Comparative study of affective disorders in three Asian countries. II. Differences in prevalence rates and symptom presentation

Social relationship quality, depression and inflammation: A cross-cultural longitudinal study in the United States and Tokyo, Japan

BACKGROUND

Depression is an illness with biological, psychological, and social underpinnings, which may include the interplay of inflammation, psychological traits, stress, social relationships, and cultural background.

AIMS

This work examines the prospective associations between social relationship quality and depressive symptoms, and between social relationship quality and inflammatory outcomes in two distinct cultures.

METHODS

Data were obtained from two longitudinal, prospective cohort studies: Midlife in the United States (MIDUS), and Midlife Development in Japan (MIDJA) between 2004 and 2010. One thousand three hundred and twenty-seven community-based adults were included in analyses, 1,054 from the United States and 273 from Tokyo, Japan. Depressive symptoms (measured by the CES-D Depression Scale) and inflammation (measured by blood sample concentrations of the inflammatory biomarkers interleukin-6 and C-reactive protein) were the outcomes. Social relationship quality was the predictor. Culture, trait independence and interdependence, and psychosocial stressors were examined as moderators of the link between social relationship quality and depressive symptoms.

RESULTS

Higher social relationship quality was associated with lower depressive symptoms in the United States (β = -6.15, p < .001), but not in Japan (β = -1.25, p = .390). Social relationship quality had no association with inflammation. Psychosocial stressors moderated the link between social relationship quality and depressive symptoms in both the United States (β = -0.39, p = .001) and Tokyo (β = -0.55, p = .001), such that social relationship quality acted as a buffer against depressive symptoms as psychosocial stress increased.

CONCLUSION

Improving the perceived quality of social relationships appears to be a stronger target for depression interventions in the United States than in Tokyo, Japan.

Cognitive complaints and predictors of perceived cognitive dysfunction in adults with major depressive disorder: Findings from the Cognitive Dysfunction in Asians with Depression (CogDAD) study

BACKGROUND

Several studies have described the presence of perceived cognitive dysfunction amongst Asian patients with major depressive disorder (MDD). To date, no study has been conducted investigating the predictors of perceived cognitive dysfunction amongst Asian MDD patients.

METHODS

This was a post-hoc analysis of the Cognitive Dysfunction in Asian patients with Depression (CogDAD) study. Descriptive statistics were used to describe the most common cognitive complaints by patients. Univariate and multivariate analyses were performed to determine variables associated with perceived cognitive dysfunction (Perceived Deficit Questionnaire-Depression, PDQ-D).

RESULTS

The CogDAD study population is comprised of MDD patients with mild-to-moderate depression (Patient Health Questionnaire 9-item [PHQ-9]: 11.3 ± 6.9) who reported perceived cognitive dysfunction (PDQ-D = 22.6 ± 16.2). The most common cognitive complaints were: mind drifting (42.3%), trouble making decision (39.6%) and trouble concentrating (38.0%). Predictors of perceived cognitive dysfunction were: being Southeast Asians (vs. Taiwanese) (p < 0.001), current episode longer than 8 weeks (vs. 1-8 weeks) (p < 0.05), the presence of disability (vs. no disability) (p < 0.05), younger age (p < 0.01), and higher PHQ-9 total scores (p < 0.001).

LIMITATIONS

The causal relationship between predictive variables and PDQ-D could not be tested due to the cross-sectional nature of the study. Furthermore, a neuropsychological test was not included in the CogDAD study and use of concomitant medications, including anti-depressants, could have impacted patient's perceived cognitive ability.

CONCLUSIONS

The present study results suggest a potential role for subjective cognitive assessment in patients with MDD who are young, with long durations of depression or severe depression.

An exploratory study of social problems experienced by ambulatory cancer patients in Japan: Frequency and association with perceived need for help

OBJECTIVE

Little is known about the social problems experienced by cancer patients in non-Western countries. The aims of this study were (1) to explore the characteristics and frequencies of social problems in cancer outpatients, as well as their associations with the need for help, and (2) to take the initial steps to develop an instrument for the assessment of cancer-related social problems in Japan.

METHODS

A cross-sectional group of 109 patients completed the Social Problem Checklist and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire C30. Participants rated the levels of the problem severity and the need for help on each item. Factor structure, internal consistency, and construct validity were also assessed.

