Not Saying I Am Happy Does Not Mean I Am Not: Cultural Influences on Responses to Positive Affect Items in the CES-D

SINCE its initial development in the 1970s, the Center for Epidemiologic Studies-Depression scale (CES-D; Radloff, 1977) has been widely used as a screening tool for depression in both clinical and research settings. Although it was based on samples composed largely of European Americans, the CES-D has now been translated into more than 50 different languages. These versions of the CES-D have excellent psychometric properties, and the instrument is generally held in high regard by researchers around the world (Nezu, Nezu, McClure, & Zwick, 2002). The availability of multiple translations and the wide acceptance of the instrument have led to both the use of the CES-D in diverse cultural groups and concerns about its cross-group comparability or measurement equivalence (e.g., Crockett, Randall, Shen, Russell, & Driscoll, 2005). Problems with measurement equivalence are evidenced by differential item functioning (DIF). DIF occurs when respondents from different groups show differing tendencies toward endorsing an item despite having been matched with respect to the overall ability or attribute that the item is intended to measure (Dorans & Holland, 1993; Zumbo, 1999). Studies using several analytic techniques have identified DIF in the CES-D across diverse groups. Two of the more common findings are that women are more likely than men to endorse the “crying spells” item (e.g., Cole, Kawachi, Maller, & Berkman, 2000; Stommel et al., 1993) and that Blacks are more likely than non-Hispanic Whites to endorse items reflecting problematic interpersonal relationships (“people are unfriendly” and “people disliked me”; e.g., Blazer, Landerman, Hays, Simonsick, & Saunders, 1998; Cole et al.; Kim, Chiriboga, & Jang, 2009). These findings of sex- and race-based DIF suggest that researchers should take caution when using the CES-D in cross-group comparisons because the observed mean differences may be attributable to item response bias rather than to true differences in mental health status (Mui, Kang, Chen, & Domanski, 2003). The present study was designed to explore cultural bias in responses to the two positive affect items in a short form of the CES-D (Andresen, Malmgren, Carter, & Patrick, 1994). Most mental health screening instruments, including the CES-D, contain both positively and negatively worded questions or statements. Using a mix of positive and negative wording is one way to avoid agreement bias or acquiescence (e.g., Anastasi, 1982; Nunnally, 1978). However, recent studies have called attention to potential response biases associated with the phrasings of items (e.g., Chodosh, Buckwalter, Blazer, & Seeman, 2004; DiStefano & Motl, 2006; Quilty, Oakman, & Risko, 2006). It has been suggested that culture has a strong influence on the over- or under-endorsement of items phrased in certain ways (DiStefano & Motl; Iwata & Buka, 2002). Response biases on positive affect items are a particular concern for researchers studying persons from Asian cultures, which often value modesty and self-effacement as cultural virtues and inhibit the expression of positive emotion (Iwata & Buka, 2002; Y. Jang, Kim, & Chiriboga, 2005). Previous studies on Korean populations have speculated that the reluctance of Koreans to respond positively to positive affect items might elevate overall CES-D scores within this population (e.g., Cho, Nam, & Suh, 1998; Y. Jang et al., 2005; Noh, Kaspar, & Chen, 1998; Young, Fogg, & Choi, 2002); however, this issue has not been fully explored. The present study conducted DIF analysis with three large data sets of elderly non-Hispanic Whites, Korean Americans, and Koreans living in Korea that each included the 10-item CES-D. Although race/ethnicity is not synonymous with culture, we refer to the samples as cultural groups here for simplicity. Our first hypothesis was that compared with the non-Hispanic Whites, the Korean Americans and Koreans would have more pronounced DIF for the positive affect items. In addition, the sample of Korean Americans provided a unique opportunity to further explore the role of culture and acculturation in response patterns. Acculturation refers to the degree to which a person from another culture has learned the language and behaviors expected of persons who live in the host culture (Sam & Berry, 2006). People may also adopt the ways of thinking and expressing that are prevalent in the host culture (Iwata & Buka, 2002; Y. Jang et al., 2005). The literature suggests that people vary greatly in the degree to which they are acculturated (Sam & Berry, 2006). Thus, our second hypothesis was that the DIF for the positive affect items would be observed when comparing Korean American older adults who were less acculturated and those who were highly acculturated with mainstream American cultures.