The conception of depression in Chinese American college students

Validation of the Center for Epidemiologic Studies Depression Scale (CES-D) in a Moroccan sample with substance use disorder

BACKGROUND

Transcultural validation studies of depression scales are rare in Morocco. The Center for Epidemiologic Studies Depression Scale (CES-D) is commonly one of the most common and frequently used screening instruments for depressive symptoms, but the scale has not, up to date, been validated in dialect of Arabic in Moroccan contexts. Given the importance of assessing and preventing depressive symptoms in our Moroccan context, this study aims to validate the CES-D, translated, and adapted to the dialect of Arabic and Moroccan culture, in a sample with substance use disorder.

METHODS

The data were analyzed in two successive phases. First, exploratory factor analysis (EFA) was used to assess the factor structure in the pilot sample (N = 140). Then, this structure was confirmed in the validation sample (N = 205) using confirmatory factor analysis (CFA).

RESULTS

Exploratory factor analysis extracted three factors different from the four factors in the original version. Confirmatory factor analysis confirmed the structure of three factors. The fit indices level showed acceptable to good performance of the measurement model. The instrument showed sufficient reliability and convergent validity, as demonstrated by acceptable values of composite reliability (CR = 0.89-0.93) and average variance extracted (AVE = 0.64-0.66), respectively. The square roots of AVE were higher than factor-factor pairs correlations, and the Heterotrait-Monotrait ratio (HTMT) of correlations values was less than 0.85, indicating acceptable discriminant validity.

CONCLUSIONS

Overall reliability and both convergent and discriminant validity tests indicated that the Moroccan dialectal Arabic version of the CES-D had a good performance and may serve as a valid tool for measuring the severity of depression in people with substance use disorder.

Factor structure of the Chinese CES-D and invariance analyses across gender and over time among Chinese adolescents

BACKGROUND

Research findings on the factor structure and invariance of the Center for the Epidemiological Studies Depression Scale (CES-D) are inconclusive. Besides, very few studies have examined factorial invariance of the scale over time. Related studies based on Chinese adolescents are also sparse. This study attempted to examine the factor structure of the CES-D and its invariance across gender and time over a one-year period among adolescents in mainland China.

METHOD

A total of 3,010 adolescents (mean age = 13.16 years, 1,730 boys) completed a questionnaire including the CES-D at Wave 1 and 2,648 of them completed the same survey one year later. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were performed to examine the factor structure of the CES-D. Factorial invariance of the resultant factor structure was tested using cross-sectional multi-group CFA (girls vs. boys) at Wave 1 and Wave 2 and longitudinal CFA (Wave 1 vs. Wave 2).

RESULTS

EFA and CFA revealed a three-factor model of the CES-D, including "somatic complaints," "depressed affect," and "positive affect." Additionally, findings supported the factorial invariance across gender and over time for the three-factor model.

LIMITATIONS

Limitations of the present study included a lack of adolescents from different areas in mainland China (particularly rural areas) and only a one-year follow-up.

CONCLUSIONS

This pioneering study suggests that there are three stable dimensions of the CES-D in Chinese adolescents in mainland China which are invariant across gender and over time.

Somatization and Coping in Ethnic Minority Recruits

INTRODUCTION

Military service can have beneficial social effects on minorities. However, minority groups are also often at greater risk of somatizing psychological distress and coping maladaptively. In military training this would result in lower mental health of minorities and contribute to higher drop-out rates. We thus examined if recruits with different ethnocultural backgrounds report different somatization levels and coping styles.

MATERIALS AND METHODS

Seven hundred and forty male recruits of the Swiss Armed Forces aged 18-26 took part in a cross-sectional study during basic training. Participants filled out self-rating questionnaires covering sociodemographics, somatization (SCL-90-R), coping styles (INCOPE-2), and social support (F-SozU). The recruits' ethnic self-identification was used to compare three groups: native Swiss (89%); Turkish or Balkan minority (5%); heterogeneous ethnic minority (6%). Group differences in somatization scores were tested with a Kruskal-Wallis test; group differences in coping styles were tested with a multivariate ANCOVA, controlling for the level of social support experienced.

