This study contributes to the development of mental health interventions that meet the particular needs of vulnerable ethnic and cultural minority groups in the U.S.
The specific aims of this project are: (a) to develop an easy-to-use depression screening measure that can assist primary care providers and social workers in referring individuals for mental health treatment, and (b) to better understand the cultural nature of how Chinese Americans who are not acculturated to U.S. society experience and express depression. The culture-bound character of depression is understood as a reflection of the basic belief in mind-body integration in Chinese culture. This belief is hypothesized to be associated with a symptom constellation for depression that contains equally important and intertwined somatic, interpersonal, and psychological complaints. This contrasts with the Western biomedical assumption of mind-body separation, and a symptom constellation that is heavily psychological, and limited in types of somatic and interpersonal elements. The need for this study is based on three types of findings. First, clinicians underdiagnose depression in unacculturated Chinese Americans due to a misunderstanding of symptom reports that are predominantly somatic, especially during initial encounters and when clients are not asked about other symptoms. Second, Chinese Americans who hold a more somatic conceptualization of their condition view medical care as the appropriate form of treatment. Third, Chinese Americans commonly deny the need and utility of mental health care due to cultural barriers (e.g., stigma, belief in self-help and herbal remedies), lack of knowledge of mental health treatment, and their experience of clinical treatments that do not match their problem conceptualization. To develop and validate a pilot scale based on the Center for Epidemiologic Studies Depression Scale (CES-D), eight mental health clinicians and their thirty-two adult patients diagnosed with major depression, somatization disorder, or neurasthenia-a DSM-IV culture-bound syndrome considered to be the 'somatized' form of depression-will be asked to give their conceptualizations of illness and critique potential scale items drawn from existing depression measures. To validate a pilot scale, the CES-D-CA, a sample of 220 adults consisting equally of diagnosed patients and community members, and females and males, will complete the CES-D-CA, the CES-D, and a measure of acculturation. An item response theory Rasch model will be used to determine the most discriminating and efficient set of items for the CES-D-CA from the validation dataset. To examine the culture-bound hypothesis of the significant overlap of somatic and psychological components of depression and the clinical salience of neurasthenia, the validation sample of 220 adults will also complete measures of somatization and neurasthenia. Confirmatory factor analyses will be performed on the CES-D-CA and CES-D data to test the cultural specificity of the latent structure of depression. ? ? ?
| Wong, Rose; Wu, Rufina; Guo, Carmen et al. (2012) Culturally Sensitive Depression Assessment for Chinese American Immigrants: Development of a Comprehensive Measure and a Screening Scale Using an Item Response Approach. Asian Am J Psychol 3:230-253 |
