DEBORAH J. MORTON, SUSAN A. SCHOENROCK, E. PERCIL STANFORD, K. MICHAEL PEDDECORD, AND CRAIG A. MOLGAARD

U S E OF T H E C E S - D A M O N G A C O M M U N I T Y SAMPLE OF OLDER M E X I C A N - A M E R I C A N S

ABSTRACT. This study is a descriptive and comparative analysis of the Center for Epidemiologic Studies Depression (CES-D) scale as administered to a sample of Mexican-Americans (n=455) age 45 years and older. This sample was part of a crosssectional survey (Health and Lifestyles After 45) carried out in 1985-1987 by the University Center on Aging at San Diego State University. Results indicate that CES-D mean scores (overall=ll.3) and caseness rates (overall=25.9%) are comparable with depression data reported from other studies among samples of Mexican-Americans. Factor analysis provided evidence indicating cultural response preferences among Mexican-Americans, particularly immigrants, who tend to somatize dysphoric complaints. A re-examination of an often cited CES-D ethnic validation study is included. Implications for construct validity of the CES-D among older Mexican-Americans are discussed. Key Words: depression, CES-D, older Mexican-Americans

INTRODUCTION Currently, Hispanics are the most rapidly growing ethnic minority in the United States. In the 30 years from 1950 to 1980, their numbers have increased from 2.7% to 6.4% of the total United States population (Alston and Aguirre 1987). According to Malgady, Rogler and Constantino (1987), the 1985 advance census estimates the figure to be 7.2%. Malgady et al. go on to state the annual growth rate from 1970 to 1980 was 6.1% for Hispanics, 1.8% for blacks and .06% for whites. Additionally, although Hispanics tend to be a young population when compared to whites, approximately 5% of all Hispanics are 65 years of age and older with almost 7% of that group 85 years or older. (Agree 1985). Due to such population increases, there is now a greater concern over the health status of Hispanics. However, the literature lacks studies dealing solely with the older Hispanic. Furthermore, Malgady et al. (1987) note that the majority of these studies are plagued by culturally and linguistically biased interpretations along with weak methodology. An example of scarcity in the literature relating to older Hispanics is in the area of mental health assessment. The purpose of this paper is to contribute to the existing data in this field, more specifically the area of depression as assessed by the Center for Epidemiologic Studies Depression scale (CES-D) (Radloff 1977). In a review of recent literature, there have been several studies Journal of Cross-Cultural Gerontology 4" 289-306, 1989. © 1989 by Kluwer Academic Publishers. Printed in the Netherlands.

290

DEBORAH J. MORTON ET AL.

which have utilized the CES-D with Hispanics. Although some have sampled populations that have included people age 65 and over (Himmelfarb and Murrell 1983; Lecca, Greenstein and McNeil 1987; Mendes de Leon and Markides 1988), the majority of the studies have been limited to those younger than 65 (Frerichs, Aneshensel and Clark 1981; Vernon and Roberts 1982; Vega, Kolody, Valle and Hough 1986a; Vega, Kolody, Hough and Figueroa 1987a; Burnam, Timbers and Hough 1987; Marck, Solis, Richardson, Collins, Birba and Hisserich 1987). In addition to CES-D studies among Hispanics lacking older persons, a common limitation of existing samples is that they tend to be characterized by low income, dangerous occupations coupled with high unemployment, and low levels of education, all of which appear to contribute to poor physical and mental health status. The questions then become: Are these disturbing figures of high levels of depression entirely accurate or are they confounded by the sample demographics? Additionally, are the assessment procedures sensitive to cultural variation or is there some degree of built-in bias due to the origin and validation of the CES-D among mainstream populations? Another interesting aspect of the recent literature is that the construct validity of the CES-D for use among Hispanic populations is based solely upon one study, namely that of Roberts (1980). Upon a detailed examination of this study, the conclusions based upon a confirmatory factor analysis appear to be somewhat ambiguous and unclear. Therefore, the purpose of this study is twofold: a) to present a descriptive and comparative analysis of the results of the CES-D among an older MexicanAmerican population and, in addition, b) to re-examine the development of the measure and the process by which it was determined to be appropriate for use among Hispanics. Along with this critique will be a presentation of results of a factor analysis among an older Mexican-American sample. METHODS Data for this paper were obtained from the Health and Lifestyles After 45 (HALAF) project conducted in San Diego County, California, from 1985 to 1987. The overall research goals of the HALAF project were geared toward the investigation of the relationship of chronological age, health and functional dependence among the minority and non-minority aged. This included measurement of health, socio-cultural, psychological, behavioral and ecological factors involved in the assessment of functional dependence. The long term aim of the project was to delineate a multidimensional classificatory system for older individuals based upon levels of functional dependence rather than chronological age. Such a screening system would serve to identify the potentiality of functional dependence in later life and, therefore, permit the intervention of preventive methods to arrest functional dependence in its early stages. The entire HALAF sample consisted of a total of 2,105 non-institutionalized people aged 45 and over of which 819 were white, 629 were black, and 657