RESULTS

Recruits from the heterogeneous ethnic minority group reported significantly greater levels of somatization than their native Swiss comrades. Coping styles did not differ between the three ethnic groups, but higher levels of social support were associated with better coping.

CONCLUSION

Military doctors ought to place importance on the differential diagnosis of medically unexplained physical symptoms in ethnic minority recruits. This would contribute to minimize the risk of misdiagnosis. Military mental health professionals who counsel recruits reporting somatic symptoms are advised to be sensitized to an ethnic minority status. Physical complaints could mask affective problems or be part of an adjustment disorder symptomatology.

Promising Results from the Use of a Korean Drama to Address Knowledge, Attitudes, and Behaviors on School Bullying and Mental Health among Asian American College-Aged Students

The limited research on bullying, mental health (MH), and help-seeking for Asian American (ASA) college students is concerning due to the public health importance. Korean drama (K-Drama) television shows may be an innovative approach to improve knowledge, attitudes, and behaviors (KAB) on bullying. This study examined whether the KAB about school bullying improved after watching a K-Drama and asked participants about their perspectives of using a K-Drama as an intervention. A convenience sample of college students (n = 118) watched a K-Drama portraying school bullying and MH issues. Pre-/post-tests on KAB on bullying were conducted. Interviews (n = 16) were used to understand their experiences with K-Dramas. The mean age was 22.1 years (1.6 SD), 83.9% were female, and 77.1% were ASAs. Many reported experiences with anxiety (67.8%), depression (38.1%), and school bullying victim experience (40.8%). Post-test scores revealed significant differences in knowledge by most school bullying variables (e.g., victim; witness) and MH issues. There were varying significant findings in post-test scores in attitudes and behaviors by these variables. Participants reported that they "love" the drama, felt an emotional connection, and thought that K-Dramas can be an educational tool for ASAs. K-Dramas may be an effective population-level tool to improve health outcomes among ASAs.

Higher Incidence of Psychiatrist-Diagnosed Depression in Taiwanese Female School-Age Children and Adolescents with Type 1 Diabetes: A Nationwide, Population-Based, Retrospective Cohort Study

OBJECTIVES

The aim of this study was to investigate the risk of clinical depression associated with type 1 diabetes in female Taiwanese children and adolescents.

METHODS

Using Taiwan's National Health Insurance Research Database, we identified 1373 female children and adolescents, aged 5-18 years, with type 1 diabetes diagnosed between 2000 and 2007. A comparison cohort was assembled, which consisted of 20 patients without type 1 diabetes, based on frequency matching for age interval and index year for each patient with type 1 diabetes. Both groups were followed until a psychiatrist diagnosed depression or the end of the follow-up period, up to a maximum period of 5 years from the index date. A Poisson regression model was used to calculate incidence rate ratios (IRRs) for depression between the type 1 diabetes cohort and the comparison cohort.

RESULTS

The incidence rate of depression in the type 1 diabetes cohort was 228.4 per 100,000 person-years and that in the comparison cohort was 73.9 per 100,000 person-years. The type 1 diabetes cohort showed a significantly higher incidence of depression compared with the comparison cohort (IRR of 3.09, p < 0.001).

CONCLUSION

Findings from this nationwide, population-based, retrospective cohort study showed that the incidence of psychiatrist-diagnosed depression was significantly higher in female Taiwanese school-age children and adolescents with type 1 diabetes compared with those without the disease.

Adolescent Self-Esteem in Cross-Cultural Perspective

Theorists and researchers have raised the question of whether self-esteem has similar meanings and correlates in individualistic and collectivist cultures. This study examined the cross-cultural equivalence of the Rosenberg Self-Esteem Scale in four countries and compared its association with parental warmth and acceptance and depressed mood. Participants were 11th graders in the United States ( n = 422), the Czech Republic ( n = 490), China ( n = 502), and Korea ( n = 497). Cross-cultural similarities in the factor structure of the self-esteem scale and in the relations of self-esteem to other variables were more striking than cross-cultural differences. Across cultures, parental warmth was significantly related to both positive and negative self-image, each of which in turn was related significantly to depressive symptomatology. There was little evidence for the hypothesis that self-esteem would more strongly mediate the relation between parental warmth and adolescent depressive symptoms in the more individualistic(as opposed to collectivist) cultures.

