A symptom profile of depression among Asian Americans: is there evidence for differential item functioning of depressive symptoms?

BACKGROUND: Theoretical and clinical publications suggest the existence of cultural differences in the expression and experience of depression. Measurement non-equivalence remains a potential methodological explanation for the lower prevalence of depression among Asian Americans compared to European Americans. METHOD: This study compared DSM-IV depressive symptoms among Asian Americans and European Americans using secondary data analysis of the Collaborative Psychiatric Epidemiology Surveys (CPES). The Composite International Diagnostic Interview (CIDI) was used for the assessment of depressive symptoms. Of the entire sample, 310 Asian Americans and 1974 European Americans reported depressive symptoms and were included in the analyses. Measurement variance was examined with an item response theory differential item functioning (IRT DIF) analysis. RESULTS: χ2 analyses indicated that, compared to Asian Americans, European American participants more frequently endorsed affective symptoms such as 'feeling depressed', 'feeling discouraged' and 'cried more often'. The IRT analysis detected DIF for four out of the 15 depression symptom items. At equal levels of depression, Asian Americans endorsed feeling worthless and appetite changes more easily than European Americans, and European Americans endorsed feeling nervous and crying more often than Asian Americans. CONCLUSIONS: Asian Americans did not seem to over-report somatic symptoms; however, European Americans seemed to report more affective symptoms than Asian Americans. The results suggest that there was measurement variance in a few of the depression items.

Fresh fields and pathways new: recent genetic insights into cardiac malformation.

Cardiovascular malformations are the most common type of birth defect. Currently, only a fraction of cases have associated causative factors and little is known about the aetiology of the rest. Despite this, our understanding of normal and abnormal heart development continues to grow, a number of recent discoveries even challenging long-held concepts. In this review, we highlight some of this new knowledge, emphasising aspects that may be of interest to the clinician.

Learning on the Web. Case 9: a mother's heartache.

A 35 year old white woman presented with chest pain and breathlessness 10 days following an elective caesarean section. This was her second pregnancy, which had proceeded to term without complications. Up until then, she had been completely fit and well. Her ECGs were found to be abnormal, and the ultrasound study of her heart gave serious cause for concern. This interactive case report charts the evolution of the patient's clinical course and provides concise and up-to-date literature reviews on two cardiac conditions that share a predilection for women in the peripartum period.

How evidence based are therapeutic decisions taken on a medical admissions unit?

OBJECTIVES: To audit the proportion of drug treatments started on a medical admissions unit that is justified by published evidence, and the proportion for which no justification could be found. METHODS: Retrospective review of randomly selected case notes to identify drug treatments started and the problem(s) for which they were prescribed, followed by literature searches. RESULTS: A total of 132 treatment-problem pairs were found, comprising 85 unique treatment-problem pairs. An evidence base was found in support of 78 of the treatments started (59.1%). A further 41 treatment-problem pairs could be argued to be reasonable practice (sometimes included in guidelines), even though no published trial data support them. Ninety per cent of drug treatments started on the medical admissions unit have either an evidence base or are accepted practice. CONCLUSIONS: Regular audit of this nature could be carried out on units admitting acute medical patients. Similar audits in internal medicine have delivered consistent results (50%-60%); there is a baseline level against which units can compare themselves. Clinical audit is an integral feature of clinical governance; all wards admitting acute medial patients could conduct similar audits on a random sample of patients.

The role of acculturation in the career adjustment of Asian American workers: a test of Leong and Chou's (1994) formulations.

F.T.L. Leong and E.L. Chou (1994) provided a theoretical model for understanding the acculturation process among Asian Americans and applied that model to predicting the potential career adjustment problems encountered by Asians in the United States. Several of the hypotheses proposed by Leong and Chou were empirically tested in 2 separate studies. In Study 1, acculturation (R.M. Suinn, K. Rickard-Figueroa, S. Lew, & P. Vigil, 1987) was found to be positively related to job satisfaction (A.H. Brayfield & H.F. Rothe, 1951) and negatively related to occupational stress and strain (S. H. Osipow & A.R. Spokane, 1981) in a sample of 39 Asian American employees from 2 major companies who attended career development workshops. In Study 2, acculturation was found to be positively related to supervisors' performance ratings in a different sample of 27 Asian American employees. These preliminary data suggest that acculturation plays an important role in the career development of Asian Americans. The theoretical, research, and counseling implications of the findings are discussed.

Barriers to providing effective mental health services to Asian Americans.

Using the research framework recommended by L. Rogler, R. Malgady, and D. Rodriguez (1989), the current paper examines the barriers to providing effective mental health services to Asian Americans. Beginning with the recognition that Asian Americans consists of numerous heterogeneous subgroups, the issue of the stereotype of Asian Americans as the "model minority" was also discussed. The primary focus of the paper is on Stages 2, 3, and 4 within the Rogler et al. (1989) model and the identification and discussion of cultural factors that hinder the delivery of mental health services to Asian Americans. The paper is therefore organized into these three sections: (a) help-seeking or mental health service utilization, (b) evaluation of mental health problems, and (c) psychotherapeutic services. In each of the sections, not only are the barriers to delivery of effective mental health services discussed but so are the research and methodological problems as well as some directions for future research. This critical review of the literature has been prepared with the goal of serving as a "blueprint" for us to pursue rigorous but relevant research to identify and reduce these cultural barriers to providing effective mental health services to Asian Americans.

Choice of medical specialty: analysis of students' needs.

The purposes of this study were to assess the career development needs of entering medical students as measured by the Medical Career Development Inventory and to examine gender differences in responses to the inventory. A total of 115 entering medical students (representing two entering classes) took the inventory two months prior to matriculation. Analysis suggested that this sample of entering students had formed a vocational identity and that they had evaluated the suitability and viability of a commitment to a physician's career. However, the participants had not formed a clear picture of their specialty interest and goals. No significant gender differences were indicated. A recommended career assistance workshop is presented as appropriate for these students' needs.

Estimates of psychological distress among Vietnamese refugees: adolescents, unaccompanied minors and young adults.

This study focuses on the assessment of psychological distress among three subgroups of Vietnamese refugee youth: adolescents, unaccompanied minors, and young adults. Using translated and backtranslated instruments, data was gathered in refugee camps in the Philippines in order to provide baseline measurement for future comparisons, as well as to begin to develop normative standards for these populations. A rationale for the choice of instruments (Vietnamese Depression Scale, Hopkins Symptom Checklist-25 and General Health Questionnaire) is offered and mean scores and percentages scoring above established clinical cut-offs are presented. Results indicate relatively high levels of depression and anxiety for the young adult group, although anxiety appeared high across all three groups. All three groups also scored poorly on self-reports of general health, with the young adults and unaccompanied minors being especially overrepresented in the clinical range. Significant method problems were noted regarding construct validity in the assessment of depression, and instructional set differences that may account for the relatively low intercorrelations between seemingly similar measures.

Outcome of implanted spinal cord stimulation in the treatment of chronic pain: arachnoiditis versus single nerve root injury and mononeuropathy. Brief clinical note.

Over a 3 1/2-year period, a series of 20 chronic pain patients with back pain and with documented organic difficulties were treated by means of implanted spinal cord stimulation. Short-term treatment outcome was found to be significantly related to diagnosis, with single nerve root injury and mononeuropathy patients having better treatment outcomes than arachnoiditis patients with multiply injured nerve roots. Outcome was not related to the psychological evaluation, or age, sex, number of previous pain surgeries, pain location, the Minnesota Multiphasic Personality Inventory, or the Pain Assessment Index. Implications for patient selection are discussed.