Barry S. Carlton

Prediction of Major Depression and Dysthymia From CES-D Scores Among Ethnic Minority Adolescents

OBJECTIVE The Native Hawaiian Mental Health Research Development Program is an epidemiological longitudinal study of adolescents residing in Hawaii. This article examines the utility of the Center for Epidemiologic Studies-Depression Scale (CES-D) for predicting DSM-III-R diagnoses of major depression (MD) and dysthymic disorder (DD) and investigates whether prediction differs by gender and ethnicity. METHOD Diagnostic Interview Schedule for Children interviews were conducted with 556 adolescents randomly selected from among more than 7,000 students who had completed the CES-D. RESULTS Six-month prevalence rates were as follows: MD = 8.5%, DD = 4.7%, either (MDDD) = 9.9%. Prevalence rates were significantly higher among females, but after CES-D scores were accounted for, gender no longer predicted depression in most analyses. When a cutoff score of 16 was used, classification accuracy was lower for Native Hawaiians than non-Hawaiians. However, after group differences in gender and grade level were accounted for, the predictive validity of the CES-D did not differ by ethnicity. CES-D factor 1 scores identified MD, DD, and MDDD about as well as the total score or all three factors together. CONCLUSIONS These results support the validity of the CES-D for screening for depression among adolescents of Native Hawaiian and other minority backgrounds.

Cumulative effect of family environment on psychiatric symptomatology among multiethnic adolescents.

PURPOSE To examine the influence of family adversity and support on levels of psychiatric symptomatology in Hawaiian and non-Hawaiian adolescents. METHOD More than 4000 students from five high schools in Hawaii completed a survey during the 1992-1993 school year about their family environment and mental health. The response rate was approximately 60%. Logistic regression analyses were performed and responses for Hawaiians and non-Hawaiians were compared. RESULTS Hawaiian adolescents experienced significantly more adversity than their non-Hawaiian counterparts. The cumulative effect of family adversity had a greater effect on psychiatric symptomatology than any single indicator. Family support reduced the risk for internalizing symptoms, particularly for Hawaiian adolescents. The influence of family support was less clear for externalizing symptoms, increasing the risk for some adolescents and decreasing the risk for others. CONCLUSION We identified strong associations between family adversity and levels of psychiatric symptomatology. We found that Hawaiian adolescents are at increased risk for psychiatric symptomatology, given the presence of family adversity and the effect of reduced family support. However, risk was also substantial for non-Hawaiians. Clinicians need to assess the family environment routinely and implement family-oriented interventions.

Prediction of anxiety disorders using the State-Trait Anxiety Inventory for multiethnic adolescents

The purpose of this study was to determine the validity of the State-Trait Anxiety Inventory (STAI) in predicting DSM-III-R anxiety disorders based on the Diagnostic Interview Schedule for Children (DISC, Version 2.3) and using Asian/Pacific Islander adolescents. An overall prevalence rate of 9.19% for generalized anxiety disorder, overanxious disorder, or social phobia was consistent with past studies. As hypothesized, STAI negatively worded (i.e., Factor 2) items were better predictors than positively stated (i.e., Factor 1) items. The STAI State mean was a better predictor of concurrent DISC anxiety disorders as compared to STAI State Factors I or 2. In contrast, the STAI Trait Factor 2 (negatively worded) composite was the best predictor for nonconcurrent DISC anxiety disorders as compared to STAI Trait Factor 1 or the overall STAI Trait subscale. Satisfactory predictive-validity values were obtained when using the STAI State mean and Trait Factor 2 composite. Implications of these findings are discussed, including using the STAI as a screening measure for ethnically diverse adolescents.

Demographic and Social Variables Associated with Psychiatric and School-Related Indicators for Asian/Pacific-Islander Adolescents

Background: Factors associated with Asian/Pacific-Islander adolescent adjustment is a greatly neglected research area. Aims: The purpose of the present study was to investigate the relation between demographic, social and adjustment measures based on a large-scale investigation of Asian/Pacific-Islander youths. Method: A total of 2577 adolescents were surveyed across 4 public schools in Hawai‘i during the 1992-1993 school year. Results: Three social variables (number of relatives frequently seen, family support and friends’ support) exhibited statistically significant but low correlations. Family support had the highest negative association with the four psychiatric symptoms (depression, anxiety, aggression, substance use). Friends’ support was inconsistently associated with the adjustment measures, and the number of relatives frequently seen resulted in negligible effects. In contrast, demographic variables, especially ethnicity, played a much greater role in the association with the four school-related measures (grade-point average, absences, suspensions, conduct infractions). Discussion: For Asian/Pacific-Islander youths, the quality of the social supports, including family relations, may be particularly important in the adolescents’ adjustment. When examining school-related outcomes, demographic variables, with particular emphases on ethnicity and culture, must be considered. When developing and implementing prevention and intervention services and programs, consideration of family and ethnic-cultural influences should be taken into account, with further research needed in several related domains: other SES influences, life stressors, migration-generational effects, ethnic identity, self-concept indicators and socio-political aspects.