Acculturation and Its Effect on Depressive Symptom Structure in a Sample of Mexican American Elders

In this study, we compared the depressive symptoms reported by Mexican American elders who scored higher and lower on a linguistic acculturation scale. Prevalence, equality of covariance matrices, equality of error variances, and factor structures were examined for the 20 items included in the Center for Epidemiologic Studies Depression (CES-D) Scale. The sample consisted of 3,050 community-dwelling Mexican Americans from five states. Significant differences were found on all parameters, indicating that level of acculturation is associated with pervasive differences in the way items are endorsed on the most commonly used inventory of depressive symptoms. Results add to literature suggesting that there may not be a universal structure to symptoms. Higher or lower scores may have different implications for people representing different cultures and/or stages of acculturation, something that both researchers and clinicians should be sensitive to when interpreting results of screening tests.

Evaluation and treatment of low and anxious mood in Chinese-speaking international students studying in Scotland: study protocol of a pilot randomised controlled trial

Background

Low mood is a common mental health problem affecting up to 121 million people worldwide and is common in students, particularly international students. Cognitive behavioural therapy (CBT) is known to be effective as a treatment for low mood and anxiety when delivered one to one by an expert practitioner, however this can be expensive and many services have waiting lists and delayed access. A range of additional ways of increasing access to services includes the offer of online courses such as computerised CBT as a possible additional pathway for care. This project aims to test the feasibility of a pilot randomised controlled trial of an online CBT-based life skills course with Chinese-speaking international students experiencing low mood and anxiety.

Methods/design

Chinese-speaking international students with symptoms of low mood and/or anxiety will be recruited from the University of Glasgow, Scotland. Participants will be remotely randomised to receive either immediate access (IA) or delayed access (DA) to a guided/supported online CBT-based life skills package, the “Living Life” package (Chinese version). Participants will be randomly assigned to IA or DA to the intervention. The primary end point will be at 3 months when the delayed group will be offered the intervention. Levels of depression, anxiety, social functioning and satisfaction will be assessed.

Discussion

This pilot study will test the trial design, ability to recruit, gather completed questionnaires, test drop-out rates and investigate completion and acceptability of the package. The study aims to reduce uncertainties about the delivery of a future substantive study and will also inform a sample size calculation for that subsequent substantive randomised controlled trial (RCT) which will be carried out to determine the effectiveness of the online package in improving low mood and anxiety in the Chinese-speaking student population.

Trial registration

Current Controlled Trials ISRCTN30816908

Validation of the Center for Epidemiologic Studies Depression Scale in black single mothers

BACKGROUND AND PURPOSE

The purpose of this study was to investigate the factor structure of the Center for Epidemiologic Studies Depression (CES-D) scale in a community sample of Black single mothers and to evaluate the scale's construct validity.

METHODS

Principal components and exploratory factor analysis were used. The participants responded to the CES-D scale and Spielberger's State-Trait Anger Expression Inventory.

RESULTS

The final sample consisted of 208 Black single mothers aged 18-45 years. A 2-factor structure was accepted. Construct validity was confirmed via significant correlations with the anger scales. A method artifact for the 2-factor solution was ruled out.

CONCLUSION

The CES-D scale is valid for use with Black single mothers. Additional psychometric evidence for the CES-D for Black single mothers is warranted.

Epidemiology of major depressive disorder in mainland china: a systematic review

BACKGROUND

Major depressive disorder (MDD) is one of the important causes of disease burden in the general population. Given the experiencing rapid economic and social changes since the early 1990s and the internationally recognized diagnostic criteria and interview instruments across the surveys during 2001-2010 in china, the epidemiological studies on MDD got varied results. We performed this meta-analysis to investigate current, 12-month and lifetime prevalence rates of MDD in mainland China.

METHODS

PubMed, Embase, Chinese Biological Medical Literature database (CBM), Chinese National Knowledge Infrastructure database (CNKI), and the Chinese Wanfang and Chongqing VIP database were searched for associated studies. We estimated the overall prevalence of MDD using meta-analysis.