CES-D AMONG OLDER MEXICAN-AMERICANS

291

were Hispanics of Mexican descent. Only 17.1% of the Mexican-Americans in the sample were born in the United States, the majority (82.9%) having been born in Mexico. Eligibles were identified using random digit dialing telephone screening supplemented by a multi-stage block sampling procedure using doorto-door screening. Both samples were selected from census tracts with an 18% or greater concentration of blacks and/or Mexican-Americans. After the households were identified, eligibles were determined by the sampling method of Bryant (1975). This method helps to alleviate the problem of a disproportionate number of females in the final sample. The HALAF instrument was a composite of several existing data collection instruments which have known reliability, validity and sensitivity along with a group of questions specifically designed for the study. Information in the areas of demographics, physical health history, status and behavior, mental health, health service utilization and insurance, folk medicine behavior, nutrition and diet, social resources, activities of daily living (ADL), and Alzheimer's risk factors were collected. Except for the CES-D, the HALAF instrument was translated into Spanish appropriate for Southern California, verified through several back translations using expert bilingual judges and then tested in a pilot study in order to minimize language bias. The translation utilized for the CES-D was taken from Vega, Kolody and Valle, (1986b). Face-to-face interviews were conducted in the home by ethnically and linguistically matched interviewers and lasted an average of 1.5 hours. Among the Mexican-American group, 91.2% of the interviews were conducted in Spanish. Approximately 10% of all interviews were verified by telephone or personal visit follow-up. Included in the HALAF instrument as one of the mental health measures useful for the assessment of functional dependence was the CES-D. The CES-D is a 20 item checklist scored on a four-point scale (0-3) with the higher numbers indicating the presence of symptoms most or all of the time. Four of the items indicate positive affect and are, therefore, scored in the opposite manner. Scoring range is from 0 to 60 with the higher scores indicating more depressive symptomology. The intended utilization of the CES-D was not to diagnose clinical depression, but to measure current symptoms of depression and how often each symptom occurred during the previous week. The 20 items cover a range of symptoms associated specifically with depression and not just general distress. The CES-D has known validity and reliability for use as a non-diagnostic screening measure among community studies of the elderly (Murrell and Himmelfarb 1983; Radloff and Ted 1986), of Mexican-Americans (Weissman, Sholomskas, Pottenger, Pmsoff and Locke 1977; Roberts 1980), and of elderly Hispanics (Mahard 1988). The CES-D has also been utilized in numerous studies among Mexican-Americans in California and Baja California (Frerichs, Aneshensel and Clark 1981; Vega, Warheit, Buhl-Auth and Meinhardt 1984; Vega, Kolody, Valle and Hough 1986a; Vega, Kolody and Valle 1986b; Vega, Kolody, Hough and Figueroa 1987a; Vega, Kolody and Valle 1987b) and, therefore, provides a large data base for comparative purposes.

292

DEBORAHJ. MORTONET AL.

