Cross-Cultural Equivalence of the CES-D with Native American/Alaskan Native and White Youth over the Transition to Adulthood

Background and Purpose: Previous research has shown a lack of cultural equivalence for some items in the Center for Epidemiologic Studies Depression (CES-D) scale, a scale applied in each wave of the National Longitudinal Study of Adolescent Health (Add Health) to assess the emotional state of study respondents. However, measures employed longitudinally with adolescents and young adults need to reliably and validly measure and capture changes in latent constructs over the transition to adulthood for the appropriate developmental age and ethnicity of respondents. This is particularly important for Native American/Alaskan Native youth with documented high rates of completed suicide and depression risk. Consequently, my objective was to examine the cross-cultural measurement equivalence and stability over time of the factor structure of the ten CES-D questions used in Waves I and IV of Add Health for Native American/Alaskan Native respondents. White respondents were included for comparison.

Methods: Secondary public use Add Health data previously collected through self-administered questionnaires and interviews between 1994 and 2008 was analyzed. The sample included all Native American/Alaskan Native (n = 187; n = 135) and White (n = 3,496; n= 2,870) young adults who responded to the ten CES-D questions at Wave I and Wave IV, respectively. Due to the small sample size, respondents who self-identified as both Native American/Alaskan Native and White were included in the Native American/Alaskan Native sample. Item-rest correlations, factor patterns and loadings, measurement errors, and variance and covariance matrices for the ten CES-D questions included in Waves I and IV, as well as a final model reduced to nine questions, were assessed with descriptive statistics, internal consistency analysis, and exploratory and confirmatory factor analysis.

Results: At Wave IV, respondents were aged 24 to 33 with a mean age of 28. Females comprised the majority of the sample with 61% in the Native American/Alaskan Native sample and 52% in the White sample. Results showed that the ten-item, three-factor reduced CES-D scale lacks cultural measurement equivalence between Native American/Alaskan Native and White youth and young adults, as expected. Additionally, the ten items have less than adequate factor structure stability regardless of ethnicity over both waves examined. The nine-item, two-factor scale had similar issues.

Conclusions and Implications: The CES-D shows instability of factor structures and inadequate cross-cultural measurement equivalence over time for Native American/Alaskan Native and White respondents in Add Health, even using a reduced scale. Consequently, findings reported using this measure might be invalid. Limitations include the small sample of Native American/Alaskan Native respondents. Future longitudinal studies attempting to examine latent mental health constructs over the transition to adulthood should ensure that chosen scales are constructed and validated for use with respondents from all age groups and ethnicities in the sample. These findings highlight the importance of ensuring cross-cultural validity of scales administered in longitudinal research and in evidence-based practice. Cross-cultural validity is a vital condition required by social work researchers who strive for cultural competency and ultimately cultural proficiency with both the populations they serve and those with whom they conduct research.