Assessment Of Depression For Ethnic Minorities

Although several instruments for assessing depressive symptoms and major depression exist, some measures may not adequately or appropriately include symptom patterns or idioms that characterize the illness for ethnic/ minority patients. Improved understanding of possible racial or ethnic variations in the manifestation of depressive symptoms will increase diagnostic accuracy (Ayalon & Young, 2003) and lead to better characterization and detection of disorders across distinct groups. Clinicians should use the combination of a standardized assessment tool and individualized assessment of social history, acculturation, physical symptoms and functioning, and atypical symptom expression.

Some studies have found that measures of depressive symptomatology are invariant across race and ethnic groups; therefore, they may be seen as universally valid indicators of distress. Aneshensel, Clark, and Frerichs (1983) used confirmatory factor analysis to determine whether variance in factor patterns of various depressive symptom scales existed in a community sample of European, African Americans, and English-speaking and Spanish speaking Latinos. They did not find any significant differences for the depression factor. Similarly, Hepner, Morales, Hays, Orlando, and Miranda (2005) did not find evidence for item bias or item performance differences between African American and European American women for the mood module of the Primary Care Evaluation of Mental Disorders (PRIME-MD), a widely used primary care assessment tool for screening depression. These findings suggest that standardized instruments may be helpful for assessment of ethnic/minority patients.

A number of other studies, however, have found group differences in the measurement of depressive symptoms. One study found differences in the patterns of depressive symptoms across four groups: whites, blacks, and English- and Spanish-speaking Hispanics (Aneshensel et al., 1983); other researchers have found evidence for variance in depression symptoms among Latinos (Posner, Stewart, Marin, & PĂ©rez-Stable, 2001). Still other studies have found evidence for ethnic differences in the meaning and diagnostic utility of depression, anxiety, and somatic symptoms in ethnic/minority groups. In our study of race differences in the factor structure of the

Center for Epidemiologic Studies—Depression (CES-D) Scale (Radloff, 1977), we found variance in the factor structure of symptoms between European American and African American national survey respondents (Kohn-Wood, Banks, Ivey, & Hudson, 2007). Specifically, African Americans were significantly less likely to endorse three items, "I enjoyed life," "I felt full of energy," and "I felt people cared for me." Colea, Kawachib, Mallerd, and Berjman (2000) utilized item response bias analyses to conclude that two CES-D items ("people are unfriendly" and "people dislike me") were biased by race towards higher endorsement among elderly African Americans in comparison to elderly Whites, possibly due to being confounded with perceptions of racial prejudice. Similarly, in Ayalon and Young's (2003) examination of depressive symptomatology on the Beck Depression Inventory (BDI), a measure similar to the CES-D, 4 of 21 items, including self-dislike, sleep disturbance, loss of appetite, and loss of libido, were significantly more likely to indicate depression severity for African Americans than for European Americans. These studies point to the importance of understanding the comparability of measurement instruments across populations. Are we measuring the same thing across different groups? Given the limited evidence for symptom pattern differences, it is critically important to supplement standardized measures with individualized information. Other than linguistic translations of existing standardized instruments, the field generally lacks available ethnic-specific assessment instruments such as the CES-D-K, recommended for use with Korean populations (Noh, Avison, & Kaspar, 1992).

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