RESULTS

In total, 72.5% of the participants encountered ≥1 problem, and 33% experienced ≥1 serious problem. The amount of help needed tended to be lower than problem severity, especially for family and social life issues. The most common reason for not needing help, as reported by approximately 40% of patients who experienced problems, was the preference for self-management. A 3-factor model was extracted that included financial matters, medical information, and family and social life. Excellent internal consistencies for each factor and convergent correlations between the relevant subscales of European Organization for Research and Treatment of Cancer Quality of Life Questionnaire C30 and Social Problem Checklist were confirmed.

CONCLUSIONS

A substantial proportion of participants had cancer-related social problems, but they had ambivalent help-related needs. Interventions that enhance the patient's abilities for self-care could be essential to help cancer outpatients manage social problems in Japan.

Culturally Adapted Cognitive-Behavioral Therapy for Chinese Americans With Depression: A Randomized Controlled Trial

OBJECTIVE

No randomized controlled trials (RCTs) for adults have compared the effectiveness of a well-specified psychotherapy and a culturally adapted version of the same treatment. This study evaluated the effectiveness of cognitive-behavioral therapy (CBT) and culturally adapted CBT (CA-CBT) in treating depressed Chinese-American adults.

METHODS

This RCT treated 50 Chinese Americans who met criteria for major depression and sought treatment at community mental health clinics. Screening of participants began in September 2008, and the last assessment was conducted in March 2011. Participants were stratified by whether they were already taking antidepressants when they first came to the clinic and randomly assigned to 12 sessions of CBT or CA-CBT. The study did not influence regular prescription practices. The primary outcomes were dropout rates and Hamilton Depression Rating Scale scores at baseline, session 4, session 8, and session 12.

RESULTS

Participants in CA-CBT demonstrated a greater overall decrease in depressive symptoms compared with participants in CBT, but the groups had similarly high depression rates at week 12. Differences in dropout rates for the two groups approached, but did not meet, statistical significance (7%, CA-CBT; 26%, CBT).

CONCLUSIONS

Chinese Americans entered this study with very severe depression. Participants in both CBT and CA-CBT demonstrated significant decreases in depressive symptoms, but the majority did not reach remission. Results suggest that these short-term treatments were not sufficient to address such severe depression and that more intensive and longer treatments may be needed. Results also indicate that cultural adaptations may confer additional treatment benefits.

Atypical Epidemiologic Finding in Association between Depression and Alcohol Use or Smoking in Korean Male: Korean Longitudinal Study of Aging

OBJECTIVE

The purpose of this study is to examine the relationship between substance use and depressive symptoms in a cohort of Koreans aged 45 years and older from a large, population-based study. Using the 2006 Korean Longitudinal Study of Aging, we estimated the prevalence of depressive symptoms and its association with smoking and alcohol use.

METHODS

Depressive symptoms were measured using the CES-D 10-item scale. Age, marital status, educational attainment, employment and any disability were the control variables. Because there were gender differences in smoking and alcohol use, we also performed a separate analysis by gender.

RESULTS

In the multivariable logistic regression, ex-drinkers were more likely to be depressed than non-drinkers (OR, 1.37; 95% CI, 1.08-1.74 for males; OR, 1.78; 95% CI, 1.23-2.57 for females). Compared to non-drinkers, males with moderate drinking habits (OR, 0.75; 95% CI, 0.63-0.90) were less likely to be depressed, whereas heavy male drinkers were more likely to be depressed (OR, 1.43; 95% CI, 1.07-1.91). Female smokers were more likely to be depressed than female non-smokers (OR, 2.07; 95% CI, 1.51-2.83).

CONCLUSION

This study showed atypical pattern of relationship between smoking and depression and U-shaped relationship between depressive symptoms and alcohol consumption in male population. Both of these findings could be inferred from that these regional characteristics might be cross-sectional finding of chronologic transition result from a rapid rise of late life depression in Korea.

Differences in psychiatric symptoms among Asian patients with depression: a multi-country cross-sectional study

AIM

The aim of this study was to compare the symptomatic and clinical features of depression among five groups of patients with major depressive disorder (MDD) living in China, Korea, Malaysia/Singapore, Taiwan, and Thailand.