CONCLUSIONS

Seventeen eligible studies were included. Our study showed that the overall estimation of current, 12-month and lifetime prevalence of MDD was 1.6, 2.3, 3.3%, respectively. The current prevalence was 2.0 and 1.7% in rural and urban areas, respectively; between female and male, it was 2.1 and 1.3%, respectively. In addition, the current prevalence of MDD diagnosed with SCID (Structured Clinical Interview for DSM-IV) was 1.8% and that diagnosed with CIDI (Composite International Diagnostic Interview) was 1.1%. In conclusion, our study revealed a relatively high prevalence rate in the lifetime prevalence of MDD. For current prevalence, MDD diagnosed with SCID had a higher prevalence rate than with CIDI; males showed a lower rate than females, rural residents seemed to have a greater risk of MDD than urban residents.

Treatment gap in common mental disorders: the Singapore perspective

AIMS

The problem of wide treatment gaps in mental disorders is endemic world wide. The study aims to establish the treatment gap of common mental disorders in Singapore.

METHODS

A national sample of 6616 persons aged 18 years and above was surveyed with the World Mental Health Composite International Diagnostic Interview in which for each diagnostic module, respondents were asked a series of questions regarding treatment contact.

RESULTS

Treatment gap varied considerably between disorders; alcohol abuse had the largest treatment gap (96.2%), followed by obsessive compulsive disorder (89.8%) and alcohol dependence (88.3%). The disorder for which people were most likely to seek help was major depressive disorder. Women with dysthmia were more likely than men to seek help but this help seeking behavior was reversed among those with alcohol abuse and dependence. Age of onset was significantly associated with treatment contact with those who had an earlier age of onset less likely to have treatment contact than those with late age of onset for all disorders except obsessive compulsive disorder.

CONCLUSIONS

Our findings suggest that treatment gaps are wide even in an economically developed country like Singapore and other than sociodemographic factors, cultural influences might play an important role in help seeking behavior.

The prevalence and impact of major depressive disorder among Chinese, Malays and Indians in an Asian multi-racial population

BACKGROUND

Reports of rates of depression among different Asian ethnic groups within the same country using standardized assessments are rare in the extant literature.

METHODS

This was a household survey of 6616 adult residents of Singapore which constituted a national representative sample. Face to face interviews were conducted with the English, Chinese and Malay versions of the World Mental Health Composite International Diagnostic Interview. The response rate was 75.9%.

RESULTS

The lifetime and 12-month prevalence estimates for MDD were 5.8% and 2.2%, respectively. MDD was significantly higher among the females, Indians, those who were divorced/separated, or widowed. The median age of onset of MDD was 26 years with the highest risk of onset in those aged 18-34 years while the age group of 65 years and above had the lowest risk of onset. Chronic physical conditions were present in approximately half of the respondents with MDD. MDD was also associated with considerable disability in terms of days of role impairment. More than half (59.6%) of those with lifetime MDD had not ever sought professional help.

LIMITATIONS

This was a cross-sectional household survey that excluded those who were institutionalized. Responses were self-reported and therefore subjected to recall bias.

CONCLUSIONS

Our findings add to the body of knowledge on the differential rates of depression among different ethnic groups; the association with disability, comorbid physical conditions and the considerable proportion of untreated cases also have important clinical and policy implications.

Malaysian Moslem mothers' experience of depression and service use

Standard psychiatric criteria for depression developed in the United States and United Kingdom are increasingly used worldwide to establish the prevalence of clinical disorders and to help develop services. However, these approaches are rarely sensitive to local and cultural expressions of symptoms or beliefs about treatment. Mismatch between diagnostic criteria and local understanding may result in underreporting of depression and underutilization of services. Little such research has been conducted in Malaysia, despite the acknowledged high rate of depression and low access to services. This study examines depression in Moslem Malay women living in Johor Bahru, Southern Peninsular Malaysia, to explore depression symptoms using the Structured Clinical Interview for DSM-IV. The 61 women interviewed were selected on the basis of high General Health Questionnaire scores from a large questionnaire survey of 1,002 mothers. The illustrative analysis looks at descriptions of depressed mood, self-depreciation and suicidal ideation, as well as attitudes toward service use. The women gave full and open descriptions of their emotional symptoms, easily recognizable by standard symptom categories, although somatic symptoms were commonly included, and the spiritual context to understanding depression was also prevalent. However, few women had knowledge about treatment or sought medical services, although some sought help from local spiritual healers. Attending to such views of depression can help develop services in Malaysia.

