least once, and the frequency of reporting attempts was 4.32 times greater among women than among men. Male addicts also tended to engage in potentially more dangerous attempt methods than women. Depressive male addicts were 2.17 times more likely to have attempted suicide than nondepressive addicted men. Among women, no association could be established between having attempted suicide and the presence of depression. Substance addicts have a relatively high risk of attempting suicide and the co-occurrence of depression seems to increase prevalence of suicidal behavior among men.

The Revised Ces-D Scale for Caregivers of the Elderly in India

The purpose of this article is to empirically determine the factor structure of the original Radloff's (1977) Center for Epidemiological Studies-Depression Scale (CES-D), on Indian caregivers of the elderly population. The CES-D was administered to 255 caregivers via face to face interviews. The confirmatory factor analysis results did not support the original four-factor theoretical structure, but did suggest a three-factor model. In addition the three-factor version showed high internal consistency among the sub scales. The results of the present study indicate that the revised CES-D scale reflects the difference in the manifestation of depression in caregivers of the elderly in the Indian community in Allahabad, India. This scale should be validated further by replication. Implications for future research are presented.

Evaluation of the Psychometric Properties of the Asian Adolescent Depression Scale and Construction of a Short Form: An Item Response Theory Analysis

The present study applied item response theory to examine the psychometric properties of the Asian Adolescent Depression Scale and to construct a short form among 1,084 teenagers recruited from secondary schools in Hong Kong. Findings suggested that some items of the full form reflected higher levels of severity and were more discriminating than others, and the Asian Adolescent Depression Scale was useful in measuring a broad range of depressive severity in community youths. Differential item functioning emerged in several items where females reported higher depressive severity than males. In the short form construction, preliminary validation suggested that, relative to the 20-item full form, our derived short form offered significantly greater diagnostic performance and stronger discriminatory ability in differentiating depressed and nondepressed groups, and simultaneously maintained adequate measurement precision with a reduced response burden in assessing depression in the Asian adolescents. Cultural variance in depressive symptomatology and clinical implications are discussed.

The Usability of CAT System for Assessing the Depressive Level of Japanese-A Study on Psychometric Properties and Response Behavior

BACKGROUND

An innovative measurement system using a computerized adaptive testing technique based on the item response theory (CAT) has been expanding to measure mental health status. However, little is known about details in its measurement properties based on the empirical data. Moreover, the response time (RT) data, which are not available by a paper-and-pencil measurement but available by a computerized measurement, would be worth investigating for exploring the response behavior.

PURPOSE

We aimed at constructing the CAT to measure depressive symptomatology in a community population and exploring its measurement properties. Also, we examined the relationships between RTs, individual item responses, and depressive levels.

METHOD

For constructing the CAT system, responses of 2061 workers and university students to 24 depression scale plus four negatively revised positive affect items were subjected to a polytomous IRT analysis. The stopping rule was set for standard error of estimation < 0.30 or the maximum 15 items displayed. The CAT and non-adaptive computer-based test (CBT) were administered to 209 undergraduates, and 168 of them administered again after 1 week.

RESULTS

On average, the CAT was converged by 10.4 items. The θ values estimated by CAT and CBT were highly correlated (r = 0.94 and 0.95 for the 1st and 2nd measurements) and with the traditional scoring procedures (r's > 0.90). The test-retest reliability was at a satisfactory level (r = 0.86). RTs to some items significantly correlated with the θ estimates. The mean RT varied by the item contents and wording, i.e., the RT to positive affect items required additional 2 s or longer than the other subscale items.

CONCLUSION

The CAT would be a reliable and practical measurement tool for various purposes including stress check at workplace.

Do people cope with situations as they say? Relationship between perceived coping style and actual coping response

AIM

The coping style that individuals think they will use when encountering stressful situations may differ from actual coping response in real situations.

METHODS

In a longitudinal study on some 500 university students, perceived coping style was identified using the Coping Inventory for Stressful Situations on the first occasion. In the subsequent eight test occasions, which occurred on a weekly basis, the students were asked about a negative life event that occurred during the past week and the actual coping responses they used.

RESULTS

The perceived coping style and the actual coping response matched well for task-oriented and emotion-oriented coping. For avoidance-oriented coping, however, perceived coping style and actual coping response were weakly correlated.

CONCLUSION

Epidemiological studies on coping and mental health should discriminate coping style and coping response. Clinicians should be cautious about patients' own information about avoidance-oriented coping.

