González-Forteza C, Solís TC, Jiménez TA, Hernández FI, González-González A, Juárez GF, Medina-Mora ME, Fernández-Varela MH

Language: Spanish
References: 65
Page: 53-59
PDF size: 99.09 Kb.

ABSTRACT

Introduction: Depression and its symptoms are becoming one of the most important health problems worldwide. The impact of depression on the productive life of people, and the burden it represents because of its co-morbidity, is growing. Some authors estimate that depression is the second cause for the global loss of years of healthy life and the first one in developed countries. An increasing proportion of teenage population has mental health issues. Depression and its symptoms are among the most common, but they are not an epidemic problem yet, although spread enough as to maintain interest in its current impact and in its negative consequences over individual health. Depression has a prominent place among mood disorders in Mexico (4.5%), and women are who mostly suffer it (5.8%), which has remained consistent over time. Different difficult situations occur during adolescence along with depression, depressive mood, and depressive symptoms. This situation may be related to changes and processes that occur during this period when individuals cope with situations they cannot handle, which in turn become stressful. Therefore, it is necessary to study and to work with adolescents in order to be able to differentiate affective, cognitive, somatic, and behavioral expressions, which are proper to this stage, from those possibly caused by an illness that could have negative consequences. Adolescent depression influences mood and the way individuals live unpleasant or annoying experiences, thus it affects almost every aspect of life and becomes a risk factor for psychiatric and behavioral problems. However, there are some areas that need more research, for example: the specific characteristics and expressions of the problem including gender comparisons and using designs with special groups. Data show that depression is growing in adolescents; therefore it is a priority to work on detection and prevention to reduce its impact on mental health and to develop cost-effective intervention strategies. One way to do this is using valid-reliable screening tools because they are cheap, and methodologically-logistically useful. The Center for Epidemiological Studies Depression Scale (CESD) has been used in different studies with Mexican adolescents, and has proven to have good psychometric characteristics. The CES-D has never been used with an entire population in a great scale study. The objective of this paper is to measure the validity and reliability of the scale (construct, concurrent, and external validity, as well as internal consistency) in a population of high school and college freshman students from Mexico City.
Method: Design. The study was a census made with high school and college freshman students during 2009. Data were collected in 22 schools. Population. A sample of 58568 students participated in the census. The mean age was 17 years old (±2.7). Most of the students lived in homes with one to four other persons at the moment of the study (55.4%); 86% said that only their father worked at that moment, and 59.4 said that only the mother; 79.7% of the students lived with both parents, and 17.9% only with their mother; 57403 students (98.0% of the population) completed the CES-D in the age range of 14-24 years: 27264 (47.5%) men, and 30139 (52.5%) women. Instrument. The Automated Medical Examination (Examen Médico Automatizado–EMA) is a diagnostic questionnaire designed by the General Directorate of Medical Services (Dirección General de Servicios Médicos) of the Universidad Nacional Autónoma de México (UNAM). It is a questionnaire with four self-report forms that collect informatio n about the physical and mental health, the family, and the general context of every student. This information is used to create a diagnosis of vulnerability and a predictive profile for developing prevention programs, as well as research protocols that help in promoting a culture for health care. The CES-D was included for the measurement in 2009.
Results: Overall internal consistency was adequate (α=.83). Internal consistency analysis generated a four-factor solution (explained variance 54.1%); each factor had good internal consistency and theoretical agreement. The scale showed a significant discriminative power for opposite scores (z=-144.121, p‹.001), and a positive significant correlation with the Okasha Suicidality Scale (rΦ=.325, p=.000). A cut-off point of 16 or higher was established to identify students with high depressive symptomatology. 14.7% of the participants in this study had high depressive symptomatology (11.1% men, 17.9% women).
Conclusions: The CES-D is a valid and reliable epidemiological instrument for different populations. Since depression is a complex and dynamic phenomenon, it is important to evaluate the psychometric properties of any instrument used to measure it. The results of this study showed that the CES-D maintains its internal consistency as well as good concurrent-external validity. Coefficients are higher for women and they increase with age; thus, it would be necessary to refine some aspects to measure younger subjects in a more consistent manner. The data proved that CES-D is a useful instrument for distinguishing different levels of depressive symptomatology; this is relevant because the scale is often used in collective contexts, allowing systematic monitoring of depression with good cost-effective results. Monitoring is also important to keep acceptable levels of emotional wellbeing in student population. Development and refinement of instruments such as the CES-D would potentially lead to opportune and eliable detection of adolescents who may be at risk for suffering mental health problems. This would facilitate implementing more stable and continuous prevention and attention programs to reduce the negative impact of depression in the short term.

