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J Gerontol B Psychol Sci Soc Sci. 2010 Nov;65(6):684-90. doi: 10.1093/geronb/gbq052. Epub 2010 Jul 21.

Not saying I am happy does not mean I am not: cultural influences on responses to positive affect items in the CES-D.

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  • 1Department of Aging and Mental Health Disparities, Florida Mental Health Institute, University of South Florida, 13301 Bruce B. Downs Boulevard, MHC 1400, Tampa, FL 33612, USA.



Given the emphasis on modesty and self-effacement in Asian societies, the present study explored differential item responses for 2 positive affect items (5 = Hopeful and 8 = Happy) on a short form of the Center for Epidemiologic Studies-Depression scale. The samples consisted of elderly non-Hispanic Whites (n = 450), Korean Americans (n = 519), and Koreans (n = 2,030).


Multiple Indicator Multiple Cause models were estimated to identify the impact of group membership on responses to the positive affect items while controlling for the latent trait of depressive symptoms.


The data revealed that Koreans and Korean Americans were less likely than non-Hispanic Whites to endorse the positive affect items. Compared with Korean Americans who were more acculturated to mainstream American culture, those who were less acculturated were less likely to endorse the positive affect items.


Our findings support the notion that the way in which people endorse depressive symptoms is substantially influenced by cultural orientation. These findings call into question the common use of simple mean comparisons and a universal cutoff point across diverse cultural groups.

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