Although there is some controversy surrounding cutpoints associated with the CES-D, most studies, whether among Hispanic populations or not, generally utilize a score of 16 or greater to indicate possible caseness (Comstock and Helsing 1976; Weissman et al, 1977) and a score of greater than 23 to be indicative of probable caseness (Husaini, Neff, Harrington and Hughes 1980). These studies determined the cutpoints based on validation with chnical samples. Himmelfarb and Murrell (1983) have recommended a cutpoint of 20 (as opposed to 16) for people over age 50 based on a procedure similar to Husaini et al. (1980). However, since the Himmelfarb and Murrell (1983) study utilized a clinical sample for validation of which less than half (45%) had a primary diagnosis of depression, and since their study is unique in the use of this cutpoint, for comparative purposes, this analysis will apply the more widely recognized cutpoints mentioned earlier. Additionally, a portion of the HALAF sample is younger than 50 and is, therefore, not an "older" sample as defined by Himmelfarb and Murrell (1983). The analysis in this paper is limited to an examination of the CES-D as administered to 69% (n=455) of the entire sample of Mexican-Americans in the HALAF sample. This was due to a delayed inclusion of the CES-D into the HALAF study. The remaining 31% of the Mexican-American group in the HALAF sample should not be considered refusals or non-responses to the CESD. The CES-D simply was not a part of the entire HALAF instrument at that time. The CES-D was administered by handing respondents a "card" on which the 20 items were listed along with the 0-3 choices. Interviewers read each of the 20 items as a question and respondents were asked to tell the interviewer which number corresponded to the appropriate answer. Administered in this manner, we believe response bias was negligible. All 455 respondents answered at least 18 of the 20 items. Missing values for each item were less than 2%. Because of the low percentage of missing values, the procedure for estimating total scores for those who answered less than 20 items but more than 15, as suggested by Radloff (1977), was deemed unnecessary. Had this procedure been followed, it would only have served to inflate the final scores. Reliability was tested using Cronbach's Alpha, which yielded a high coefficient of .91 for the entire sample (n=455) of Mexican-Americans. The purpose of this paper is to present a descriptive analysis of prevalence rates of depressive symptomology among an older population of MexicanAmericans for comparison with the existing hterature. We will also examine the response structure of the CES-D with older Mexican-Americans through the use of factor analytic techniques. To the best of our knowledge, there is only one other analysis which reported the factor structure of the CES-D when administered to a cross section of Mexican-Americans (Roberts 1980).

CES-D AMONG OLDER MEXICAN-AMERICANS

293

TABLE I Mean CES-D scores and analysis of variance for selected demographic characteristics of the sample of Mexican-Americans (n=455) Demographic Variable

n

% in category Mean SD

Total

455

100.0

11.3

11.8

Age Group 45-54 55-64 65-74 75+

95 123 141 95

20.9 27.1 31.1 20.9

12.0 12.6 8.0 12.8

13.2 12.7 9.5 11.8

Gender Male Female

183 272

40.2 59.8

8.6 13.2

9.6 12.8

17.1 c

Nativity U.S. Mexico

64 389

14.1 85.5

10.6 1 !.3

11.3 11.8

3.23

Education 0--4years 5-8 years 9-11 years 12+ years

260 149 22 23

57.3 32.8 4.8 5.1

12.7 9.1 8.3 13.0

11.8 11.3 11.9 13.7

3.63 a Group '0--4years' is different from '5-8 years' and 9-11 years'.

Marital Status Married Never Married Widowed Divorced Separated

249 22 92 44 45

55.1 4.9 20.4 9.7 10.0

9.7 12.5 12.0 16.2 13.7

11.0 12.8 12.3 13.2 11.9

3.73 b Group 'married' is different from 'separated' and 'divorced'. Group 'widowed' is different from 'divorced'.

Income (yearly) < $5,000 5,000-9,999 10,000-14,999 15,000-19,999 20,000+

41 253 101 25 10

9.5 58.8 23.5 5.8 2.3

11.4 12.9 9.0 8.8 5.5

9.5 12.7 9.8 10.0 11.7

3.0P Group '$5,000-9,999' is different from '$10,000-14,999' and '20,000+'.

Employment Status Unemployed Employed Retired

44 51 281

11.7 13.6 74.7

11.5 11.0 5.9 8.5 12.1 12.1

a p 23; a) divorced, b) 12 or more years of education, c) separated, d) female, and e) aged 75 or over. Please note that (d) and (e) have identical caseness rates. FACTOR ANALYSIS In the often cited CES-D validation study by Radloff (1977), a factor analysis was performed to assist in illustrating the statement that the CES-D had adequate reliability, validity and factor or response structure within each subgroup of the population. Principal components factors analysis with varimax rotation yielded four factors with items loading above .40 (Radloff, 1977). The four factors identified were as follows: (1) (2) (3) (4)

Depressed affect Positive affect Somatic Interpersonal

items = items = items = items =

blues, depressed, lonely, cry, sad good, hopeful, happy, enjoy bothered, appetite, effort, sleep, get going unfriendly, dislike.

