The construct validity of two depression measures, Zung’s Self-rating Depression Scale (SDS) and the Asian Adolescents Depression Scale (AADS), was investigated. Three studies were conducted using two samples collected in two stages, and the results were used to construct the Asian Depression Scale (ADS). Participants responded to the SDS and AADS in random order of presentation during stage 1; two months later, validation variables were collected. Study 1 found that the SDS is a reliable and valid measure of depression for Singaporean Chinese, but it does not cover the interpersonal dimension found in the AADS. Study 2 combined the two measures and found six factors. One of these factors, negative social self, which was a unique Asian depressive symptom cluster, consisted only of AADS items, while the affective manifestation and psychosomatic symptoms factor primarily consisted of items from the SDS. Study 3 selected high-loading items from the identified factors to construct the ADS, which showed excellent internal reliability, and good convergent and discriminant validity. Incremental predictive validity found on criterion data collected in stage 2, supported the nonspuriousness of the Asian Depression Scale. 1. Introduction Depression is a common human condition. Subjective experiences and symptom presentation; however, vary from culture to culture [1–5]. Depressive symptoms are often expressed in “emic”—culturally conditioned “idioms of distress” [6–8]. This has led to problems in assessing depression in different cultural groups (e.g., [9–13]). The culture-depression relationship has been theorized to be mediated by the self-construal held by the individual (for instance, Markus & Kitayama [14]). The collectivist cultures of most Asian communities were found to contain relatively more interdependent self-construal (Triandis [15]); therefore, the “idiom of distress” in these communities might contain more symptoms concerning the social aspects of the self [2, 16]. Epidemiological studies of depression in Asians are rare and have used a variety of instruments, most of which were developed in non-Asian populations [17, 18]. These studies have reported low rates of depression in the Asia Pacific region [17]. Recently, however, observers have noted a rapid increase in reported cases of depression in Asian populations [18, 19], especially in regions such as Singapore, where there has been rapid industrial and economic development. The lack of consensus over diagnostic criteria, the lack of culturally appropriate norms [20], and the controversy over the
References
[1]
Y. E. Chentsova-Dutton and J. L. Tsai, “Understanding depression across cultures,” in International Encyclopedia of Depression, R. E. Ingram, Ed., pp. 363–385, Springer, New York, NY, USA, 2009.
[2]
C. A. Essau and W. C. Chang, “Epidemiology, co-morbidity and course of adolescent depression,” in Treatments for Adolescent Depression, C. A. Essau, Ed., pp. 3–26, Oxford University Press, London, UK, 2009.
[3]
A. Kleinman, Patients and Healers in the Context of Culture: An Exploration of the Borderland between Anthropology, Psychiatry and Medicine, University of California Press, Berkeley, Calif, USA, 1980.
[4]
A. Kleinman, “Culture and depression,” The New England Journal of Medicine, vol. 351, no. 10, pp. 951–953, 2004.
[5]
A. Kleinman and B. J. Good, “Introduction: culture and depression,” in Culture and Depression: Studies in the Anthropology and Cross-Cultural Psychiatry of Affect and Disorder, A. Kleinman and B. J. Good, Eds., pp. 1–33, University of California Press, Berkeley, Calif, USA, 1985.
[6]
A. J. Marsella, “Thoughts on cross-cultural studies on the epidemiology of depression,” Culture, Medicine and Psychiatry, vol. 2, no. 4, pp. 343–357, 1978.
[7]
V. Patel, “Cultural factors and international epidemiology,” British Medical Bulletin, vol. 57, pp. 33–45, 2001.
[8]
J. L. Tsai and Y. Chentsova-Dutton, “Understanding depression across cultures,” in Handbook of Depression, I. H. Gotlib and C. L. Hammen, Eds., Guildford Press, New York, NY, USA, 2002.
[9]
E. L. Barbee, “African american women and depression: a review and critique of the literature,” Archives of Psychiatric Nursing, vol. 6, no. 5, pp. 257–265, 1992.
[10]
N. Iwata and S. Buka, “Race/ethnicity and depressive symptoms: a cross-cultural/ethnic comparison among university students in East Asia, North and South America,” Social Science and Medicine, vol. 55, no. 12, pp. 2243–2252, 2002.
[11]
R. Malik, “Culture and emotions: depression among Pakistanis,” in Culture in Psychology, C. Squire, Ed., pp. 145–159, Routledge, London, UK, 2000.
[12]
G. Obeyesekere, “Depression, Buddhism and the Work of Culture in Sri Lanka,” in Culture and Depression, A. Kleinman and B. J. Goode, Eds., pp. 134–152, University of California Press, Berkeley, Calif, USA, 1985.
[13]
T. Phan, Z. Steel, and D. Silove, “An ethnographically derived measure of anxiety, depression and somatization: The Phan Vietnamese psychiatric scale,” Transcultural Psychiatry, vol. 41, no. 2, pp. 200–225, 2004.
[14]
H. R. Markus and S. Kitayama, “Culture and the self: implications for cognition, emotion and motivation,” Psychological Review, vol. 98, pp. 224–253, 1991.