Positive association between the plasma levels of 5-hydroxyindoleacetic acid and the severity of depression in patients with chronic obstructive pulmonary disease

BACKGROUND

The role of plasma monoamines in patients with chronic obstructive pulmonary disease (COPD) with depression is unclear. To investigate monoamines in 20 depressed patients with COPD, the plasma concentrations of serotonin, 5-hydroxyindoleacetic acid (5-HIAA), homovanillic acid, and 3-methoxy-4-hydroxyphenylglycol (MHPG) were measured and compared with those in 50 non-depressed COPD patients, and also with 23 age- and gender-matched non-smokers and 13 smokers as non-depressed healthy controls.

METHODS

Diagnosis of depression was assessed using the Centre for Epidemiologic Studies Depression Scale. Plasma concentrations of monoamines were measured by high-performance liquid chromatography.

RESULTS

None of the depressed COPD patients had suicidal ideation. The plasma 5-HIAA level [median, (25% and 75% quartiles)] in depressed COPD patients [6.8 ng/mL, (4.9 and 13.1)] was significantly higher than in non-depressed COPD patients [5.4, (4.2 and 7.5)] (p=0.022) and non-smokers [5.1 (3.8 and 7.2)] (p=0.041), but not smokers [4.7, (4.0 and 6.7)] (p>0.05). The plasma 5-HIAA level (r=0.24, p=0.049) was significantly associated with the severity of depression in patients with COPD. The plasma MHPG level was significantly higher in depressed COPD patients (p=0.043) than in smokers, but was not higher than that in non-depressed COPD patients or non-smokers, although the level of MHPG was not associated with the severity of depression.

CONCLUSION

The plasma 5-HIAA level is increased in depressed COPD patients. Plasma monoamines may be a good biomarker for detection of depression in patients with COPD.

Depression, but not sleep disorder, is an independent factor affecting exacerbations and hospitalization in patients with chronic obstructive pulmonary disease

BACKGROUND AND OBJECTIVE

Patients with chronic obstructive pulmonary disease (COPD) may experience depression and sleep disorders, which can adversely affect their health-related quality of life (HRQOL). The aim of this study was to investigate depression and sleep disorders among 85 COPD patients and 46 control subjects, aged 40 years and over.

METHODS

Patients underwent spirometry and arterial blood gas analysis, self-completed St. George's respiratory questionnaire and were assessed on the center for epidemiologic studies depression (CES-D) and the Pittsburgh sleep quality index (PSQI). The frequency of exacerbations among COPD patients was prospectively monitored for 12 months.

RESULTS

The prevalence of depression and sleep disorders was significantly higher among COPD patients than control subjects. The relative risks (95% confidence interval) of depression and sleep disorders were 7.58 (1.03 to 55.8) and 1.82 (1.03 to 3.22), respectively, in COPD patients compared with control subjects. Among COPD patients, there was a correlation between CES-D and PSQI. Lower body mass index, more severe dyspnoea, poorer HRQOL, lower partial pressure of arterial oxygen and higher partial pressure of arterial carbon dioxide were significantly associated with the incidence of depression and sleep disorders. Exacerbations and hospitalizations were more frequent among COPD patients with depression than those with sleep disorders alone or those without depression or sleep disorders.

CONCLUSIONS

Depression and sleep disorders are very common co-morbidities among COPD patients and significantly reduce activities and HRQOL among these patients. Depression, but not sleep disorder, is an independent risk factor for exacerbations and hospitalization among COPD patients.

Factor structure of the Center for Epidemiologic Studies Depression Scale in Taiwanese adolescents

BACKGROUND

The original study of Radloff (Appl Psychol Meas. 1977. 1:385-401) on the Center for Epidemiologic Studies Depression Scale (CES-D) indicated a 4-factor model in the adult population. However, the factor structure of the CES-D in Asian adolescents has not been extensively validated. The aim of this study was to examine the factor structure of the Chinese version of the CES-D in a large representative Taiwanese adolescent population.

METHOD

A total of 10 116 adolescents completed the Chinese version of the CES-D. We used confirmatory factor analysis to examine the adequacy of 5 models of the factor structure in adolescents who were divided into 4 groups by sex and age. We also enrolled the variables of suicide tendency, insomnia, and peer relationships into the confirmatory factor analysis to examine the factor structure of the CES-D and examined the correlations between the CES-D factors and these variables.

RESULTS

The results of this study indicated that the four-factor model (depressed affect, somatic symptoms, interpersonal problems, and positive affect) had the highest validity in Taiwanese adolescents. We also found that although the 4 factors of the CES-D were correlated with each other, their correlations with suicide tendency, insomnia, and peer relationships were different.