METHODS

Consecutive consenting adults (aged 18-65) who met DSM-IV criteria for non-psychotic MDD – based on the Mini International Neuropsychiatric Interview – and who were free of psychotropic medication were evaluated in a cross-sectional study. Depressive symptoms were evaluated using the 10-item Montgomery–Asberg Depression Rating Scale (MADRS) and the 13-item depression subscale of the Symptoms Checklist 90-Revised (SCL-90-R). In addition, the 10-item SCL-90-R Anxiety Subscale was completed. ancova were conducted, adjusting for confounders: age, completion of secondary education, marital status, work status, religion, index episode duration, and depressive severity. For the magnitude of differences, a threshold of 0.10 was taken as the minimum effect size representing clinical significance, and an effect size of 0.25 was considered moderate.

RESULTS

Four MADRS symptoms differentiated these five groups, the most prominent being ‘lassitude’ and ‘inner tension’. Nine SCL-90-R depression items also differentiated the groups, as did eight SCL-90-R Anxiety Subscale items. The MADRS lassitude item had the largest effect size (0.131). The rest of those statistically significant differences did not exceed 0.10.

CONCLUSION

MDD is more similar than different among outpatients in these diverse Asian countries. The between-country differences, while present and not due to chance, are small enough to enable the use of common clinician and self-report rating scales in studies involving Asians with MDD from various ethnic backgrounds.

Clinical features of depression in Asia: results of a large prospective, cross-sectional study

INTRODUCTION

The objective of this study was to investigate the clinical features of depression in Asian patients.

METHODS

It was a cross-sectional, observational study of depression in China, Korea, Malaysia, Singapore, Taiwan, and Thailand. Participants were drug-free outpatients with depressed mood and/or anhedonia. Symptoms and clinical features were assessed using the Montgomery-Asberg Depression Rating Scale, Symptoms Checklist 90-Revised (SCL-90-R), and the Fatigue Severity Scale. Other measures included the Medical Outcome Survey 36-Item Short-Form Health Survey (SF-36), the Sheehan Disability Scale, and the Multidimensional Scale of Perceived Social Support (MSPSS).

RESULTS

A total of 547 outpatients with major depressive disorder were included in the analyses. Among the Montgomery-Asberg Depression Rating Scale symptoms, "reported sadness" and "reduced sleep" had the highest severity, with means (SDs) of 3.4 (1.2) and 3.4 (1.6), respectively. Apart from the SCL-90-R depression and anxiety domains, the SCL-90-R obsession-compulsion syndrome had the highest domain score, with a mean (SD) of 1.9 (0.9). Among eight domains, the mean (SD) SF-36 pain subscale score of 58.4 (27.7) was only second to that for the SF-36 physical function. In comparison to other disability domains, the Sheehan Disability Scale work/school had the highest subscale score, with a mean (SD) of 6.5 (2.9). The mean (SD) MSPSS "family" subscale score of 4.7 (1.7) was higher than the MSPSS "friends" and "significant others" subscale scores.

DISCUSSION

This study suggests that pain has a minimal impact on the quality of life in Asian patients with depression. Noteworthy issues in this population may include insomnia, obsessive-compulsive symptoms, working/school disability, and family support.

Associations of substance abuse and sexual risks with self-reported depressive symptoms in young adults in northern Thailand

Depression among young adults is a significant mental health issue worldwide. Withdrawal from amphetamine and chronic alcohol use is associated with significant increases in depressive symptoms. Young adults with depressive symptoms are more likely to engage in sexual risk behaviors than peers who are not depressed. We investigated the association between substance abuse and sexual risk behaviors with recent depressive symptoms (using the Centers for Epidemiologic Studies Depression Scale [CES-D] scale) in a sample of 1189 young adults aged 18 to 25 years in Chiang Mai, Thailand, who were recruited based on recent methamphetamine use or were sex partners of a methamphetamine user. High reports of depressive symptoms, based on CES-D scores ≥22, were seen in 45% of women and 31% of men (P < 0.0001) and were associated with alcohol problems (Cut down, Annoyed, Guilty, Eye-opener [CAGE] score and frequency of drunkenness) and frequent methamphetamine use in men but not women. For women, higher depressive symptoms were associated with greater numbers of reported sexual partners during the past year where condoms were infrequently used. These results point to the importance of identifying substance abuse among young adults in Thailand and its contribution to depressive symptoms and the importance of recognizing depression as a significant public mental health problem in this population.

