Universal and culturally specific symptom expression and potential risk and protective factors for depression

Abstract

The purpose of this study was to explore the universal and culturally specific symptom expressions and potential risk and protective factors for depression in Taiwan. The online version of the Taiwanese Depression Assessment Battery (DAB), a multivariate depression assessment tool that measures depression and 13 risk and protective factors, was administered to 1013 undergraduate students in Taiwan from 2004 to 2009. Of the 1013 participants, 433 completed the DAB again two weeks later. In addition to the Beck Depression Inventory-II (BDI-II; Beck, Steer, & Brown, 1996) included in the DAB, the Quick Inventory of Depressive Symptomatology-Self Report (QIDS-SR16; Rush et al., 2003), the Center for Epidemiologic Studies-Depression (CES-D; Randloff, 1977), the Zung Self-Rating Depression Scale (Zung SDS; Zung, 1965), and the Taiwanese Depression Questionnaire (TDQ; Y. Lee, Yang, Lai, Chiu, & Chau, 2000) were also administered to the students. All depression measures in this study showed strong internal consistency and concurrent validity estimates. Principal-axis factor analyses of each of the depression measures revealed Cognitive-Affective and Somatic factors for the BDI-II, Depressive Symptoms, Insomnia, and Weight/Appetite factors for the QIDS-SR16, Depressive Symptoms and Positive Affect for the CES-D, Depressive Symptoms and Positive Affect for the Zung-SDS, and one factor Depressive Symptoms for the TDQ. Principal-axis factor analysis with five depression measures combined yielded 11 factors, including Cognitive-affective, Interpersonal Problems and Depressed Affect, Embodied affective, Restless Sleep, Appetite Loss, Crying, Irritability, Lack of Interest, Concentration Problems, Suicidality, and Appetite/Weight Gain factors. The Taiwanese DAB also showed good internal consistency, test-retest reliability estimates, and convergent validity estimates. Using each of the depression measures as a criterion variable for simultaneous regression analyses, the risk and protective factors measured in the Taiwanese DAB accounted for 38 to 48% variance in the depression scores. All Taiwanese DAB risk and protective factors, except perceived social support and assertiveness social skills, were indicated as significant predictors in regression models. Universal and culturally specific symptom expressions and risk and protective factors for depression are discussed. Limitations of the study were listed.