CONCLUSIONS

This study supported the usefulness of the Chinese version of the CES-D as a tool to understand the concept of depression in Taiwanese adolescents.

Sex Differences in Genetic and Environmental Contributions to Depression Symptoms in South Korean Adolescent and Young Adult Twins

It has been reported that prevalence estimates, symptom presentation, and sociocultural risk and protective factors for depression differ between Caucasian and East Asian populations. But, nonetheless, as the vast majority of twin studies of depression symptoms have been carried out using Caucasians, genetic and environmental influences on depression symptoms in East Asians remain poorly understood. In the present study, the Center for Epidemiologic Studies — Depression Scale (CES-D) was administered to 490 pairs of South Korean adolescent and young adult twins (ages: 13–23 years) by telephone interview. In males, monozygotic (MZ) and dizygotic (DZ) twin correlations were similar (.44 vs. .41), suggesting the importance of shared environmental factors in depression symptoms. In females, however, MZ twin correlation was much greater than DZ twin correlation (.40 vs. .23), indicating the importance of genetic influences. The total phenotypic variance for the CES-D was greater in females than in males. Variance components model confirmed sex differences in the magnitude of genetic and environmental influences on depression symptoms: Additive genetic, shared environmental, and individual specific environmental effects in the full model were, res pectively, 12% (95% CI: 0–54%), 32% (95% CI: 0–53%), and 56% (95% CI: 44–70%) in males, and 41% (95% CI: 0–52%), 0% (95% CI: 0–36%), and 59% (95% CI: 48–72%) in females. Similar results were observed when ‘culturally biased’ items of the CES-D were separately analyzed. These variance components estimates for depression symptoms in East Asians overlap those observed in Caucasians.

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.

Examining the dimensions of hospital safety climate and psychosocial risk factors among Japanese nurses

PURPOSE

The purpose of this study was to examine the dimensions, reliability, and main loading factors associated with a Japanese safety climate and psychosocial risk factor scale.

DESIGN

The authors used a cross-sectional survey of nurses from a university teaching hospital in Japan during 2008 (N = 996). The survey tools were based on components previously identified in a variety of international studies, including the Hospital Safety Climate Scale (HSCS) originally developed by Gershon et al. in 2000.

RESULTS

Factor analysis of the Japanese HSCS demonstrated key themes in the areas of workplace-related issues, protective devices or mechanisms, and managerial dimensions (Cronbach's α = .887). Factor analysis of the psychosocial scale revealed key themes comprising individually related items and group dynamics (Cronbach's α = .882).

CONCLUSIONS

This study revealed high internal consistency in the Japanese-language safety climate and psychosocial risk factor scales. The authors also identified various factors and themes consistent with previous international research.

IMPLICATIONS FOR PRACTICE

Transcultural research using standard psychosocial tools can reveal important and reliable findings if carefully translated and adapted for the host environment.

The CES-D in Chinese American women: construct validity, diagnostic validity for major depression, and cultural response bias

Previous studies of the Center for Epidemiologic Studies Depression Scale (CES-D) in Chinese Americans describe internal reliability and factor structure. We report CES-D construct validity and diagnostic validity for major depression in a probability sample of 168 community-dwelling Chinese American women. Internal consistency was satisfactory (Cronbach's alpha=0.86). Good construct validity was indicated by significantly higher mean CES-D scores for respondents who reported lower social support, worse self-perceived general health, or stressful life events, including intimate partner violence. Cultural response bias was found, with positively-stated CES-D items (e.g. "I was happy") producing higher depression scores in immigrants and subjects who preferred to speak Chinese. Diagnostic validity for major depression was assessed using the Composite International Diagnostic Interview. A CES-D cut-off score of 16 had sensitivity of 100% (95% CI: 44% to 100%), specificity of 76% (95% CI: 69% to 82%), PPV of 7% (95% CI: 3% to 19%) and NPV of 100% (95% CI: 97% to 100%). Our findings suggest that the CES-D is useful for screening out non-depressed subjects in a first-stage assessment. However, it should be followed by a diagnostic tool in Chinese American women with scores above the cut-off in order to identify those with clinical depression.

