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  • International Psychogeriatrics, Vol. 8, No. 3, 1996 0 1996 Intematiorial Psychogeriatric Association

    Geriatric Depression Scale as a Community Screening Instrument for

    Elderly Chinese Immigrants

    Ada C. Mui

    ABSTRACT. Depression is the most prevalent mental health problem among the elderly, including Chinese-American elderly. A Chinese-language version of the popular Geriatric Depression Scale Long Form (GDS-LF) and Short Form (GDS-SF) was developed. Based on the responses of 50 elderly Chinese immigrants to the U.S. (25 women and 25 men), the GDS-LF evidenced high internal consistency but the GDS-SF did not. Factor analysis was then used to develop a new version of the GDS-SF, which was internally consistent. The revised GDS-SF is an important and easy-to-administer tool for community screening of depression among elderly Chinese immigrants.

    Data from the 1990 census indicate that the population of Asian Americans and other immigrants grew by 108% from 1980 to 1990, whereas the total US. population grew only by 10% ( U S . Bureau of the Census, 1991). The increasing numbers of Asian and other immigrants have resulted in greater demands for research sensitive to cross-cultural methodological issues. Although depression is a common psychological problem among the elderly, few researchers have studied depression in older Chinese Americans or immigrants. In addition, the possibility of cultural effects in measuring depression has complicated the accurate assessment of depression in this population. Mui (1993) suggested that reported ethnic differences in depression may reflect different modes of expres- sion rather than true differences in mental health status. In addition, instruments to measure depression may not be sufficiently culturally sensitive to assess the mental health of Chinese-American elderly subjects.

    Brink and his colleagues (1982) developed a 30-item easy-to-administer inventory to serve as a screening test for depression among the elderly-the Geriatric Depression Scale-Long Form (GDS-LF). It was further validated (Yesavage et al., 1983) and has been shown to have excellent internal consis- tency (alpha. = .94) and test-retest stability ( r = .85), as well as good construct

    From the Columbia University Schoolof Social Work, New York, New York, U.S.A. (A. C. Mui, PhD, ACSW).

    445

  • 446 A. C. Mui

    and discriminant validity. It has been used widely among community and institutionalized elderly (see Table 1 for a list of GDS validation studies).

    Sheikh and Yesavage (1986) also developed a GDS-Short Form (GDS-SF) in order to make this measure a simpler screening device for depression. They selected 15 questions from the GDS-LF that had the highest correlation with depressive symptoms to their validation study. Their findings (using 18 normal elderly and 17 depressed elderly) provided support for the utility of the GDS- SF in successfully differentiating depressed from nondepressed subjects (see Table 2).

    Recently, researchers have used the GDS with Chinese elderly populations. Chiu and his colleagues (1993) established the reliability and validity of the original 30-item GDS-LF (alpha = .92) among both normal and depressed Chinese elderly in Hong Kong. The GDS-SF was also validated (alpha = .90) with both depressed and nondepressed Chinese elders in Hong Kong (Lee et al., 1993). Both the GDS-LF and GDS-SF were found to be reliable instruments for the Chinese elderly. The GDS-SF later was used to assess the prevalence of depressive symptoms among Chinese elders aged 70 and over in a Hong Kong citywide random sampling survey (Woo et al., 1994). The overall prevalence of moderate to severe depression for this Hong Kong elderly Chinese sample was 29.2% for men and 41.1% for women (using a cutoff point of 8).

    In the U.S., epidemiologic studies have examined the prevalence of depres- sive symptoms in community samples using a variety of self-rating scales and interviews. Depending on the selected cutoff points and instruments, the reported prevalence of depression among those over 65 living in the community ranged from 2% to 5% for major depressive disorders to as high as 44% to 50% for depressive symptoms (Blazer et al., 1988).

    Although the GDS has been widely used among the general population of elderly in the U.S., and it has been tested with Chinese elderly in Hong Kong, it has never been tested with Chinese-American immigrants. In the present study, I assessed the cultural appropriateness, reliability, and validity of the GDS for this group. Because of the importance of having a short form of the instrument for elderly respondents who may tire easily or have difficulty concentrating, I also tested the reliability of the GDS-SF developed by Sheikh and Yesavage (1986). The long-term goal is to make the Chinese version of the GDS-SF available in community-based agencies and other human service agencies so as to facilitate screening, early detection, and early intervention with Chinese- American elderly and immigrant populations.

    METHOD

    Subjects

    Subjects were 50 Chinese elderly immigrants living in a major U.S. metropoli- tan area who volunteered to participate in the study (age range, 62 to 9 1 ; mean

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