Culturally Sensitive Depression Assessment for Chinese American Immigrants: Development of a Comprehensive Measure and a Screening Scale Using an Item Response Approach

The present mixed methods study developed a comprehensive measure and a screening scale of depression for Chinese American immigrants by combining an emic approach with item response analysis. Clinical participants were immigrants diagnosed by licensed clinicians who worked in the community. Qualitative interviews with clinicians and clinical participants (N = 63) supported the definition of the construct of depression—which guided scale development—and a 47-item pilot scale. Clinical and community participants (N = 227) completed the pilot scale and measures of neurasthenia and acculturative stress, and the Patient Health Questionnaire Depression Module (PHQ-9). A Rasch Partial Credit Model of 42-items—representing psychological, somatic and interpersonal domains of distress—best fit the data. Twenty-three items overlapped with the DSM-IV symptoms of major depression. Twenty-seven items were biased by acculturation-related variables. Nine items appropriate for self-report screening in primary care and community organizations were chosen to form a brief scale. Both measures showed strong reliability and concurrent and convergent validity. The 9-item scale had better content validity than the PHQ-9. Implications regarding the impact of culture for assessment are highlighted.