Cross-national comparison of social support structures between Taiwan and the United States

The study compares the effects of structural bases and functional elements of social support on mental health in Taiwan and the United States, using the study conducted in the United States by Lin, Ye, and Ensel (1999) as a reference. Based on a nationally representative sample of Taiwanese adults (n = 2,835), a fundamental similarity in social support structure and function between the two countries was observed. First, the structural bases of social support had a hierarchical order in their effects on depression: Binding (presence of an intimate relationship) was the strongest in reducing depression, whereas belonging (community participation) was the weakest, with bonding (social networks) in between. Regarding the functional elements, perceived social support was a better protector of mental health than actual social support, a finding in line with previous research. On the other hand, several notable differences in the structural bases and functional elements of social support between the two societies were observed, possibly due to the differential cultural and historical characteristics.

Predictors of self-reported depression in Korean children 9 to 12 years of age

PURPOSE

The aim of this study was to evaluate the relationships among various psychosocial factors, behavior problems, and depressive symptoms reported by parents, and to investigate self-reported depression in Korean children using a community sample.

MATERIALS AND METHODS

The sample consisted of 1279 children between 9 and 12 years of age. The children were evaluated using the Korean version of the Child Behavior Checklist (K-CBCL) and the Child Depression Inventory (CDI).

RESULTS

The average self-reported depression score as measured by the CDI was 12.34 (SD: 6.79), and a cut-off point of 19 identified approximately 14% of the children as depressed. The group difference was identified by the age at which younger children were found to have higher CDI scores. Univariate logistic regression analysis showed that the high-CDI group and the low-CDI group differed in all behavioral domains identified in the parent-reported subscales of the K-CBCL. Age and father's education level were also independently associated with the risk for childhood depression. In addition, results from the logistic regression analyses indicated that parental reporting of problem internalization, total behavior problems, and social competence were independent predictors of child depression not identified by the anxious/depressed subscale.

CONCLUSION

It is believed that extensive behavioral problems reported by parents and several sociodemographic factors are related to childhood depression. However, parents tend to under-report depressive symptoms relative to what their own children report. Thus, clinicians must consider the self-reports of children related to depression in their diagnosis and intervention, because reports of depressive symptoms from children are more valid measures than those from parents.

Is there an Asian idiom of distress? Somatic symptoms in female Japanese and Korean students

The term 'idiom of distress' is used to describe culturally specific experiences of suffering. Most of these studies have been conducted with small groups, making comparison of symptom profiles difficult. Female undergraduate and graduate students in Japan (n = 50) and Korea (n = 61) completed the Beck Depression Inventory (BDI) and 7-day daily reports of their experiences of 46 somatic symptoms. Between-culture comparisons revealed that BDI scores did not differ; however, the Korean women had significantly higher somatic distress means than the Japanese women. Despite the higher Korean distress mean, regression analysis showed that somatic distress explained 30% of the variance of BDI score for the Japanese but only 22% of the variance for the Koreans. Within-culture comparisons showed that both high-BDI Japanese and Koreans had 19 somatic distress symptoms with significantly higher means than their low-BDI counterparts; 11 somatic symptoms were shared by the two groups. Multidimensional scaling matrices were used to compare symptom proximities and revealed cultural differences. The problems with using broad racial categories in clinical research, the clinical significance of these findings, and the implications for psychiatric nursing assessment and practice are discussed.

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.

Assessing cross-cultural differences through use of multiple-group invariance analyses

The use of structural equation modeling in cross-cultural personality research has become a popular method for testing measurement invariance. In this report, we present an example of testing measurement invariance using the Sense of Coherence Scale of Antonovsky (1993) in 3 ethnic groups: Chinese, Japanese, and Whites. In a series of increasingly restrictive constraints on the measurement models of the 3 groups, we demonstrate how to assess differences among the groups. We also provide an example of construct validation.

Somatic and depressive symptoms in female Japanese and American students: a preliminary investigation

The present study examined the relationship between common somatic symptoms and depression in samples of Japanese and American college students. Fifty Japanese and 44 American women completed the Beck Depression Inventory (BDI) and rated 56 somatic-distress items for 7 days. Japanese had higher levels of somatic distress than Americans. ANOVA of somatic distress by BDI-level revealed that the High BDI Japanese group reported 26 somatic symptoms (including stomach ache, dizziness, and shoulder pain) with significantly higher means when compared with the low BDI group. High BDI Americans had a significantly higher mean for joint pain compared to the Low BDI group. The importance of the body in transcultural psychiatry is explored, and implications for primary and mental health care are discussed.

