Robert E. Roberts

Adolescent psychopathology: I. Prevalence and incidence of depression and other DSM-III—R disorders in high school students.

Data were collected on the point and lifetime prevalences, 1-year incidence, and comorbidity of depression with other disorders (Diagnostic and Statistical Manual of Mental Disorders [3rd ed., rev.]) in a randomly selected sample (n = 1,710) of high school students at point of entry and at 1-year follow-up (n = 1,508). The Schedule for Affective Disorders and Schizophrenia for School-Age Children was used to collect diagnostic information; 9.6% met criteria for a current disorder, more than 33% had experienced a disorder over their lifetimes, and 31.7% of the latter had experienced a second disorder. High relapse rates were found for all disorders, especially for unipolar depression (18.4%) and substance use (15.0%). Female subjects had significantly higher rates at all age levels for unipolar depression, anxiety disorders, eating disorders, and adjustment disorders; male subjects had higher rates of disruptive behavior disorders.

Screening for Adolescent Depression: A Comparison of Depression Scales

The ability of two depression scales, the Center for Epidemiologic Studies Depression Scale (CES-D) and the Beck Depression Inventory (BDI), to identify cases of DSM-III-R major depression and dysthymia was investigated in a large, community sample of high school students. Receiver operating characteristics analyses indicated that different caseness criteria should be used for boys and girls for both the CES-D and the BDI. Internal consistency-reliability and sensitivity and specificity for detecting current episodes of current depression and dysthymia were adequate and comparable to those found with adult samples, but both the CES-D and the BDI generated many false positives. Multiple screening using the serial strategy increased positive predictive power substantially for both the CES-D and the BDI, whereas using the parallel strategy had very little effect on the efficacy of the two screeners. The results indicate that neither the BDI nor the CES-D should be used by themselves as methods for case ascertainment in either epidemiological or experimental studies, although the BDI does function somewhat better than the CES-D as a screener.

Reliability of the CES-D scale in different ethnic contexts☆

Reliability of the Center for Epidemiologic Studies Depression Scale, a 20-item symptom checklist, is examined using data from a sample of community respondents containing Anglos (254), Blacks (270), and Mexican Americans (181). Although the survey response rate was lower for Mexican Americans, quality of the data provided by this group was not significantly different from that for Anglos or Blacks. That is, there were no differences among these groups in terms of missing data or internal consistency reliabilty (as measured by Cronbachs alpha and Spearman-Brown split halves). Factor-analytic results also demonstrate the same general structure of responses among the three groups.

Assessment of Depression in Adolescents Using the Center for Epidemiologic Studies Depression Scale

Operating characteristics of the Center for Epidemiologic Studies Depression Scale (CES-D) were examined by using data from 4 samples of students in Grades 9-12. Although it appears that the CES-D scale may be appropriate for use with adolescents, the issues of stability of scores over time, appropriate cutoff scores, and usefulness in detecting cases of clinical depression remain unresolved

Symptoms of depression in adolescence: A comparison of Anglo, African, and Hispanic Americans

This research investigated differences in prevalence of depressive symptoms among adolescents from diverse ethnocultural groups. Data from a national survey of persons 12–17 years of age (n=2200) were analyzed, comparing symptom levels of Anglo, African, Mexican, and other Hispanic Americans using a 12-item version of the Center for Epidemiologic Studies Depression Scale. Overall, the results indicate differences in rates of depression. Females reported more symptoms of depression than males in every ethnic group. Among the ethnic groups, Mexican American males reported more depressive symptoms than other males and the same was true for Mexican American females, although to a lesser extent. Logistic regression of three different caseness scores (16+, 21+, 31+), adjusting for age, gender, perceived health, and occupation of the primary wage earner in the household, indicated that only Mexican American adolescents reported more depressive symptoms than the Anglo majority. The relative risk ranged from 1.46 to 1.83.