Exploring the Validity of the College Student Reasons for Living Inventory among Asian American College Students

We examined the cultural validity of the College Student Reasons for Living Inventory (CSRLI) with Asian American College Students (N = 314). Although results did not completely replicate the six factor structure of the CSRLI as identified in Westefeld, Cardin, and Deaton (1992), partial support was found. The content of the five factors that emerged corresponded to five of the original scales. Our factor solution accounted for 50.25% of common variance and demonstrated moderate to high coefficient alphas. Validity of the CSRLI subscales was supported through significant negative relations with measures of depression and hopelessness. Furthermore, the CSRLI subscales accounted for 8% of the variance in suicidal behavior above and beyond that accounted for by the risk factors of depression and hopelessness alone.

Intimate partner violence among Asian immigrant communities: health/mental health consequences, help-seeking behaviors, and service utilization

Intimate partner violence (IPV) is a serious epidemic among Asian immigrant communities. Yet little is known about the scope, nature, and related contextual, cultural, and social factors of IPV among this population. In particular, the lack of research has been evident in examining health and mental health outcomes of IPV and service utilization, revealing notable gaps in health disparities which result in a failure to provide relevant services and law enforcement protection for battered Asian immigrant women. This article examines critically the growing body of literature on IPV among Asian immigrant populations in several areas: (a) the context of IPV: cultural, social, and individual/familial, (b) prevalence of IPV, (c) physical health and increased risk for sexually transmitted disease and HIV/AIDS, (d) mental health consequences and substance use, (e) social support and help-seeking behaviors, and (f) barriers to service utilization. Future directions for practice, policy, and research are discussed.

A longitudinal analysis of depressive symptoms among Asian and Pacific Islander mothers at-risk for child maltreatment

This longitudinal study examined racial differences in depressive symptoms at three time points among Asian, Native Hawaiian/Other Pacific Islander (NHOPI) and white mothers at-risk for child maltreatment (n = 616). The proportion of mothers with depressive symptoms ranged from 28 to 35% at all time points. Adjusted analyses revealed that Asian and NHOPI mothers were significantly more likely than white mothers to have depressive symptoms but this disparity was present only among families at mild/moderate risk for child maltreatment. Future research should identify ways to reduce this disparity and involve the Asian and NHOPI communities in prevention and treatment program design and implementation.

Disparities in use of mental health and substance abuse services by Asian and Native Hawaiian/other Pacific Islander women

The purpose of this study was to determine if disparities exist in lifetime utilization of mental health/substance abuse services among Asian, Native Hawaiian/Other Pacific Islander (NHOPI) and white mothers. The study sample was comprised of mothers assessed to be at-risk (n = 491) and not at-risk (n = 218) for child maltreatment in the Hawaii Healthy Start Program study. Multiple logistic regression models were used to test the effects of predisposing, need, and enabling factors on utilization of services. Results revealed that, among mothers with depressive symptoms, compared with whites, Asians and NHOPI were significantly less likely to have received services. There were no significant racial differences in use of mental health/substance use services by other factors. These results suggest that racial disparities exist in utilization of mental health/substance abuse services among mothers with depressive symptoms. Future research is needed to identify barriers and facilitators to accessing needed services for Asian and NHOPI women.

A Person-centered Approach to Studying the Linkages among Parent-Child Differences in Cultural Orientation, Supportive Parenting, and Adolescent Depressive Symptoms in Chinese American Families

This longitudinal study examined whether supportive parenting mediates relations between parent- child differences in cultural orientation (generational dissonance) and depressive symptoms with a sample of 451 first and second generation Chinese American parents and adolescents (12-15 years old at time 1). Using a person-centered approach, meaningful typologies of cultural orientation were derived for fathers, mothers, and adolescents. Overall, results provided support, though qualified, for the notion that generational dissonance is linked to depressive symptoms through decreased supportive parenting. In general, having a parent with a bicultural profile seemed to be most advantageous if adolescents similarly had a bicultural profile, whereas more American oriented adolescents with more Chinese oriented parents reported the least supportive parenting and most depressive symptoms. Directions for future research and the benefits of using a person-centered approach in research of acculturation and generational dissonance are discussed.

