Cultural equivalence in depressive symptoms in older white, black, and mexican-American adults: Clinical investigations

OBJECTIVES: To examine cultural equivalence in responses to depressive symptom items of three racial or ethnic elderly groups. DESIGN: Cross-sectional analyses of two national data sets. SETTING: The New Haven Established Populations for Epidemiologic Studies of the Elderly (EPESE) and the five-state Hispanic EPESE (H-EPESE). PARTICIPANTS: Whites (n=1,876) and blacks (n=464) were drawn from the New Haven EPESE and Mexican Americans (n=2,623) were drawn from the H-EPESE. MEASUREMENT: The original 20-item version of the Center for Epidemiologic Studies Depression Scale (CES-D). RESULTS: From differential item functioning analyses, a lack of measurement equivalence was found for 16 depressive symptom items. Mexican Americans were predisposed to endorse 12 depressive symptoms. Blacks were more likely than whites to endorse two interpersonal items (unfriendly and disliked). Mexican Americans were more likely than whites to respond to four positive affect items (good, hopeful, happy, and enjoyed) and more likely than blacks to endorse three positive items (good, happy, and enjoyed). CONCLUSION: Results suggested response bias to depressive symptom items in racially and ethnically diverse older adults. Mexican Americans were more likely than whites to endorse the large number of depressive symptom items. Blacks were much more likely to respond in patterns similar to those of the whites. Findings from this study provide a foundation for developing culturally appropriate depression measures in health disparities research.