Depression symptoms and assessment in China are influenced by unique cultural values of collectivism and by social-political factors specific to China. This study validated the Chinese version of the 52-item Multidimensional Depression Assessment Scale (MDAS) with clinically depressed patients in Inner Mongolia. The study sought to examine the psychometric properties of the MDAS and understand the construct of depression in a specific collectivistic cultural context using a scale with comprehensive dimensions of depressive symptoms in the emotional, cognitive, somatic and interpersonal domains. A total of 171 clinically depressed participants in Inner Mongolia completed the Chinese versions of the MDAS and the Beck Depressive Inventory (BDI). The reliability and validity of the MDAS were tested, and an exploratory factor analysis (EFA) was conducted on the MDAS to examine the underlying structure of the measure. The MDAS and BDI were compared in terms of sensitivity and reactivity on the basis of the cut-off value of BDI. The Chinese-MDAS was found to have good psychometric properties, including high Cronbach’s alphas for the total scale and for each subscale (0.90–0.97), indicating good reliability, as well as a high and significant correlation with the BDI (r = 0.72; p < .001), suggesting good validity. The factor analysis indicated the emergence of a salient factor of interpersonal symptoms in Chinese depressed patients, suggesting the importance of interpersonal symptoms in Chinese depressed individuals. A cut-off value of 118.5 with high sensitivity and specificity was found on the MDAS based on the cut-off value of the BDI. The Chinese-MDAS demonstrated good psychometric properties among depressed individuals in Inner Mongolia. This study paves the way for the measure’s further development and cultural adaptation in a Chinese depressed population.
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Akobeng, A. K. (2007). Understanding diagnostic tests 3: Receiver operating characteristic curves. Acta Paediatrica, 96(5), 644–647. https://doi.org/10.1111/j.1651-2227.2006.00178.x.
Baglin, J. (2014). Improving your exploratory factor analysis for ordinal data: A demonstration using FACTOR. Practical Assessment, Research and Evaluation, 19(5), 1–15.
Beck, A. T., Ward, C. H., Mendelson, M., Mock, J., & Erbaugh, J. (1961). An inventory for measuring depression. Archives of General Psychiatry, 4(6), 561–571.
Beck, A. T., Steer, R. A., & Garbin, M. G. (1988). Psychometric properties of the Beck depression inventory: Twenty-five years of evaluation. Clinical Psychology Review., 8(1), 77–100.
Bedford, O., & Hwang, K. K. (2003). Guilt and shame in Chinese culture: A cross-cultural framework from the perspective of morality and identity. Journal for the Theory of Social Behaviour, 33(2), 127–144. https://doi.org/10.1111/1468-5914.00210.
Bernstein, I. H., & Teng, G. (1989). Factoring items and factoring scales are different: Spurious evidence for multidimensionality due to item categorization. Psychological Bulletin, 105(3), 467–477.
Brislin, R. W. (1986). The wording and translation of research instruments. In W. J. Lonner & J. Berry (Eds.), Field methods in cross-cultural research (pp. 137–164). Beverly Hills, CA: SAGE.
Chen, H., & Mui, A. C. (2014). Factorial validity of the Center for Epidemiologic Studies Depression Scale short form in older population in China. International Psychogeriatrics, 26(1), 49–57. https://doi.org/10.1017/S1041610213001701.
Cheung, H. N., & Power, M. J. (2012). The development of a new multidimensional depression assessment scale: Preliminary results. Clinical Psychology and Psychotherapy, 19(2), 170–178.
Cheung, H. N., Chan, S. W. Y., & Williams, J. M. (2020). Validation of Chinese multidimensional depression assessment scale (MDAS) in Inner Mongolia pregnant women and risk factors of antenatal depression in Inner Mongolia in the era of one-child policy. PLoS One, 15(3), e0227944. https://doi.org/10.1371/journal.pone.0227944.
Chinese Society of Psychiatry. (2001). Chinese classification of mental disorders (version 3). Beijing: Shandong Science and Technique Press.
Costello, A. B., & Osborne, J. W. (2005). Best practices in exploratory factor analysis: Four recommendations for getting the most from your analysis. Practical Assessment, Research & Evaluation, 10(7), 1–9 http://pareonline.net/pdf/v10n7.pdf.
Courtney, M. G. R. (2013). Determining the number of factors to retain in EFA: Using the SPSS R-menu v2.0 to make more judicious estimations. Practical Assessment, Research and Evaluation, 18(8), 1–14.
de Joode, J. W., van Dijk, S. E. M., Walburg, F. S., Bosmans, J. E., van Marwijk, H. W. J., de Boer, M. R., et al. (2019). Diagnosticaccuracyof depressionquestionnaires in adultpatientswith diabetes: Asystematicreviewand meta-analysis. PLOS ONE, 14(6), e0218512.
Duan, L, P. (2016). Every 100 thousand Inner Mongolia citizens share 1.48 mental health specialist. (in Chinese). North News.