Effects of Language and Ethnic Status on Reliability and Validity of the Center for Epidemiologic Studies-depression Scale with Psychiatric Patients

Data from 562 psychiatric patients were analyzed to assess the effects of ethnic status (Anglo/Mexican origin) and language (English/Spanish) on the reliability and validity of the Center for Epidemiologic Studies-Depression Scale. The results indicate no systematic variation in either reliability (test-retest, internal consistency), dimensionality, or ability of the CES-D Scale to detect clinical depression among Anglos or persons of Mexican origin classified according to language use as Spanish dominant, English dominant, or bilingual. However, the data indicate that this particular screening instrument does not adequately discriminate between patients with clinical depression and those without depression. These results corroborate several recent studies that question the utility of the CES-D Scale as a depression screening instrument. Taken together, the available evidence suggests that the ability of the CES-D Scale to detect major depression is so limited that further use of the instrument as a screening scale would seem unwarranted, at least in treatment settings.

Prevalence of treated and untreated psychiatric disorders in three ethnic groups

The pattern and overlap of treated and untreated rates of psychiatric symptoms and disorders were examined in a sample of whites, blacks, and Mexican-Americans. In addition, we compared treatment sources for family or personal problems for the three groups. The results suggest caution in substituting treated for untreated rates and also in interchanging rates based on symptom scales with rates from clinical diagnostic instruments. Underutilization was assessed by linking psychiatric status with reports of help-seeking behavior. Comparisons indicated that all groups underuse services relative to need, but underutilization is greater for blacks and Mexican-Americans. With the exception of nonpsychiatric physicians, use of treatment sources was similar for all groups. Whites were much more likely than blacks or Mexican-Americans to use this source of care. Possible reasons for this difference are discussed in the context of the methodology employed in the study.

Sex differences in depression reexamined

This study uses data from a survey conducted in 1974 to compare rates of depressive symptoms among married couples (N = 752) differentiated by the traditional or nontraditional sex-role relationship (division of labor) in the family. Wives reported more symptoms of depression than husbands in both nontraditional (in which both husband and wife work) and traditional relationships. Within-sex analyses show that the employment status of the wife has no significant effect on depression scores. Although these results corroborate some earlier findings regarding sex differences in depression, e.g., that women have higher rates, they do not corroborate the data (collected in I965) reported by Rosenfield (1980), in which the males in nontraditional relationships have higher rates of depression than the females.

Using the CES-D Scale to Screen for Depression and Anxiety: Effects of Language and Ethnic Status

The purpose of this report is to present data on the effects of language (English/Spanish) and ethnic status (white/non-Hispanic or Mexican origin) on the ability of the Center for Epidemiologic Studies Depression (CES-D) scale to detect cases of clinical depression and generalized anxiety identified using the Diagnostic Interview Schedule (DIS) in psychiatric treatment settings. The agreement between the CES-D scale and the DIS diagnoses of major depressive disorder (MDD) and generalized anxiety disorder (GAD) was poor, especially among Mexican-origin patients interviewed in Spanish. Multiple regression analysis revealed that the CES-D scale was positively associated with MDD in all groups. In addition, GAD also was associated with the CES-D scale in Anglos and English-speaking Mexican-Americans but not in Spanish-speaking Mexican-Americans.

Prevalence of psychological distress among Mexican Americans.

Data are presentedfrom sample surveys conducted in 1974 (N = 3,119) and 1975 (N = 657) in Alameda County, California, comparing psychological distress among Mexican Americans, blacks, and Anglos. Measures of psychological distress include satisfaction with leisure, marriage, and job, reported happiness, positive and negative affect, and reported episodes of emotional problems and chronic nervous trouble. Based on crude prevalence rates, there are no differences among the ethnic groups in either sample in reported emotional or mental illness, and negative affect. There are differences in happiness, job satisfaction, and chronic nervous trouble in the 1974 study but not the other. In the remaining three comparisons (satisfaction with leisure and with marriage, positive affect) there are significant differences in both studies, Chicanos faring worse than Anglos but somewhat better than blacks. Controlling for the effects of age, sex, education, income, marital status, and physical health status in general reduces but does not eliminate most of these ethnic differences, and in no case is the rate for Chicanos lower than that for Anglos.