Naleen N. Andrade

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.

Factor structure of the CES-D (Center for Epidemiologic Studies Depression Scale) among Filipino-American adolescents

Abstract The present study used factor analytic procedures to examine the factor structure of the CES-D among Filipino-American adolescents residing in rural and small town Hawaii. A total of 243 Filipino-American high school students completed the 20-item scale, and maximum likelihood analyses were employed to obtain a final solution. The results indicated that two factors provide a reasonably good fit: factor I combined depressed affect, somatic-retardation and interpersonal items, and factor II consisted of the remaining four positive affect items. The overlap of depressed affect and somatic symptoms support previous findings found among Asian American adults and other ethnic minority adolescents. The loading of the interpersonal items on the first factor is more unusual and suggests that interpersonal factors are not distinguished from depressed affect for the Filipino-American adolescent group. The usefulness of the CES-D as a tool to gain an understanding of the concept of depression across cultures is discussed.

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.

Suicide and suicidal-related behaviors among indigenous Pacific Islanders in the United States.

The authors present a comprehensive review on U.S. Pacific Islander suicide and suicide-related behaviors to extend the knowledge and understanding of suicide and suicide-related behaviors among the indigenous peoples of the state of Hawai‘i, the territories of American Samoa, Guam, Commonwealth of the Northern Mariana Islands, and the Pacific Island Nations of Micronesia (Federated States of Micronesia, the Republic of Belau [Palau], and the Republic of the Marshall Islands). Historical, geographic, epidemiological, social, and cultural information is presented on these Pacific Island populations. Suicide behavioral data are presented for Pacific Islanders living within the U.S. and affiliated Pacific territories and nations from the existing scientific literature along with archival data and 2 epidemiological studies that assess suicidal behaviors and related psychosocial factors and measures of psychopathology among large community samples of youth in Hawai‘i. The authors describe common patterns and differences among these populations, along with social-cultural practices that may explain suicide phenomenology among these U.S. indigenous peoples who—while small in numbers when compared with the total U.S. population—possess striking health disparities when compared to other populations within the U.S. and in their island homelands.

Structural Equation Modeling of Group Differences in CES-D Ratings of Native Hawaiian and Non-Hawaiian High School Students.

This report uses different forms of latent variable structural equation models (SEMs) of group differences in self-reported Center for Epidemiologic Studies Depression (CES-D) inventory results among a sample of Hawaiian and non-Hawaiian high school students.The models examined are organized progressively by increasing complexity, including mean differences models in the ANOVA tradition, mean differences combined with path analysis models, extensions to confirmatory factor analysis models, and common factor differences in multiple group models.Within each type of analysis, SEMs are defined and fitted to real CES-D data, and broad issues of group differences and invariance are considered.The substantive results indicate a high degree of invariance between Hawaiian and non-Hawaiian students within the same high schools on self-ratings of depression from the CES-D scale.These analyses illustrate theoretical and practical issues about common features and relationships among standard analysis of variance approaches and contemporary structural equation methodology.

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.

Recent Trends in American Board of Psychiatry and Neurology Psychiatric Subspecialties

ObjectiveThis article reviews the current status and recent trends in the American Board of Psychiatry and Neurology (ABPN) psychiatric subspecialties and discusses the implications of those trends as well as several key questions whose answers may well determine subspecialty viability.MethodsData are presented on specialty and subspecialty programs; graduates; and ABPN certification candidates and diplomates drawn from several sources, including the records of the ABPN, the websites of the Accreditation Council for Graduate Medical Education and the American Medical Association, and the annual medical education issues of JAMA.ResultsFewer than half of psychiatry graduates pursue sub-specialty training. While most recent specialty graduates attempt to become certified by the ABPN, many subspecialists elect not to do so. There have been recent decreases in the number of fellowship programs and trainees in geriatric psychiatry and addiction psychiatry. The pass rates for fellowship graduates are superior to those for the “grandfathers” in all of the newer psychiatric subspecialties. Lower percentages of subspecialists than specialists participate in maintenance of certification, and maintenance of certification pass rates are high.ConclusionThe initial interest in training and certification in some of the ABPN subspecialties appears to have slowed, and the long-term viability of those subspecialties may well depend on the answers to a number of complicated social, economic, and political questions in the new health care era.

Psychiatric symptoms of Hawaiian adolescents

The purpose of this study was to examine the interrelationship of depressive symptoms with symptoms of anxiety, aggression, and substance abuse in Native Hawaiian adolescents. A total of 1,819 Native Hawaiian students were recruited from three high schools as part of the initial phase of an ongoing, 4-year, longitudinal, cross-sequential study. Psychiatric symptoms were measured with the Center for Epidemiological Studies-Depression Scale (CES-D), Spielbergers State Anxiety Inventory (SAI), Braver Aggression Dimension Scale (BADS), and Substance Abuse Subtle Screening Inventory-Abbreviated (SASSI-A). Scales were standardized for this minority population. Depressive symptoms were strongly associated with symptoms of anxiety and aggression but only weakly associated with self-reported substance abuse. Girls had substantially higher scores than boys on all scales. Ninth graders reported more aggressive symptoms than did 12th graders. The educational level of the adolescents main caregiver was not associated with symptoms reported in any of the scales. Native Hawaiian adolescents report similar symptoms and symptom clusters as do adolescents on the mainland U.S. However, Native Hawaiian adolescent girls report a greater number of symptoms in all categories when compared to boys. This distinguishes them from most mainland adolescent populations.

A conceptual model of cultural predictors of anxiety among Japanese American and part-Japanese American adolescents.

A model integrating Japanese ethnicity, cultural identity, and anxiety was developed and assessed in Japanese American and part-Japanese American high school seniors (N = 141). Using measures from the Hawaiian High Schools Health Survey, the model incorporated the State-Trait Anxiety Inventory, the Major Life Events Scale, and the Japanese Culture Scale (JCS). Japanese American adolescents scored higher on the JCS and reported fewer anxiety symptoms than part-Japanese American adolescents. Predictors for anxiety were being Japanese American versus part-Japanese American, income, and culturally intensified events. A significant interaction of behavior by self-identification was obtained. The model had good overall fit, suggesting that cultural identity formation may contribute to anxiety experienced particularly by adolescents of mixed heritage.

Variation in self-esteem among adolescents in an Asian/Pacific-Islander sample

Abstract Variation in global self-esteem among adolescents differentiated in terms of age, gender, Hawaiian/part-Hawaiian and non-Hawaiian ethnicity, self-reported grades (SRGs) and socioeconomic status (SES) was examined in the present study. Being older, male or non-Hawaiian and higher SRGs or SES were hypothesized to be associated with higher global self-esteem. Six hundred and ninety-six Hawaiian/part-Hawaiian and non-Hawaiian high school students provided responses to demographic items, the 10-item Rosenberg Self-Esteem Scale [RSES; Rosenberg, M. (1965). Society and the adolescent self-image . Princeton, NJ: Princeton University Press], and items assessing SRGs and SES. Adolescent males reported significantly higher self-esteem than adolescent females. Adolescents differing in SRGs and SES also varied significantly from one another in self-esteem, with the general pattern indicating higher SRGs and SES to be associated with higher self-esteem. The significant age-by-SRGs interaction effect suggested the consequence of academic success throughout the high school years. Findings regarding the present Asian/Pacific-Islander adolescent sample corresponded with that found for other adolescent samples of different ethnic compositions, which provided support for the generalizability of variation in global self-esteem and its noted correlates across various socio-cultural contexts.