Fabrega, H. (1996). Cultural and historical foundations of psychiatric diagnosis. In J. E. Mezzich, A. Kleinman, H. Fabrega, & D. L. Parron (Eds.), Culture and psychiatric diagnosis: A DSM-IV perspective (pp. 3–14). Washington, DC: American Psychiatric Press, Inc..
Field, A. P. (2005). Discovering statistics using SPSS. London: SAGE.
Fried, E. (2014). Covert heterogeneity of major depressive disorder: Depression is more than the sum-score of its symptoms. Berlin: Freie Universität Berlin.
Gaskin, C. J., & Happell, B. (2014). On exploratory factor analysis: A review of recent evidence, an assessment of current practice, and recommendations for future use. International Journal of Nursing Studies, 51(3), 511–521. https://doi.org/10.1016/j.ijnurstu.2013.10.005.
Gill, S. C., Butterworth, P., Rodgers, B., & Mackinnon, A. (2007). Validity of the mental health component scale of the 12-item short-form health survey (MCS-12) as measure of common mental disorders in the general population (article). Psychiatry Research, 152(1), 63–71. https://doi.org/10.1016/j.psychres.2006.11.005.
Guo, W., Tsang, A., Li, T., & Lee, S. (2011). Psychiatric epidemiological surveys in China 1960-2010: How real is the increase of mental disorders? Current Opinion in Psychiatry, 24(4), 324–330. https://doi.org/10.1097/YCO.0b013e3283477b0e.
Guttman, L. (1945). A basis for analyzing test-retest reliability. Psychometrika, 10, 255–282.
Habibzadeh, F., Habibzadeh, P., & Yadollahie, M. (2016). On determining the most appropriate test cut-off value: The case of tests with continuous results. Biochemia medica, 26(3), 297–307. https://doi.org/10.11613/BM.2016.034.
Hsiao, F., Klimidis, S., Minas, H., & Tan, E. (2006). Cultural attribution of mental health suffering in Chinese societies: The views of Chinese patients with mental illness and their caregivers. Journal of Clinical Nursing, 15(8), 998–1006. https://doi.org/10.1111/j.1365-2702.2006.01331.x.
Humphreys, L., & Ilgen, D. (1969). Note on a criterion for the number of common factors. Educational and Psychological Measurement, 29(3), 571–578.
Hwang, K. K. (2001). The deep structure of Confucianism: A social psychological approach. Asian Philosophy, 11(3), 179–204. https://doi.org/10.1080/09552360120116928.
Kim, G., Decoster, J., Huang, C.-H., & Chiriboga, D. A. (2011). Race/ethnicity and the factor structure of the Center for Epidemiologic Studies Depression Scale: A meta-analysis. Cultural Diversity and Ethnic Minority Psychology, 17(4), 381–396. https://doi.org/10.1037/a0025434.
Lai, D., Tong, H., Zeng, Q., & Xu, W. (2010). The factor structure of a Chinese geriatric depression scale-SF: Use with alone elderly Chinese in Shanghai, China. International Journal of Geriatric Psychiatry, 25(5), 503–510. https://doi.org/10.1002/gps.2369.
Lasa, L., Ayuso-Mateos, J. L., Vázquez-Barquero, J. L., Diez-Manrique, F. J., & Dowrick, C. F. (2000). The use of the Beck depression inventory to screen for depression in the general population: A preliminary analysis. Journal of Affective Disorders, 57(1), 261–265. https://doi.org/10.1016/S0165-0327(99)00088-9.
Li, Y., Aggen, S., Shi, S., Gao, J., Li, Y., Tao, M., Zhang, K., Wang, X., Gao, C., Yang, L., Liu, Y., Li, K., Shi, J., Wang, G., Liu, L., Zhang, J., du, B., Jiang, G., Shen, J., Zhang, Z., Liang, W., Sun, J., Hu, J., Liu, T., Wang, X., Miao, G., Meng, H., Li, Y., Hu, C., Li, Y., Huang, G., Li, G., Ha, B., Deng, H., Mei, Q., Zhong, H., Gao, S., Sang, H., Zhang, Y., Fang, X., Yu, F., Yang, D., Liu, T., Chen, Y., Hong, X., Wu, W., Chen, G., Cai, M., Song, Y., Pan, J., Dong, J., Pan, R., Zhang, W., Shen, Z., Liu, Z., Gu, D., Wang, X., Liu, X., Zhang, Q., Flint, J., & Kendler, K. S. (2014). The structure of the symptoms of major depression: Exploratory and confirmatory factor analysis in depressed Han Chinese women. Psychological Medicine, 44(7), 1391–1401. https://doi.org/10.1017/S003329171300192X.
Liao, S.-C., Chen, W. J., Lee, M.-B., Lung, F.-W., Lai, T.-J., Liu, C.-Y., Lin, C. Y., Yang, M. J., & Chen, C. C. (2012). Low prevalence of major depressive disorder in Taiwanese adults: Possible explanations and implications. Psychological Medicine, 42(06), 1227–1237. https://doi.org/10.1017/S0033291711002364.
Lorenzo-Seva, U., & Ferrando, P. J. (2006). FACTOR: A computer program to fit the exploratory factor analysis model. Behavior Research Methods, 38(1), 88–91.