Four of the items, failure, fearful, mind and talk did not load unless the cutoff figure was lowered to .35. Radloff states that these four factors are compatible with the elements of depression which were built into the scale. Additionally, the author states that with few exceptions, the four factor structure was delineated across all subgroups (lhree age groups, two sexes, blacks, whites, three levels of education and two "need help" groups). These findings supported evidence of construct validity and the conclusion that the CES-D is appropriate for use across a wide range of demographic subgroups of English-speaking Americans. Roberts (1980) tested the CES-D for its suitability among MexicanAmericans. He found that although the response rate for the Mexican-Americans

300

DEBORAH J. MORTON ET AL,

was lower than that for the blacks and whites, there were no differences between the three groups in relation to missing data or internal consistency reliability. Roberts (1980), like Radloff (1977), performed a confirmatory factor analysis and concluded that the same general four factor response structure emerged for the Mexican-American group (see Appendix A) as had been found by Radioff. However, prior to running the factor analysis, Roberts weighted by a value of one, each of the 16 items that had originally loaded for Radloff. Additionally, it appears Roberts used a very high cutpoint of .68 for his factor analytic results when stating that the items loading (see underlined scores in Appendix A) were consistent with Radloff (1977). This is confusing in that he also states in the text that the items loaded at .60 or better. If that were the case, then the items labeled as blues and depressed would be added to the third factor labeled somatic affect. Taking this one step further, if Roberts had used .40 or better for the cutoff loading value as did Radloff, then the items labeled fearful, get going, bothered, sleep, trouble concentrating, appetite, talked less, effort, and dislike would have been added to the first factor - depressed affect, and the items labled cry, sad, and lonely would have been added to the third factor - somatic affect. It appears that using the value of .40 for the loading cutoff would cause some of the items to load on both the depressed affect factor and the somatic affect factor. This would certainly serve to muddle the interpretation somewhat. If a factor loading value of .40 or above is utilized, the confounding of the items on the somatic and depressed affect factors found by Roberts (1980) may possibly be explained by the tendency of Mexican-Americans, particularly immigrants, to present physical health problems rather than psychological problems. The propensity of Hispanics towards somatization of dysphoric complaints is evident in the literature. Escobar, Gomez and Tuason (1987), cites several studies as evidence of this phenomena, conducted in and out of the United States. A study comparing depressed Colombians and depressed Anglos in the U.S., validated by two different instruments, stated that the Colombians somatized more than the Americans (Escobar, Randolph and Hill 1983). Another study (Escobar 1986) found Mexican-American male schizophrenic veterans to report significantly more positive somatic symptoms than their white counterparts, again using two different assessment measures. A third study, referred to by Escobar (1987) conducted among a community sample in Los Angeles, found no significant differences among Mexican-American and Anglo males when reporting mean number of positive DIS-III somatic complaints, but found a very large difference between females, most especially those over the age of 40 years. Further support for the cultural tendency of Hispanics towards somatization is evident in Kolody, Vega, Meinhardt and Bensussen, (1986). This study stated that Mexican-Americans are similar to the Chinese (as described by Kleinman (1977)) in their proclivity to somatize depressive disorder. Kolody and colleagues in the same study, with a sample of 521 Mexican-Americans, of which approximately 40% were immigrants, investigated the relationship between depressive symptomology and the severity and prevalence of somatic corn-

CES-D AMONGOLDERMEXICAN-AMERICANS

301

plaints. Depressive symptomology was not measured by the CES-D, but with a similar instrument known as the Florida Health Study Depression Measure (developed by Vega, et al. 1984). The study found that there was a linear relationship between the number of depressive symptoms and the severity of health complaints which did not vary when selected demographic characteristics were controlled. When compared to the Anglos in the sample, the MexicanAmericans exhibited statistically stronger associations between somatic complaints and depressive symptomology. The immigrant Mexican-Americans exhibited the highest depressive symptomology when reporting only minor health complaints. The results of a factor analysis performed on the HALAF sample presented here support the findings of Kolody et al. (1986) and Escobar (1987) (see Table IV). TABLE IV Factor loadings of CES-D items for Mexican-Americans (n---455) ITEM

FACTOR 1

FACTOR 2

FACTOR 3

Depressed Sad Get Going Lonely Sleep Crying Talked Less Effort Bothered Fearful Blues Failure Appetite Trouble Concentrating Hopeful