Measures of psychological acculturation: a review

This article reviews conceptual and methodological issues in the measurement of psychological acculturation. The major issues involve the question of dimensionality and the assessment of specific domains of cultural change. Bidimensional scales that cover both overt and internal domains are more informative for the assessment of general levels of psychological acculturation. The validity of such scales must be examined in terms of the actual exposure of individuals to and involvement in each culture, and the influence of sociocultural factors on the course of acculturation. The parallel application of qualitative and quantitative methods may be useful for validity studies. The complementary use of emic and etic approaches will enhance the psychometric soundness of acculturation scales.

Folk concepts of mental disorders among Chinese-Australian patients and their caregivers

AIM

This paper reports a study of (a) popular conceptions of mental illness throughout history, (b) how current social and cultural knowledge about mental illness influences Chinese-Australian patients' and caregivers' understanding of mental illness and the consequences of this for explaining and labelling patients' problems.

BACKGROUND

According to traditional Chinese cultural knowledge about health and illness, Chinese people believe that psychotic illness is the only type of mental illness, and that non-psychotic illness is a physical illness. Regarding patients' problems as not being due to mental illness may result in delaying use of Western mental health services.

METHODS

Data collection took place in 2001. Twenty-eight Chinese-Australian patients with mental illness and their caregivers were interviewed at home, drawing on Kleinman's explanatory model and studies of cultural transmission. Interviews were tape-recorded and transcribed, and analysed for plots and themes.

FINDINGS

Chinese-Australians combined traditional knowledge with Western medical knowledge to develop their own labels for various kinds of mental disorders, including 'mental illness', 'physical illness', 'normal problems of living' and 'psychological problems'. As they learnt more about Western conceptions of psychology and psychiatry, their understanding of some disorders changed. What was previously ascribed to non-mental disorders was often re-labelled as 'mental illness' or 'psychological problems'.

CONCLUSION

Educational programmes aimed at introducing Chinese immigrants to counselling and other psychiatric services could be made more effective if designers gave greater consideration to Chinese understanding of mental illness.

Cultural variation in affect valuation

The authors propose that how people want to feel ("ideal affect") differs from how they actually feel ("actual affect") and that cultural factors influence ideal more than actual affect. In 2 studies, controlling for actual affect, the authors found that European American (EA) and Asian American (AA) individuals value high-arousal positive affect (e.g., excitement) more than do Hong Kong Chinese (CH). On the other hand, CH and AA individuals value low-arousal positive affect (e.g., calm) more than do EA individuals. For all groups, the discrepancy between ideal and actual affect correlates with depression. These findings illustrate the distinctiveness of ideal and actual affect, show that culture influences ideal affect more than actual affect, and indicate that both play a role in mental health.

Adult Korean Americans: their attitudes toward seeking professional counseling services

This exploratory study examined the attitudes of 157 adult Korean Americans, who routinely gather at a community center, about obtaining professional counseling services. Data gathered from self-report instruments were used to determine gender, income, and educational differences and preferences for seeking sources of help. No significant gender or income level differences were found among the participants with respect to their attitudes in procuring professional counseling. However, study-participants with higher levels of education indicated more positive attitudes about securing professional assistance. Also significant differences were found between female and male respondents regarding their preferences for help-seeking. Implications for practice and future research are discussed.

Meta-analysis of the factor structures of four depression questionnaires: Beck, CES-D, Hamilton, and Zung

Four separate metaanalyses of factor analyses were conducted for the Beck Depression Inventory (BDI), the Center for Epidemiological Studies Depression Scale (CES-D), the Hamilton Rating Scale for Depression (HRSD), and the Zung Self-Rating Depression Scale (SDS). The total number of participants (N) and studies (k) included in each of the metaanalyses were the following: BDI (N = 13,643, k = 33), CES-D (N = 22,340, k = 28), HRSD (N = 2,606, k = 17), and SDS (N = 12,621, k = 13). Metaanalysis results suggest that the specific depression symptom factors within each test appear to be relatively robust and well established and match fairly closely previously hypothesized factor structures. A general Depression Severity factor and a small Somatic Symptoms factor are found in all four tests and two tests had a small Positive Affect factor. There were fewer common specific depression symptom factors across tests than expected.