Views of depressed patients in Pakistan concerning their illness, its causes, and treatments

Although the core symptoms of depression appear uniform across cultures, their presentations might vary from one culture to another. This interview study was part of a project to establish whether cognitive behavior therapy could be effective for the treatment of depression in a developing country. We interviewed outpatients from a university teaching hospital in Pakistan who were diagnosed as having depression. We tried to elicit their knowledge and perceptions of depression, its causes, and treatments, and their views about nonpharmacological treatments. We discovered that patients had very little knowledge of mental illnesses in general, and depression in particular. They believed that mental health problems were the result of stress or trauma, and that only medicines could help them. Patients had no knowledge of the roles of psychologists or psychotherapy. Their model of understanding mental illnesses appeared to represent a psychosocial understanding, with physical symptoms being their main concern.

Lifestyle changes of Japanese people on overseas assignment in Michigan, USA

BACKGROUND

Temporary work assignments in the United States (US) are widely considered to have negative health outcomes on Asians mostly due to adverse changes in diet and exercise, though there is little research on this phenomenon. This study investigated the impact of lifestyle changes on the biological and psychological health and health behaviours of Japanese people on temporary assignments in the US.

METHODS

In this cross sectional survey, we distributed a 38 item self-administered questionnaire addressing health habits, mental health function, lifestyle changes and dietary habits to adult Japanese patients presenting for general physicals at a family medicine clinic serving Japanese patients. We conducted simple statistics and regression analysis between length of stay and other health outcomes to determine whether length of residence in the US was predictive of negative lifestyle changes.

RESULTS

Most participants reported increased caloric intake, weight gain, and less exercise. They also reported increased time with family. More women than men reported physical symptoms and anxiety related to stress. Smoking and alcohol intake were essentially unchanged. No associations were identified between length of residence in the US and health lifestyle habits or other health outcomes.

CONCLUSION

Negative lifestyle changes occur in diet and exercise for overseas Japanese people, but a positive change in increased family time was found. Women appear to be at a greater risk for somatic disorders than men. As duration of stay does not appear predictive of adverse changes, clinicians should advise patients going abroad of these risks regardless of the term of the work assignment.

Screening for depression in terminally ill cancer patients in Japan

This study attempted to assess the performance of several screening instruments for adjustment disorders (ADs) and major depression (MD) among terminally ill Japanese cancer patients. Two hundred and nine consecutive patients were assessed for ADs and MD using a structured clinical interview at the time of their registration with a palliative care unit, and two single-item interviews ("Are you depressed?" and "Have you lost interest?") and the Hospital Anxiety and Depression Scale (HADS) were administered. Screening performance was investigated by calculating sensitivity, specificity, the positive predictive value, negative predictive value, likelihood ratio, and stratum-specific likelihood ratios. When the screening target included both an AD and MD, the HADS is a more useful screening method than the single-item interviews. Regarding screening for MD, both single-item interviews and the HADS possess useful screening performance. Different screening instruments may be recommended depending on the depressive disorders and specific populations.

Anxiety, depression and quality of life in colorectal cancer patients

BACKGROUND

Few studies have examined psychological distress and its relationship with quality of life (QL) dimensions in colorectal cancer patients.

METHODS

One hundred and twenty-eight outpatients were given psychological tests for anxiety and depression (Hospital Anxiety and Depression Scale; HADS) and QL The European Organization for Research and Treatment of Cancer Quality-of-Life Questionnaire C30 (EORTC QLQ-C30) on the same occasion. The association between the patients' emotional function (EF) scoring on EORTC QLQ-C30 and their HADS scores was analyzed by multiple linear regression.

RESULTS

Statistically significant negative relationships were found between EF and HADS-A (anxiety), HADS-D (depression), and HADS-T (total score), respectively, with the highest correlation coefficient being for HADS-A. However, HADS-D was significantly more highly correlated than HADS-A to other QL dimensions, and depression was more highly correlated than anxiety with reduced QL.

CONCLUSION

The EF dimension of the EORTC QLQ-C30 predominantly assesses anxiety. Depression has a stronger impact on the global QL of patients than anxiety; therefore, the use of an additional instrument is recommended for the assessment of depression in outpatients with colorectal cancer.