.76 ~ .'-7i" ."if5 .61 .'~ .'5"7 .-~ ~ .-~ ~ .46 ~ ~ .33

.29 .33 .18 .33 .27 .25 .17 .26 .05 .43 .28 .35 .07 .20 .19

.12 .11 .18 .16 .20 .08 .12 .21 .13 .15 .15 .22 .04 .15 .09

Enjoy Happy Good

.22 .35 .13

.71 .'~ .'~

.11 .01 .28

Disliked Urffxiendly

.24 .09

.09 .14

.71 .-~

36.8%

3.8%

Total Variance Explained

3.2%--43.8%

Furthermore, they are similar to the results obtained by Roberts (1980) when reexamining his factor analysis utilizing a factor loading cutoff value of .40 or greater. First, and most notably, the factor analysis with a standard varimax rotation produced only three, not four factors. The items in factor one loading

302

DEBORAH J. MORTON ET AL.

above .40 are a mixture of the depressed and somatic items as labeled by Radloff (1977) and Roberts (1980) and account for the highest percentage of variance explained. Second, factors two and three contain very similar items that were found by Radloff (1977) and Roberts (1980) for their factors two (positive affect) and four (interpersonal). Therefore, the only difference between the HALAF sample and Roberts' (1980) study appears to be that the somatic and depressed factors were combined and did not separate out from one another. This is what would be expected if the individuals in the sample tended to somatize their dysphoric complaints. It has been established that is exactly what occurs among a population of Mexican-Americans. Additionally, out of the six items in factor one which loaded above .60 and would, therefore, explain the most variance, two of them (get going and sleep) are considered somatic. To summarize, based upon a review of the literature, and a comparison of the factor analytic results presented here with those obtained by Roberts (1980), it appears that the specific cultural tendency of Mexican-American populations towards somatization is reflected in the scores and the factor structure of the CES-D. The CES-D appears to confound somatic and depressed factors when administered to older Mexican-Americans, most especially among immigrants. SUMMARY ANDCONCLUSIONS The CES-D is widely considered a reliable, valid and sensitive screening instrument in the assessment of depression and has been utilized in a large number of studies. These studies include populations of elderly, MexicanAmericans, and elderly Mexican-Americans. This study population is one of the few to sample older Mexican-Americans. Results are generally consistent with other studies that have reported CES-D mean scores and prevalence rates. Among the 65-74 age category and the most highly educated, mean scores and prevalence rates are dissimilar to those reported in other samples. Findings suggest that variables such as health status, social support systems, life satisfaction and frustrated status expectations need to be analyzed in order to determine plausible explanations for these discrepancies. Additionally, according to Vega, et al., (1986a) the CES-D, when compared to other checklists of depressive symptomology, is particularly applicable to use with Hispanics because it limits the over self-reporting of physical health complaints common among Hispanic populations. Although this may be the case when comparing the CES-D to other mental health screening measures, the data presented here suggest that the factor structure of the CES-D, when administered to an older Mexican-American population that exhibits mean scores and prevalence rates generally consistent with other samples, is somewhat confounded by specific cultural practices. The cultural tendency to present with physical complaints such as generalized body pains, headaches, and indigestion (Kolody et al. 1986) which when subjected to further diagnosis are reflective of classic depressive symptomology, has been well documented among both the elderly and among Hispanics. More specifically, when adminis-