Chronic orofacial pain among Korean elders: prevalence, and impact using the graded chronic pain scale

The aims of this study were to investigate the prevalence of orofacial pain symptoms in the Korean elderly population, and to evaluate factors associated with orofacial pain and graded chronic pain. Of 4,342 Korean elders from the cohort of Korean National Interview Survey of Oral Health Status in 2000, telephone interviews were conducted on a stratified random sample of 1,032 people aged 55 years or older. Prevalence of five orofacial pain symptoms (jaw joint pain, face pain, toothache, oral sores, and burning mouth) in the past 6 months along with questions from the graded chronic pain scale were assessed by telephone using a structured questionnaire. The results suggested that the 6-month prevalence of joint pain (15.5%), face pain (9.3%), toothache (26.8%), oral sores (26.2%), and burning mouth (14.2%) in Korean elders were higher than in studies on Caucasian populations. Painful oral sores and burning mouth had higher prevalence for females than for males. Subjects with joint pain, burning mouth or toothache pain were more likely to report high levels of a pain-related disability compared with subjects not reporting those symptoms. There were no age group differences in pain intensity, but the older age group reported a higher number of disability days because of their pain. Chronic orofacial pain is a substantial health problem in the elderly population.

Assessment of depression and anxiety in East Asia

This article provides a critical review of the literature on research with self-report measures of depression and anxiety in East Asia. Three trends are noteworthy. First, research on depression and anxiety in East Asia has relied heavily on the use of a limited number of translated instruments. Second, available research suggests that the Asian language versions of these instruments are reliable and valid for use with Asian populations. Third, some subpopulations in East Asia have been studied extensively with respect to depression and anxiety, but there are many regions of Asia where little research literature is available outside of those published in native language journals. The review concludes with recommendations for future research.

The Japanese version of the Multiple Affect Adjective Checklist-Revised: development and validation

In order to develop a Japanese version of the Multiple Affect Adjective Checklist-Revised (MAACL-R), the 66 scored adjectives were translated into Japanese and translated back into English as recommended by Werner and Campbell (1971). Confirmatory factor analyses evidenced the existence of five first-order factors (i.e., the anxiety, depression, hostility, positive affect, and sensation-seeking factors) and the two second-order factors (i.e., the dysphoric and pleasant affect factors) underlying the response to the Japanese MAACL-R. Internal consistency ranged from .73 to .91, and four-week retest reliability ranged from .67 to .74 on the seven scales (Anxiety, Depression, Hostility, Positive Affect, Sensation Seeking, Dysphoria, and PASS). Although correlations with the scales of the State-Trait Personality Inventory, State-Trait Anxiety Inventory, Center for Epidemiologic Studies Depression scale, a sensation-seeking scale, and a subjective well-being scale indicated only acceptable discriminant validity, adequate convergent validity was evidenced by the examination of these correlations. The Japanese version of the MAACL-R seems to be ready for use in research.

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.

Cultural differences in responses to a Likert scale

Cultural differences in responses to a Likert scale were examined. Self-identified Chinese, Japanese, and Americans (N=136, 323, and 160, respectively) recruited at ethnic or general supermarkets in Southern California completed a 13-question Sense of Coherence scale with a choice of either four, five, or seven responses in either Chinese, Japanese, or English. The Japanese respondents more frequently reported difficulty with the scale, the Chinese more frequently skipped questions, and both these groups selected the midpoint more frequently on items that involved admitting to a positive emotion than did the Americans, who were more likely to indicate a positive emotion. Construct validity of the scale tended to be better for the Chinese and the Americans when there were four response choices and for the Japanese when there were seven. Although culture affected response patterns, the association of sense of coherence and health was positive in all three cultural groups.

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.

Psychosocial correlates of depressive symptoms among Japanese high school students

PURPOSE

To determine the psychosocial factors associated with the presence and persistence of depressive symptoms among high school students in Okinawa, Japan.

METHODS

The study sample was 3202 students from 12 public senior high schools. Students completed self-administered questionnaires from October through December 1997. We measured depressive symptomatology using the Center for Epidemiologic Studies Depression Scale. We asked students to report whether they had depressive symptoms at any time in the immediate past week, and whether those symptoms persisted for 5-7 days. The psychosocial variables examined were life stressors, perceived social support, health practices, self-esteem, and Locus of Control. The relationship between the psychosocial factors and depressive symptoms was examined using hierarchical multiple regression analyses.

RESULTS

After controlling for the effects of demographic and other psychosocial variables, presence of depressive symptoms was positively associated with life stressors in the domains of friends, family, and teachers. Similarly, persistence of depressive symptoms was also positively associated with life stressors in the domains of friends and teachers. Presence and persistence of depressive symptoms were negatively associated with positive health practices, more social support, high self-esteem, and internal Locus of Control.