REFERENCES

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13. Marmorstein N, Iacono W. Mayor depression and conduct disorder in a twin sample: gender, functioning and risk for future psychopathology. J Am Acad Child Adolesc Psychiatry 2003;42(2):225-233.

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15. Radloff L. The CES-D Scale: A self report depression scale for research in the general population. Appl Psychol Meas 1977;1:385-401.

16. Aguilera R, Carreño S, Juárez F. Características psicométricas de la CESD en una muestra de adolescentes rurales mexicanos de zonas con alta tradición migratoria. Salud Mental 2004;27(6):57-66.

17. Benjet C, Hernández L, Tercero G, Hernández A et al. Validez y confiabilidad de la CES-D en peri-púberes. Rev Mex Psic 1999;16(1):175-185.

18. González-Forteza C, Ramos L, Caballero MA, Wagner F. Correlatos psicosociales de depresión, ideación e intento suicida en adolescentes mexicanos. Psicothema 2003;15(4):524-532.

19. Jiménez A, Mondragón L, González-Forteza C. Self-esteem, depressive symptoms, and suicidal ideation in adolescents: Results of three studies. Salud Mental 2007;30(5):20-26.

20. Roberts RE, Andrew JA, Lewinsohn PM, Hops H. Assessment of depression in adolescents using the Center for Epidemiologic Studies of Depression Scale. J Consult Clin Psychol 1990;2:122-128.

21. Salgado de Snyder VN, Maldonado M. Características psicométricas de la Escala de Depresión del Centro de Estudios Epidemiológicos en Mujeres Mexicanas Adultas de Áreas Rurales. Salud Publica Mex 1994;36:200-209.

22. Wong YL. The measurement properties of the Center for Epidemiologic Studies of Depression Scale in a homeless population. Psychol Assess 2000;12(1):69-76.

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24. Mariño MC, Medina-Mora ME, Chaparro J, González-Forteza C. Confiabilidad y estructura factorial del CES-D en una muestra de adolescentes mexicanos. Rev Mex Psicol 1993;10(2):141-145.

25. Edman JL, Danko GP, Andrade N, McArle JJ et al. Factor structure of the CES-D (Center for Epidemiologic Studies of Depression Scale) among Filipino-American adolescents. Soc Psychiatry Psychiatr Epidemiol 1999;34:211-215.

26. Ghubash R, Daradkeh TK, Al-Naseri KS, Al-Bloushi NBA et al. The performance of the Center for Epidemiologic Studies of Depression Scale (CES-D) in an Arab female community. Int J Soc Psychiatry 2000;46(4):241-249.

27. Burín M, Moncarz E, Velázquez S. El malestar de las mujeres. La tranquilidad recetada. México: Paidós; 1990.

28. Okasha A, Lotaif F, Sadeck A. Prevalence of suicidal feelings in a simple of non-consulting medical students. Acta Psychiatr Scand 1981;63:409-415.

29. O’Rourke N. Factor structure of the Center for Epidemiologic Studies–Depression Scale (CES–D) among older men and women who provide care to persons with dementia. Int J Testing 2005;5(3):265–277.