Pathways to care for patients with bipolar disorder

Bipolar disorder is a chronic, debilitating psychiatric illness with serious ramifications for patients, their families, and society. Despite the availability of effective treatments, this disease often goes untreated due to medical, financial, legal/governmental, and cultural barriers. In this review we explore possible reasons for this problem. Misdiagnosis of bipolar disorders is a common medical barrier. One pathway to care for individuals with bipolar disorder is through referral from primary care, but primary care physicians generally have not received special training in the recognition and management of bipolar disorder. This often leads to diagnostic delays or errors, which prevents timely 'filtering' of patients into specialized care. Using data bases we explored these pathways. Legislation in the USA, such as the Emergency Medical Treatment and Active Labor Act (EMTALA), designed to ensure access to inpatient mental health care, has instead given hospitals financial incentives to limit inpatient mental health care capacities. Reimbursement of mental health care expenses is a significant issue impacting a patient's ability to gain access to care, as bipolar disorder is a costly disease to treat. Improving access to care among the bipolar community will require multilateral strategies to influence the actions and attitudes of patients, communities, providers, health care systems, and state/national governments. In other cultures, barriers to care differ according to a number of factors such as type of services, explanatory models of illness, misdiagnosis and perceptions of care givers. It is essential that clinicians are aware of pathways and barriers so that appropriate and accessible care can be provided.

Transcultural issues in mood and anxiety disorders: a focus on Japan

Accurate comparisons of the prevalence of psychiatric disorders across Eastern and Western cultures are difficult and limited by methodological problems. Nevertheless, using standardized diagnostic and evaluation techniques, recent surveys have suggested that depression and anxiety disorders exist in all countries and cultures examined thus far, although variations in the prevalence rates and symptomatology may exist. This article discusses the influence and impact that culture can have on recognizing and treating mood and anxiety disorders, with a particular focus on Japan. Over the last 20 years, studies have consistently reported an increase in mental illness in Japan, especially symptoms of depression and anxiety. While such symptoms have had an adaptive cultural role in the past, current social and economic changes in Japan have turned any adaptive advantage into a potentially significant disadvantage, with a major impact on the capacity of individuals to function adequately. The situation is compounded by the fact that Japanese patients are reluctant to openly discuss disturbances of mood, since these are considered to be indicative of personal weakness rather than treatable medical conditions. Reluctance to discuss personal mental health hinders timely recognition and appropriate treatment.

Is There a Universal Positivity Bias in Attributions? A Meta-Analytic Review of Individual, Developmental, and Cultural Differences in the Self-Serving Attributional Bias

Researchers have suggested the presence of a self-serving attributional bias, with people making more internal, stable, and global attributions for positive events than for negative events. This study examined the magnitude, ubiquity, and adaptiveness of this bias. The authors conducted a meta-analysis of 266 studies, yielding 503 independent effect sizes. The average d was 0.96, indicating a large bias. The bias was present in nearly all samples. There were significant age differences, with children and older adults displaying the largest biases. Asian samples displayed significantly smaller biases (d = 0.30) than U.S. (d = 1.05) or Western (d = 0.70) samples. Psychopathology was associated with a significantly attenuated bias (d = 0.48) compared with samples without psychopathology (d = 1.28) and community samples (d = 1.08). The bias was smallest for samples with depression (0.21), anxiety (0.46), and attention-deficit/hyperactivity disorder (0.55). Findings confirm that the self-serving attributional bias is pervasive in the general population but demonstrates significant variability across age, culture, and psychopathology.

Depression and psychological distress in patients during the year after curative resection of non-small-cell lung cancer

PURPOSE

There have been few psychosocial studies of patients after curative resection of non-small-cell lung cancer (NSCLC). The purpose of this study was to clarify the clinical course of depression and psychological distress of such patients during the year after surgery and to identify predictors of their long-term outcome.

PATIENTS AND METHODS

A total of 212 patients completed assessments during a 12-month follow-up period after curative resection of NSCLC. Psychological measurements at 1, 3, and 12 months after surgery were conducted using the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders (ed 3), Revised, and the Profiles of Mood States (POMS) scale. Univariate and multivariate analyses were used to identify predictors of psychological outcome according to these two methods of assessment.