Path models linking correlates of self-esteem in a multi-ethnic adolescent sample

Abstract Path analysis was performed to delineate the interrelations between state anxiety, aggression, substance abuse, depression, gender, ethnicity, family support, and self-esteem in a sample of 684 Hawaiian/part-Hawaiian and non-Hawaiian (e.g. Caucasian, Filipino, Hispanic, Japanese, or Mixed/two or more ethnicities) adolescents. The theorized model proposed that self-esteem was determined by family support and gender, and that family support, in turn, was predicted by state anxiety, aggression, substance abuse, depression, and ethnicity. The derivation of this model was based on previously documented findings of the associations between self-esteem and indices of adolescent adjustment, theorized multi-directionality of these interrelations, non-existence of an exhaustive theory accounting for the predictive links between these variables, and centrality of the ohana or family system and its integral network of support within the Native-Hawaiian culture. Goodness-of-fit indices indicated a poor fit between the theorized model and data. Subsequent model modifications were based on succeeding path analytical results, and conjointly encompassed an effort to find a model that fit the data well. Changes to the theorized model included eliminating three paths (i.e. from aggression and ethnicity to family support and from gender to self-esteem), and adding three paths (i.e. from depression, state anxiety, and aggression to self-esteem). The retained “final” Model 6 fit the data very well, and delineated the prediction of self-esteem by depression, state anxiety, aggression, and family support, which was, in turn, determined by depression, state anxiety, and substance use.

Influence of Family Adversity on School-Related Behavioural Problems among Multi-Ethnic High School Students

This study examines the influence of family adversity indicators on school-related behavioural problems among Hawaiian and non-Hawaiian adolescents. Questionnaire data from 2787 students were linked to school information, including grade point average (GPA), absences, suspensions and conduct infractions. Logistic regression analyses were performed. The cumulative effect revealed higher increases in the odds ratios for school-related behavioural problems among non-Hawaiians. Surprisingly, there was no cumulative effect of family adversity among Hawaiian adolescents. Given their high rates of adversity and behavioural problems, any family adversity may significantly impact this group. The family environment must be considered in the prevention and intervention of school-related behavioural problems.

Equivalencies Regarding the Measurement and Constructs of Self-Esteem and Major Life Events in an Asian-Pacific Islander Sampler.

Construct, scalar, and functional measurement equivalencies of the Rosenberg Self-Esteem Scale (RSES) and Major Life Events checklist (MLE) and the constructs assessed were investigated across groups differentiated on Hawaiian/part-Hawaiian and non-Hawaiian (e.g., Caucasian, Filipino, Hispanic, Japanese, and mixed/2 or more) ethnicity and gender. Initial results from maximum likelihood factoring with promax rotation showed that RSES negatively worded Item 5 loaded with the positively worded Items 1, 2, 4, 6, and 7 on 1 of 2 factors for Hawaiian/part-Hawaiian female participants. Similarly, negatively worded Item 8 and the same positively worded items comprised 1 of 2 factors for non-Hawaiian male participants. For the other 2 Ethnicity x Gender groups, factors were respectively comprised of the 5 positively and 5 negatively worded RSES items. Construct equivalence or simple (2-factor) structure underlying the RSES was indicated across the 4 groups after Items 5 and 8 were excluded from a subsequent factoring procedure. Simple structure showed that Factor 1 comprised the positively worded Items 1, 2, 4, 6, and 7, and the remaining negatively worded Items 3, 9, and 10 loaded on Factor 2. Scalar equivalence of the self-esteem and major life events measures was supported by the statistical nonsignificance of the Major Life Events x Ethnicity x Gender interaction effect in multiple regression models. The consistency in the absolute size and direction of the intercorrelations between overall self-esteem, self-esteem Factors 1 and 2, and major life events variables indicated the functional equivalence of respective measures and constructs assessed. Measurement equivalency findings concerning the RSES and MLE, the constructs measured, and their utility versus caution against their use in multiethnic studies were discussed.

Sociodemographic Characterization of ECT Utilization in Hawaii

Objectives Minimal research has been done on sociodemographic differences in utilization of electroconvulsive therapy (ECT) for refractory depression, especially among Asian Americans and Pacific Islanders. Methods This study examined sociodemographic and diagnostic variables using retrospective data from Hawaii, an island state with predominantly Asian Americans and Pacific Islanders. Retrospective data were obtained from an inpatient and outpatient database of ECT patients from 2008 to 2010 at a tertiary care community hospital on O’ahu, Hawaii. Results There was a significant increase in overall ECT utilization from 2008 to 2009, with utilization remaining stable from 2009 to 2010. European Americans (41%) and Japanese Americans (29%) have relatively higher rates of receiving ECT, and Filipino Americans and Native Hawaiians have relatively lower rates in comparison with their population demographics. Japanese Americans received significantly more ECT procedures than European Americans. Conclusions Electroconvulsive therapy is underutilized by certain sociodemographic groups that may benefit most from the treatment. There are significant differences in ECT usage based on ethnicity. Such differences may be related to help-seeking behavior, economic differences, and/or attitudes regarding mental illness. Further research is needed to elucidate the reasons for differences in utilization.

Hope, help, and healing: Culturally embedded approaches to suicide prevention, intervention and postvention services with native Hawaiian youth.

Suicide rates have reached their highest documented levels in the United States with the greatest increases among indigenous youth, including Native Hawaiians. Culturally informed, effective prevention and treatment services are needed now more than ever for Native communities to heal and flourish. Multicomponent prevention and service strategies rooted in indigenous values and approaches show the most promise. Native Hawaiian communities are united around a common goal of suicide prevention, intervention and postvention, linking cultural meanings to improve understanding and guide local efforts. This paper highlights important cultural values to consider when developing and implementing suicide prevention, intervention and postvention. Strategies build upon the strengths of Native Hawaiian youth and their respective communities. Native Hawaiian sayings anchor each level and serve to organize a set of culturally informed and culturally embedded programs and approaches along the continuum of prevention, intervention and postvention. Application of indigenization to suicide prevention enhances connections to people and place, inspiring hope among Native Hawaiian youth, their families and their communities.