30. González-Forteza C, Jiménez A, Ramos L, Wagner F. Aplicación de la Escala de Depresión del Center of Epidemiological Studies en adolescentes de la Ciudad de México. Salud Publica Mex 2008;50(4):292-299.

31. González-Forteza C, Andrade P, Jiménez A. Estresores cotidianos familiares, sintomatología depresiva e ideación suicida en adolescentes mexicanos. Acta Psiquiatr Psicol Am Lat 1997;43(4):319-326.

32. González-Forteza C, Saldaña-Hernández A, Alvarez-Ruiz M, Arana-Quezadas D et al. Matices de género en la percepción del intento suicida de adolescentes estudiantes de la Ciudad de México. En: Salvador Moysén J (ed.): El claroscuro de la vida juvenil. Durango, Dgo.: Universidad Juárez del Estado de Durango y Centro de Investigación–Instituto de Investigación Científica y Estudios sobre Juventud del Instituto

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34. Murray C, López A. Alternative projections of mortality and disability by cause, 1990-2020: Global burden of disease study. Lancet 1997;349:1498-1504.

35. Moussavi S, Chatterji S, Verdes E. Depression, chronic disease and decrements in health: Evidence from the World Health Surveys. Lancet 2007;369:851-858.

36. Benjet C, Borges G, Medina-Mora ME, Fleiz C et al. La depresión con inicio temprano: Prevalencia, curso natural y latencia para buscar tratamiento. Salud Publica Mex 2004;46(5):417-423.

37. Costello E, Erkanli A, Angold A. Is there an epidemic of child or adolescent depression? J Child Psychol Psychiatry 2006;47(12):1263–1271.

38. Glied S, Pine D. Consequences and correlates of adolescent depression. Arch Pediatr Adolesc Med 2002;156(10):1009-1014.

39. Franko D, Striegel-Moore R, Bean J, Tamer Ret al. Psychosocial and health consequences of adolescent depression in black and white young adult women. Health Psychol 2005;24(6):586-593.

40. Medina-Mora ME, Borges G, Lara C, Benjet C et al. Prevalencia de trastornos mentales y uso de servicios: Resultados de la Encuesta Nacional de Epidemiología Psiquiátrica en México. Salud Mental 2003;26(4):1-16.

41. Belló M, Puentes-Rosas E, Medina-Mora ME, Lozano R. Prevalencia y diagnóstico de depresión en población adulta en México. Salud Publica Mex 2005;47(1):4-11.

42. Hankin B. Cognitive vulnerability–stress model of depression during adolescence: Investigating depressive symptom specificity in a multiwave prospective study. J Abnorm Child Psychol 2008;36:999-1014.

43. Adkins D, Wang V, Dupre M, Van den Oord E et al. Structure and stress: trajectories of depressive symptoms across adolescence and young adulthood. Structure and stress: Trajectories of depressive symptoms across adolescence and young adulthood. Soc Forces 2009;88(1):31-60.

44. De la Fuente R, Medina-Mora ME, Caraveo J. Salud mental en México. México: Fondo de Cultura Económica; 1997.

45. Birhamer B, Williamson D, Dahl R, Axelson D et al. Clinical presentation and course of depression in youth: Does onset in childhood differ form onset in adolescence? J Am Acad Child Adolesc Psychiatry 2004;43(1):63-70.

46. Marmorstein N, Iacono W. Mayor depression and conduct disorder in a twin sample: gender, functioning and risk for future psychopathology. J Am Acad Child Adolesc Psychiatry 2003;42(2):225-233.

47. Galambos N, Leadbeater B, Barker E. Gender differences and risk factors for depression in adolescence: A 4-year longitudinal study. Int J Behav Dev 2004;28(1):16-25.

48. Radloff L. The CES-D Scale: A self report depression scale for research in the general population. Appl Psychol Meas 1977;1:385-401.