CES-D AMONGOLDERMEXICAN-AMERICANS

303

tered to white or black populations, the CES-D produces four factors consistent with the components of a depressive disorder i.e. a depressive factor and a somatic factor explaining most of the total variance. The results from the HALAF sample of Mexican-Americans produced only three factors which appeared as the somatic and depressed factors combined into a single factor explaining 37% of the 44% total variance explained. These results lead to the conclusion that the evidence for conslruct validity of the CES-D when administered to older Mexican-Americans needs to be reconsidered. The emergent factor structure, confounded by cultural attitudes towards physical and mental health may, in part, account for the distressingly high mean scores and prevalence rates found in this and other studies conducted among Mexican-American populations. It should be noted that the CES-D was originally designed using white mental health standards and tested and validated among white populations. Only after the fact was the CES-D lranslated and utilized for depression screening of Hispanics. To the best of our knowledge, there is only one study which examines the construct validity of the CES-D for use with Hispanic samples (Roberts 1980). Malgady et al. (1987) states that "it is pretentious to believe that non-minority clinicians can achieve valid psychodiagnoses of Hispanic patients, even if armed with statistically 'validated' psychometric technology" (p. 232). It seems clear that diagnostic techniques, whether that be a clinician, a therapist, a researcher, or a testing instrument must be sensitive to an individual's sociocultural and linguistic background. Screening measures need to be designed which initially, not secondarily, meet specific ethnic, cultural and linguistic considerations. NOTE * This study was supported in part by the National Institute of Mental Health, Grant No. 1R01MH37067-01A2. REFERENCES CITED Agree, E.M. 1985 A Portrait of Older Minorities. American Association of Retired Persons (AARP), brochure, Washington, D.C. Alston, L.T. and B. Aguirre 1987 Elderly Mexican-Americans: Nativity and Health Access. International Migration Review, 21(3): 626-642. Berkman, L.F., C.S. Berkman, S. Kasl, D.H. Freeman, L. Leo, A. Osffeld, J. CoroniHunfley, and J.A. Brody 1986 Depressive Symptoms in Relation to Physical Health and Functioning in the Elderly. American Journal of Epidemiology, 124(3): 373-388. Bryant, B.E. 1975 Respondent Selection in a Time of Changing Household Composition. Journal of Marketing Research, 12:129-135. Burnam, M.A., D.M. Timbers and R.L. Hough 1984 Two Measures of Psychological Distress Among Mexican Americans, Mexicans and Anglos. Journal of Health and Social Behavior, 25:24-33. Burnam, M.A., R.L. Hough, M. Karno, J.I. Escobar and C.A. TeUes 1987 Acculturation and Lifetime Prevalence of Psychiatric Disorders Among Mexican-Americans in Los Angeles. Journal of Health and Social Behavior, 28:89-102. Comstock, G.W. and K.J. Helsing 1976 Symptoms of Depression in Two Communities.

304

DEBORAHJ. MORTONET AL.

Psychological Medicine, 6:551-563. Escobar, J.I., J. Gomez and V.B. Tuason 1983 Depressive Phenomenology in North and South American Patients. American Journal of Psychiatry, 140:47-51. Escobar, J.I., E.T. Randolph and M.D. Hill 1986 Symptoms of Schizophrenia in Hispanic and Anglo Veterans. Culture, Medicine, and Psychiatry, 10:259-276. Escobar, J.I. 1987 Cross-Cultural Aspects of the Somatization Trait. Hospital and Community Psychiatry, 38(2):174-170. Frerichs, R.L., C.S. Aneshensel and V.A. Clark 1981 Prevalence of Depression in Los Angeles County. American Journal of Epidemiology, 113(6):691-699. Himmelfarb, S. and S.A. Murrell 1983 Reliability and Validity of Five Mental Health Scales in Older Persons. Journal of Gerontology, 38(3):333-339. Husaini, B.A., J.A. Neff, Jh3. Harrington, M.D. Hughes and R.H. Stone 1980 Depression in Rural Communities: Vahdating the CES-D Scale. Journal of Community Psychology, 8:137-146. Kleinman, A.M. 1977 Depression, Somatization and the "New Cross Cultural Psychiatry". Social Science and Medicine, 11:3-10. Kolody, B., W.A. Vega, K. Meinhardt and G. Bensussen 1986 The Correspondence of Health Complaints and Depressive Symptoms Among Anglos and MexicanAmericans. The Journal of Nervous and Mental Disease, 174(4):221-228. Locca, P.J., T.N. Greonstein and J.S. McNeil 1987 A Profile of Mexican American Health: Data from the Hispanic Health and Nutrition Examination Survey 1982-1984. Health Services Research, Arlington, Texas. Mahard, R 1988 The CES-D as a Measure of Depressive Mood in the Elderly Puerto Rican Population. Journal of Gerontology: Psychological Sciences, 43(1):P24-P25. Malgady, R.G., L.H. Rogler and G. Constantino 1987 Ethnocultural and Linguistic Bias in Mental Health Evaluation of Hispanics. American Psychologist, 42(3):228-234. Marck, G., J. Solis, J.L. Richardson, L.M. Collins, L. Birba and J.C. Hisserich 1987 Health Behavior of Elderly Hispanic Women: Does Cultural Assimilation Make a Difference? American Journal of Public Health, 77(10):1315-1319. Mendes de Leon, C. and K.S. Markides 1988 Depressive Symptoms Among Mexican Americans: A Three-Generation Study. American Journal of Epidemiology, 127(1):150-160. Murrell, S.A., S. Himmelfarb and K. Wright 1983 Prevalence of Depression and Its Correlates in Older Adults. American Journal of Epidemiology, 117(2):173-185. Radloff, L.S. 1977 The CES-D Scale: A Sell-Report Depression Scale for Research in the General Population. Applied Psychological Measurement, 1(3):385-401. Radloff, L.S. and D.S. Rae 1979 Susceptibility and Precipitating Factors in Depression: Sex Differences and Similarities. Journal of Abnormal Psychology, 88:174-181. Radloff, L.S. and L. Ted 1986 Use of the Center for Epidemiological Studies-Depression Scale with Older Adults. Clinical Gerontologist, 5(1/2): 119-135. Roberts, R.E. 1980 Reliability of the CES-D Scale in Different Ethnic Contexts. Psychiatry Research, 2:125-134. Teri, L. and P.M. Lewinsohn 1983 Depression and Age: The Relationship of Age, Gender, and Method of Assessment on the Symptom Pattern of Depression. Unpublished manuscript, University of Oregon. Vega, W., G. Warheit, J. Buhl-Auth and K. Meinhardt 1984 The Prevalence of Depressive Symptoms Among Mexican-Americans and Anglos. American Journal of Epidemiology, 120:592-607. Vega, W.A., B. Kolody, R. Valle and R.L. Hough 1986a Depressive Symptoms and Their Correlates Among Immigrant Mexican Women in the United States. Social Science and Medicine, 22(6):645-652. Vega, W.A., B. Kolody, J.R. Valle 1986b The Relationship of Marital Status, Confidant Support, and Depression Among Mexican Immigrant Women. Journal of Marriage and the Family, 48:597-605.