RESULTS

The prevalence of depression did not change during the year after curative resection (range, 4.7% to 8.0%). The total POMS score was also unaltered during the year after surgery: the anger-hostility (P <.001) and tension-anxiety subscale scores (P <.026) had increased at 12 months, but the vigor-activity subscale score had also increased (P <.001). All predictors of psychological outcome at 12 months included a depression episode after the diagnosis of lung cancer or at 1 month after surgery. Less-educated status was also a significant predictor of depression at 12 months.

CONCLUSION

These results suggest the need for psychosocial support even after curative resection of NSCLC and indicate that an approach that includes repetitive perioperative assessment of depression and careful attention to less-educated patients might be of benefit to patients in ameliorating depression and psychological distress during the year after curative resection.

A comparison of characteristics of depressed patients and efficacy of sertraline and amitriptyline between Japan and the West

BACKGROUND

This study was conducted to investigate the differences and similarities of the profile of depressed patients and the efficacy of the antidepressants, sertraline and amitriptyline, between Japan and the West (United States, Europe), using the Hamilton Depression Rating Scale (HAM-D) score of the individual patients.

METHODS

Using common selection criteria, 680 patients from three regional clinical studies were chosen for this investigation. Factor analysis of the HAM-D scores for each regional group was carried out to compare the profile of depressed patients. Analysis of covariance was used to compare the efficacy of sertraline and amitriptyline between the regions.

RESULTS

Factor analyses clearly showed three main factors (major depressive symptoms, anxiety and sleep disturbance) to be common across all three geographic regions. Higher HAM-D component scores of "Work and interests" and "Retardation" and lower ones of "Depressed mood" and "Feeling of guilt" were observed for the Japanese patients compared to the Western patients. Improvement of anxiety symptoms was marked for the Japanese amitriptyline treated patients.

LIMITATIONS

Although the patient data used in these analyses were restricted by using identical selection criteria, there still remains some methodological shortcomings due to the original study design differences.

CONCLUSIONS

Overall, the three main factors of depression and their magnitudes were similar between Japan and the West. The presentation of major depressive symptoms in Japanese patients differed from Western patients; this could be related to social, cultural and religious differences. Marked sedative effect for Japanese patients appeared to be due to the factor of anxiety being the strongest of the three main factors in Japanese depressed patients.

Cross-cultural comparability of the Geriatric Depression Scale: comparison between older Koreans and older Americans

It is becoming increasingly clear that, in order to better understand the implications of global aging, more cross-cultural research is needed. In the present study, the structure and validity of the Geriatric Depression Scale-Short Form (GDS-SF) was examined in Korean and US samples of older adults. The participants included 153 older adults living in Korea (mean age=65.9 years) and 459 older adults from Florida (mean age=72.4 years). All participants completed the original or translated versions of the GDS-SF, as well as additional demographic and health-related measures. The results indicated that the GDS-SF exhibited good reliability in both samples. However, the results of a principal components analysis indicated that the structure was not well replicated across the two samples. In general, the present study suggests that, despite great efforts to make the questionnaires equivalent in the two cultures, the concept of depression for older adults may vary greatly in Korea and the USA. Possible explanations for cross-cultural differences are discussed, as well as implications.

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.

Ethnicity and adolescent depression: the case of Chinese Americans

This paper is concerned with whether an instrument developed in the U.S. may identify lower rates of major depression among Chinese, because its content may not cover culture-specific symptoms of depression. Data were obtained from approximately 952 Anglo and Chinese American middle school students, aged 10 to 17 years, in the Teen Life Changes Survey conducted in the spring of 1994. We investigated the hypothesis that rates of missing values would be higher, the mean score for total depression items would be lower, and internal consistency reliability and construct validity of the DSM Scale for Depression (DSD) would be lower for Chinese American adolescents compared with Anglo American adolescents. We also examined whether response functions on the DSD item would differ for these two groups. Only the latter was observed. Five of 26 items in the DSD exhibited differential functioning between Anglo and Chinese students. The results suggest that the lower prevalence of depression was not due to the ethnocentric character of the instrument in the Chinese sample. Stronger immunity to depression or other cultural factors may contribute to the lower rate of depression for the Chinese American adolescents in the Teen Life Changes study.