49. Aguilera R, Carreño S, Juárez F. Características psicométricas de la CESD en una muestra de adolescentes rurales mexicanos de zonas con alta tradición migratoria. Salud Mental 2004;27(6):57-66.

50. Benjet C, Hernández L, Tercero G, Hernández A et al. Validez y confiabilidad de la CES-D en peri-púberes. Rev Mex Psic 1999;16(1):175-185.

51. González-Forteza C, Ramos L, Caballero MA, Wagner F. Correlatos psicosociales de depresión, ideación e intento suicida en adolescentes mexicanos. Psicothema 2003;15(4):524-532.

52. Jiménez A, Mondragón L, González-Forteza C. Self-esteem, depressive symptoms, and suicidal ideation in adolescents: Results of three studies. Salud Mental 2007;30(5):20-26.

53. Roberts RE, Andrew JA, Lewinsohn PM, Hops H. Assessment of depression in adolescents using the Center for Epidemiologic Studies of Depression Scale. J Consult Clin Psychol 1990;2:122-128.

54. Salgado de Snyder VN, Maldonado M. Características psicométricas de la Escala de Depresión del Centro de Estudios Epidemiológicos en Mujeres Mexicanas Adultas de Áreas Rurales. Salud Publica Mex 1994;36:200-209.

55. Wong YL. The measurement properties of the Center for Epidemiologic Studies of Depression Scale in a homeless population. Psychol Assess 2000;12(1):69-76.

56. Yin YW, Lee PA, Tsai JL, Yeh YY et al. The conception of depression in Chinesse American college students. Cult Diversity Ethnic Min Psychology 2000;6(2):183-195.

57. Mariño MC, Medina-Mora ME, Chaparro J, González-Forteza C. Confiabilidad y estructura factorial del CES-D en una muestra de adolescentes mexicanos. Rev Mex Psicol 1993;10(2):141-145.

58. Edman JL, Danko GP, Andrade N, McArle JJ et al. Factor structure of the CES-D (Center for Epidemiologic Studies of Depression Scale) among Filipino-American adolescents. Soc Psychiatry Psychiatr Epidemiol 1999;34:211-215.

59. Ghubash R, Daradkeh TK, Al-Naseri KS, Al-Bloushi NBA et al. The performance of the Center for Epidemiologic Studies of Depression Scale (CES-D) in an Arab female community. Int J Soc Psychiatry 2000;46(4):241-249.

60. Burín M, Moncarz E, Velázquez S. El malestar de las mujeres. La tranquilidad recetada. México: Paidós; 1990.

61. Okasha A, Lotaif F, Sadeck A. Prevalence of suicidal feelings in a simple of non-consulting medical students. Acta Psychiatr Scand 1981;63:409-415.

62. O’Rourke N. Factor structure of the Center for Epidemiologic Studies–Depression Scale (CES–D) among older men and women who provide care to persons with dementia. Int J Testing 2005;5(3):265–277.

63. González-Forteza C, Jiménez A, Ramos L, Wagner F. Aplicación de la Escala de Depresión del Center of Epidemiological Studies en adolescentes de la Ciudad de México. Salud Publica Mex 2008;50(4):292-299.

64. González-Forteza C, Andrade P, Jiménez A. Estresores cotidianos familiares, sintomatología depresiva e ideación suicida en adolescentes mexicanos. Acta Psiquiatr Psicol Am Lat 1997;43(4):319-326.

65. González-Forteza C, Saldaña-Hernández A, Alvarez-Ruiz M, Arana-Quezadas D et al. Matices de género en la percepción del intento suicida de adolescentes estudiantes de la Ciudad de México. En: Salvador Moysén J (ed.): El claroscuro de la vida juvenil. Durango, Dgo.: Universidad Juárez del Estado de Durango y Centro de Investigación–Instituto de Investigación Científica y Estudios sobre Juventud del Instituto Mexicano de la Juventud, ISBN 978-968-9304-21-0, 1ª edición; 2007; pp.141-159.