Inventory of college challenges for ethnic minority students: psychometric properties of a new instrument in Chinese Americans

The Inventory of College Challenges for Ethnic Minority Students (ICCEMS) is a newly developed instrument that assesses challenges faced by ethnic minority college students across a range of cultural, academic, social, and practical domains. The present study tested the ICCEMS among Chinese American students in an attempt to identify its factor structure and assess its psychometric properties. A total of 13 factor domains emerged. The Cronbach's alpha and 1-month test-retest reliability of the subscales and the overall scale supported their reliability. Both criterion and construct validities were also demonstrated. Chinese American college students faced the greatest challenges in terms of unclear career direction and academic demands.

Some recommendations to assess depression in Chinese people in Australasia

OBJECTIVE

To provide some general recommendations for psychiatric assessment of depression among Chinese patients within a predominately Western society.

METHOD

A literature review is provided with interpretive comments.

RESULTS

The prevalence of depression reported in community studies undertaken in Chinese communities is very low. To what extent Chinese people experience and seek help for depression, and how they report depressive symptoms have long been topics of some importance. The impact of acculturation as well as concepts and interpretations of illness in traditional Chinese medicine are discussed. Awareness of sensitive issues and practices within the Chinese culture will facilitate communication between medical professionals and patients, resulting in more accurate identification and diagnosis of depressive disorders.

CONCLUSION

Direct but culturally sensitive and empathic questioning of psychological symptoms is needed to unveil patients' explanatory models, as most Chinese initially nominate only somatic symptoms to health practitioners. Successfully treated patients can promote earlier and wider utilization of mental health services to other Chinese people.

Measuring culture: a critical review of acculturation and health in Asian immigrant populations

The number of studies examining how acculturation affects the health of Asian immigrants has increased in recent years. The proliferation of studies reflects the growing size and heterogeneity of Asian immigrant populations in the United States, Canada, Australia, New Zealand, and the United Kingdom. This paper compares various approaches to acculturation within the health literature on Asian immigrants by reviewing the literature in three-health domains (1) mental health (2) physical health and (3) health services use. The review critically examines the conceptualizations and measures of acculturation in these three domains and presents major findings. We observe that measurement difficulties posed by the experiences of heterogeneous Asian groups compound theoretical and disciplinary disparities between acculturation instruments. The extent to which conceptual and methodological critiques of acculturation studies in Hispanic populations apply to studies of Asian populations is also discussed. The critical review thus provides insights into the diverse ways that the relationship between culture and health is measured in this complicated and growing literature.

A strategy to reduce cross-cultural miscommunication and increase the likelihood of improving health outcomes

Encounters between physicians and patients from different cultural backgrounds are becoming commonplace. Physicians strive to improve health outcomes and increase quality of life for every patient, yet these discordant encounters appear to be a significant factor, beyond socioeconomic barriers, in creating the unequal and avoidable excess burden of disease borne by members of ethnic minority populations in the United States. Most clinicians lack the information to understand how culture influences the clinical encounter and the skills to effectively bridge potential differences. New strategies are required to expand medical training to adequately address culturally discordant encounters among the physicians, their patients, and the families, for all three may have different concepts regarding the nature of the disease, expectations about treatment, and modes of appropriate communication beyond language. The authors provide an anthropological perspective of the fundamental relationship between culture and health, and outline systemic changes needed within the social and legal structures of the health care system to reduce the risk of cross-cultural miscommunication and increase the likelihood of improving health outcomes for all populations within the multicultural U.S. society. The authors define the strengths inherent within every culture, provide a guideline for the clinician to evaluate disease and illness within its cultural context, and outline the clinical skills required to negotiate among potential differences to reach mutually desired goals for care. Last, they indicate the structural changes required in the health care setting to enable and support such practice.