[15]
H. C. Triandis, “The self and social behavior in differing cultural contexts,” Psychological Review, vol. 96, pp. 506–520, 1989.
[16]
W. C. Chang, “A cross-cultural study of depressive symptomology,” Culture, Medicine and Psychiatry, vol. 9, no. 3, pp. 295–317, 1985.
[17]
E. Chiu and I. Hickie, “Epidemiology of depression in the Asia Pacific region,” Australasian Psychiatry, vol. 12, pp. S4–S10, 2004.
[18]
L. L. Lim, W. Chang, X. Yu, H. Chiu, M. Y. Chong, and E. H. Kua, “Depression in Chinese elderly populations,” Asia-Pacific Psychiatry, vol. 3, no. 2, pp. 46–53, 2011.
[19]
J. P. Chen, H. Chen, and H. Chung, “Depressive disorders in Asian American adults,” Western Journal of Medicine, vol. 176, no. 4, pp. 239–244, 2002.
[20]
K. S. Crittenden, S. Fugita, H. Bae, C. Lamung, and C. Un, “A cross-cultural study of self-report depressive symptoms among college students,” Journal of Cross-Cultural Psychology, vol. 23, no. 1, pp. 163–178, 1992.
[21]
F. T. L. Leong, S. Okazaki, and J. Tak, “Assessment of depression and anxiety in East Asia,” Psychological Assessment, vol. 15, no. 3, pp. 290–305, 2003.
[22]
G. Parker, G. Gladstone, and Kuan Tsee Chee, “Depression in the planet's largest ethnic group: The Chinese,” American Journal of Psychiatry, vol. 158, no. 6, pp. 857–864, 2001.
[23]
A. Yeung and R. Kam, “Recognizing and treating depression in Asian Americans,” Psychiatric Times, vol. 23, no. 14, pp. 50–59, 2006.
[24]
W. W. Zung, “A self-rating depression scale,” Archives of General Psychiatry, vol. 12, pp. 63–70, 1965.
[25]
S. S. Fugita and K. S. Crittenden, “Towards culture- and population-specific norms for self-reported depressive symptomatology,” International Journal of Social Psychiatry, vol. 36, no. 2, pp. 83–92, 1990.
[26]
B. S. C. Woo, W. C. Chang, D. S. S. Fung et al., “Development and validation of a depression scale for Asian adolescents,” Journal of Adolescence, vol. 27, no. 6, pp. 677–689, 2004.
[27]
J. B. K. Koh, W. C. Chang, D. S. S. Fung, and C. H. Y. Kee, “Conceptualization and manifestation of depression in an Asian context: formal construction and validation of a children'S depression scale in Singapore,” Culture, Medicine and Psychiatry, vol. 31, no. 2, pp. 225–249, 2007.
[28]
W. C. Chang and L. Lee, “The concentric circle revisited: relationship and self-representations in a modern Chinese community,” Psychology, vol. 3, no. 4, pp. 297–303, 2012.
[29]
B. T. Lam, “Self-construal and depression among Vietnamese-American adolescents,” International Journal of Intercultural Relations, vol. 29, no. 2, pp. 239–250, 2005.
[30]
Y. E. Chentsova-Dutton and J. L. Tsai, “Self-focused attention and emotional reactivity: the role of culture,” Journal of Personality and Social Psychology, vol. 98, no. 3, pp. 507–519, 2010.
[31]
World Health Organization, Major (ICD-10) Depression Inventory, Psychiatric Research Unit. WHO Collaborating Centre in Mental Health, 2010.
[32]
P. C. Kendall, S. D. Hollon, and A. T. Beck, “Issues and recommendations regarding use of the beck depression inventory,” Cognitive Therapy and Research, vol. 11, no. 3, pp. 289–299, 1987.
[33]
A. Yeung, S. Howarth, R. Chan, S. Sonawalla, A. A. Nierenberg, and M. Fava, “Use of the Chinese version of the beck depression inventory for screening depression in primary care,” Journal of Nervous and Mental Disease, vol. 190, no. 2, pp. 94–99, 2002.
[34]
D. Watson, L. A. Clark, and A. Tellegen, “Development and validation of brief measures of positive and negative affect: The PANAS Scales,” Journal of Personality and Social Psychology, vol. 54, no. 6, pp. 1063–1070, 1988.
[35]
W. C. Chang and R. Chu, “Asian subjective wellbeing: conceptualization and opertionalization,” in preparation.
[36]
C. R. Snyder, S. C. Sympson, F. C. Ybasco, T. F. Borders, M. A. Babyak, and R. L. Higgins, “Development and validation of the state hope scale,” Journal of Personality and Social Psychology, vol. 70, no. 2, pp. 321–335, 1996.
[37]
C. S. Carver, M. F. Scheier, and S. C. Segerstrom, “Optimism,” Clinical Psychology Review, vol. 30, no. 7, pp. 879–889, 2010.
[38]
R. L. Gorsuch, “Exploratory factor analysis: Its role in item analysis,” Journal of Personality Assessment, vol. 68, no. 3, pp. 532–560, 1997.
