Semantic Examination of a Japanese Center for Epidemiologic Studies Depression: A Cautionary Analysis Using Mixed Methods.
Denise Saint Arnault, Hiroyo Hatashita, Hitomi Suzuki
PMID 28841078WHAT IT FOUND
Revising six items in a Japanese depression questionnaire changed some answers, but the scale's overall consistency stayed the same.
The original wording may miss culturally specific meanings of distress in Japanese women.
Key findings
01The original CES-D total mean was higher than the revised mean in both groups: 9.5 versus 8.8 in the US group and 8.5 versus 7.9 in the Japan group.
02Revised wording changed how items fit with the whole scale in both directions: in the US group, four revised items fit better and two fit worse; in the Japan group, five fit better and hopelessness fit worse.
03The scale's overall consistency remained .94 for both the original and revised versions in both groups.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The samples were small: 34 women in the US and 72 in Japan received the revised items, and no power analysis was done. The US and Japan samples were not equivalent for age, education, or employment. Only women were studied, so findings may not apply to men. All women who received the revised items also received the original 20 items, which may have influenced responses. CES-D scores were very low, and the authors thought women under-reported symptoms because of stigma. The analysis was done late, after the parent study had already used the original translation, so it was an internal critique rather than a planned validation. The revised items did not produce major changes in item-scale fit, and replication in larger studies is needed.
Declared interests
The authors declared no potential conflicts of interest. The parent study was NIH funded (RO1MH071307).
The easy way to misread this
Do not read this as showing that a revised Japanese depression questionnaire is a validated clinical screening tool or that wording changes alone fix assessment. The study was small and exploratory, the US and Japan samples were not equivalent, and no power analysis was conducted.