CES-D AMONGOLDERMEXICAN-AMERICANS

305

Vega, W.A., B. Kolody, R.L. Hough and G. Figueroa 1987a Depressive Symptomatology in Northern Mexico Adults. American Journal of l~ablic Health, 77(9):1215-1218. Vega, W.A., B. Kolody and J.R. Valle 1987b Migration and Mental Health: An Empirical Test of Depression Risk Factors Among Immigrant Mexican Women. International Migration Review, 21 (3):512-530. Vernon, S.W. and R.E. Roberts 1982 Prevalence of Treated and Untreated Psychiatric Disorders in Three Ethnic Groups. Social Science and Medicine, 16:1575-1582. Weissman, M.M., D. Sholomskas, M. Pottenger, B.A. Prusoff and B.Z. Locke 1977 Assessing Depressive Symptoms in Five Psychialxic Populations: A Validation Study. American Journal of Epidemiology, 106(3):203-214.

306

DEBORAHJ. MORTONET AL. APPENDIX A Factor loadings of CES-D items for chicanos*

Item

FACTOR 1 FACTOR 2 FACTOR 3 FACTOR 4

Sad Blues Depressed Cry Lonely Fearful Get Going Bothered Sleep Mind Appetite Talk Effort Dislike

.84 .'~ ~ ~ .-~ .-5"-g .58 .56 .56 .50 .48 .42 .40 .40

.33 .29 .25 .17 .28 .15 .15 .18 .12 .17 .16 .14 -.05 .09

.55 .64 .64 .57 .50 .43 .68 .-~ .-7-7 .44 .71 ~ .70 73-7

.31 .21 .25 .44 .34 .34 .24 .30 .20 .36 .36 .31 .19 .79

Happy Hopeful Good Enjoy

.39 .14 .13 .33

.80 ~ .-~ .'~

.25 .02 -.01 .22

.18 -.03 .01 .12

Unfriendly Disliked

.21 .40

.05 .09

.20 .37

.79 .-~

29.9%

14.3%

26.3%

13.2%

Total Variance Explained

*Taken from: Roberts, R.E. (1980) Reliability of the CES-D Scale in Different Ethnic Contexts. Psychiatry Research, 2:125-132.

University Center on Aging College of Health and Human Services San Diego State University San Diego, CA.

Use of the CES-D among a community sample of older Mexican-Americans.

This study is a descriptive and comparative analysis of the Center for Epidemiologic Studies Depression (CES-D) scale as administered to a sample of M...
993KB Sizes 0 Downloads 0 Views