Lack of association of Borna disease virus and human T-cell leukemia virus type 1 infections with psychiatric disorders among Japanese patients

Borna disease virus (BDV) infection has been suspected to be a possible etiological factor in human psychiatric disorders and recently in chronic fatigue syndrome. Evidence of the correlation of BDV infection with these disorders remained unclear. Kagoshima is known to be one of the major areas in which human T-cell leukemia virus type 1 (HTLV-1) is endemic; this is the first isolated human retrovirus that causes adult T-cell leukemia with neurological symptoms. The present study aimed to clarify whether BDV and HTLV-1 infections are associated with psychiatric disorders among Japanese patients. Subjects were 346 patients with psychiatric disorders (schizophrenia, 179; mood disorder, 123; and others, 44) and 70 healthy controls. Anti-BDV antibodies from plasma samples were screened by the indirect immunofluorescence (IF) method using BDV-infected MDCK cells. Results revealed that only three samples were found to be weakly positive for BDV in the IF assay and seronegative by Western blot (immunoblot) assay. Furthermore, BDV-p24 related RNA in peripheral blood mononuclear cells from 106 of 346 psychiatric patients and 12 or 70 healthy controls by p24-reverse transcription PCR was examined. Two mood disorder patients were positive for BDV-p24 RNA but seronegative. To detect anti-HTLV-1 antibodies the plasma samples were screened by the particle agglutination method and no significant difference in seropositivity for anti-HTLV-1 antibody was found between the patients and healthy controls. These results also suggested that there is a lack of association between BDV and HTLV-1 infections with psychiatric disorders among Japanese patients.

Depression among Chinese Americans: a review of the literature

The Chinese American population is among the fastest growing ethnic minority groups in the United States. Knowledge of the interaction between culture, disease expression, and utilization of psychiatric treatment by this population is limited. This article gives a general review of the literature on depression among Chinese Americans in order to clarify misconceptions, to increase knowledge of research on depression that has been done on one specific Asian-American group, and to set a direction for future nursing research and intervention.

Participation in and outcome of treatment for major depression among low income Asian-Americans

This study examined the relationship of four aspects of psychiatric treatment (use of medication, client-therapist ethnic match, treatment in an Asian-specific clinic, and professional therapist) to participation in treatment and outcome of treatment in low income Asian-American clients (n = 273) of the Los Angeles County mental health system who were diagnosed with major depression. Based on cultural responsiveness theory, the study tested the hypothesis that use of medication in treatment would have the greatest effect on participation and outcome followed, in order, by client-therapist ethnic match, treatment in an Asian-specific clinic, and treatment by a professional therapist. The hypotheses were largely supported: treatment with medication had a significant relationship to total number of treatment sessions (participation) and improvement in the admission-discharge Global Assessment Scale (GAS) score (outcome). Treatment by a therapist of the same ethnicity as the client and treatment in an agency designated to provide services to Asian clients both had significant relationships to the number of treatment sessions but not to GAS score improvement. Four covariates included in the analysis and treatment by a professional therapist had no relationship to either of the dependent variables.

Sociocultural and clinical characteristics of patients with comorbid depressions: a comparison of substance abuse and non-substance abuse diagnoses

Patients with three varieties of major depression (MD) were compared with respect to sociocultural and clinical characteristics. The patients sought psychiatric evaluation in an intake setting during a 6-year interval. The groups that were compared included MD (sole axis I diagnosis; N = 3,913); MD with a comorbid non-substance abuse ([MD-nonSA] N = 594); and MD with a comorbid substance abuse ([MD-SA] N = 690). Prominent demographic differences were found in the three groups, with males, lower social class status, younger age, and African American ethnicity being more prominent in MD-SA. The four demographic variables, axis I status, axis II diagnosis, and axis III diagnosis constituted the independent variable in an analysis of variance (ANOVA) main-effects comparison of social function (during last year and currently in three areas) and type of depression symptoms (somatic and psychological). Of the demographic variables, age and social class proved to have significant effects on social function and psychological symptoms. Each of the three "syndromic" axes (Axis I, Axis II, and Axis III) had a significant impact on social function and psychological symptoms. Only Axis III produced differences in somatic symptoms. The social and cultural implications of these results are discussed.