Discord of measurements in assessing depression among African Americans with cancer diagnoses

OBJECTIVE: This study examined the level of agreement among the Center for Epidemiologic Studies-Depression Scale (CES-D), Hamilton Rating Scale for Depression (HAM-D), Beck Depression Inventory (BDI-II), and Observers' Rating on assessing depression of African American adults with cancer. METHODS: 75 breast and prostate cancer patients (57 African Americans and 18Whites) were interviewed and administered the depression measures. Nonparametric tests were performed to examine the level of measurement agreement by group and the symptom items of CES-D, HAM-D and BDI-II to which African American patients responded differently across measures. RESULTS: The four measures showed agreement on approximately 75% of the cases in both racial groups. However, the difference between measures in identifying depressive cases is marked. The item analysis indicated that most measurement disagreements about African American patients occurred on two items: self-report of depression and sleeping disturbance. CONCLUSION: Measurement discord may be explained by African American's reporting behavior that varies from a self-reported measure to an interviewer-administrated measure of depression. African American patients showed a reluctance to use the word "depression" and a tendency to report sleep disturbance. The findings suggest that accurately assessing depression in these patients requires a consideration of their culturally shaped life experiences.