CONCLUSIONS

The psychosocial variables associated with presence and persistence of depressive symptoms were remarkably consistent. Life stressors might be risk factors; on the contrary, positive health practices, perceived social support, high self-esteem, and internal Locus of Control might be protective factors of depressive symptoms among Japanese adolescents.

The measurement artifact in the Organizational Commitment Questionnaire

This study empirically examined the debate in the literature regarding the dimensionality of the Organizational Commitment Questionnaire. The sample comprised 803 employees from organizations in the information technology and hospitality industries. Confirmatory factor analysis showed that the Organizational Commitment Questionnaire appears to have a two-factor structure, with one factor consisting of positively worded items and the other factor, negatively worded items. Scores on both factors correlated significantly with job satisfaction, suggesting that both factors appear to be measuring a similar aspect of organizational commitment and that they present as two factors given as measurement artifacts of the item wording.

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.

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.

Prevalence of symptoms of depression in a nationwide sample of Korean adults

The prevalence and correlates of symptoms of depression in a nationwide sample of Korean adults, collected during the National Health and Health Behavior Examination Survey, were examined. A probability sample of 3,711 respondents (a response rate of 81.3%) completed the Center for Epidemiologic Studies Depression Scale (CES-D) and a variety of sociodemographic questions. In this sample 23.1% of males and 27.4% of females had scores above the cutoff point of 16 (probable depression) on the CES-D scale, and 6.8% of males and 10.4% of females were above the cutoff point of 25 (severe, definite depression). Apart from a few reports describing Afro-American and Puerto-Rican samples, these rates were somewhat higher than those found in the US and Western countries. In this report, female gender, fewer than 13 years of education, and disrupted marriage (widowed/divorced/separated) proved to be statistically significant predictors of severe, definite symptoms of depression.

Chronic neurobehavioral effects of Tokyo subway sarin poisoning in relation to posttraumatic stress disorder

Chronic neurobehavioral effects of acute sarin poisoning were evaluated in 9 male and 9 female patients who were exposed to sarin poisoning in the Tokyo subway incident in Japan. The investigators used nine neurobehavioral tests, as well as a posttraumatic stress disorder checklist, 6-8 mo after the poisoning occurred. Serum cholinesterase activity in patients on the day of poisoning (i.e., March 20, 1995) ranged from 13 to 131 IU/l (mean=72.1 IU/l). The results of analysis covariance, in which age, education level, alcohol consumption, and smoking status (covariates) were controlled in 18 sarin cases and in 18 controls, showed that the score on the digit symbol (psychomotor performance) test was significantly lower in the sarin cases than in controls. Nonetheless, the scores for the General Health Questionnaires, fatigue of Profile of Mood States, and posttraumatic stress disorder checklist were significantly higher in the sarin cases than controls. The investigators added posttraumatic stress disorder to the covariates, and only the score on the digit symbol test was significantly lower in sarin cases. In addition, the results of stepwise multiple regression analysis in 18 sarin cases revealed that scores for the General Health Questionnaires, fatigue of Profile of Mood States (i.e., fatigue, tension-anxiety, depression, and anger-hostility)-together with the paired-associate learning test-were associated significantly with posttraumatic stress disorder. The association did not remain significant for the digit symbol test score. Perhaps a chronic effect on psychomotor performance was caused directly by acute sarin poisoning; on the other hand, the effects on psychiatric symptoms (General Health Questionnaire) and fatigue (Profile of Mood States) appeared to result from posttraumatic stress disorder induced by exposure to sarin.

Use of the Center for Epidemiologic Studies Depression (CES-D) Scale in Korea

We translated the Center for Epidemiologic Studies Depression (CES-D) Scale into Korean, paying careful attention to culturally different modes of expression of depressive feelings and thoughts. The final translated version (CES-D-K) was administered to 164 psychiatric patients and 464 normal subjects residing in the community. Reliability, validity, and the optimal cutoff point of this scale were estimated, including ROC analysis. The CES-D-K was reliable and valid for the Korean population. Two optimal cutoff points were suggested: 24/25, the point which best corresponded to the clinical diagnosis of depression, and 20/21, which most effectively detects and covers depressive symptoms during screening. The higher cutoff points than those in Western countries may be due to different ways of expression affect, especially the suppression of positive affect, in cultures based on Confucian ethics.

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.

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.