Lorenzo-Seva, U., & Ginkel, v. J. R. (2016). Multiple imputation of missing values in exploratory factor analysis of multidimensional scales: Estimating latent trait scores. Anales de Psicología, 32(2), 596–608. https://doi.org/10.6018/analesps.32.2.215161.
Marsella, A. J. (1987). The measurement of depressive experience and disorder across cultures. In A. J. Marsella, R. Hirschfeld, & M. Katz (Eds.), The measurement of depression (pp. 376–399). New York: Guilford.
Matsunaga, M. (2010). How to factor-analyse your data right: do’s dont’s, and how-to’s. International Journal of Psychological Research, 3(1), 97–110.
Olsson, U. (1979). Maximum likelihood estimation of the polychoric correlation coefficient. Psychometrika, 44(4), 443–460.
Rozario, P. A., Morrow-Howell, N. L., & Proctor, E. K. (2006). Changes in the SF-12 among depressed elders six months after discharge from an inpatient geropsychiatric unit (Article). Quality of Life Research, 15(4), 755–759. https://doi.org/10.1007/s11136-005-3996-z.
Rubin, D, B. (1978) ‘Multiple imputations in sample surveys-A phenomenological Bayesian approach to nonresponse. ‘Section on Survey Research Method, Americal Statistical Association.. pp. 20–34.
Ryder, A. G., & Chentsova-Dutton, Y. E. (2012). Depression in Cultural Context: “Chinese Somatization,” Revisited. Psychiatric Clinics of North America, 35(1), 15–36. https://doi.org/10.1016/j.psc.2011.11.006.
Ryder, A. G., Yang, J., Zhu, X., Yao, S., Yi, J., Heine, S. J., et al. (2008). The cultural shaping of depression: Somatic symptoms in China, psychological symptoms in North America? Journal of Abnormal Psychology, 117(2), 300–313. https://doi.org/10.1037/0021-843X.117.2.300.
Shek, D. T. L. (1990). Reliability and factorial structure of the Chinese version of the Beck depression inventory. Journal of Clinical Psychology, 46, 35–43.
Singh, P., Huang, S., & Thompson, G. (1962). A comparative study of selected attitudes, values, and personality characteristics of American, Chinese, and Indian students. Journal of Social Psychology, 57, 123–123.
Sousa, V. D., & Rojjanasrirat, W. (2011). Translation, adaptation and validation of instruments or scales for use in cross-cultural health care research: a clear and user-friendly guideline. Journal of evaluation in clinical practice, 17(2), 268–274. https://doi.org/10.1111/j.1365-2753.2010.01434.x.
Tam, P. W. C., & Wong, D. F. K. (2007). Qualitative analysis of dysfunctional attitudes in Chinese persons suffering from depression. Hong Kong Journal of Psychiatry, 17(4), 109–114 http://www.scopus.com/inward/record.url?eid=2-s2.0-37549056969&partnerID=40&md5=f9024b910ab4ad943b22ba264358a0e7.
Tavakol, M., & Dennick, R. (2011). Making sense of Cronbach’s alpha. International Journal of Medical Education, 2, 53–55. https://doi.org/10.5116/ijme.4dfb.8dfd.
Timmerman, M. E., & Lorenzo-Seva, U. (2011). Dimensionality assessment of ordered polytomous items with parallel analysis. Psychological Methods, 16(2), 209–220. https://doi.org/10.1037/a0023353.
Tu, Y. T., Lin, S. S., & Chang, Y. Y. (2011). A cross-cultural comparison by individualism/collectivism among Brazil, Russia, India and China. International Business Research, 4(2), 175–182.
Van de Vliert, E., Yang, H., Wang, Y., & Ren, X. P. (2013). Climato-economic imprints on Chinese collectivism. Journal of Cross-Cultural Psychology, 44(4), 589–605. https://doi.org/10.1177/0022022112463605.
van Loo, H., de Jonge, P., Romeijn, J., Kessler, R., & Schoevers, R. (2012). Data-driven subtypes of major depressive disorder: a systematic review (journal article). BMC Medicine, 10(1), 1–12. https://doi.org/10.1186/1741-7015-10-156.
Vares, E., Salum, G., Spanemberg, L., Caldieraro, M., & Fleck, M. (2015). Depression dimensions: integrating clinical signs and symptoms from the perspectives of clinicians and patients. PLOS one, 10(8), 1–15. https://doi.org/10.1371/journal.pone.0136037.
Wong, R., Wu, R., Guo, C., Lam, J. K., & Snowden, L. R. (2012). Culturally sensitive depression assessment for Chinese American Immigrants: Development of a comprehensive measure and a screening scale using an item response approach. Asian American Journal of Psychology, 3(4), 230–253. https://doi.org/10.1037/a0025628.
World Health Organization (WHO) (2017). Depression fact sheet. http://who.int/mediacentre/factsheets/fs369/en/. Accessed 18/8/2017.
Xie, Y., & Hu, J. (2014). An Introduction to the China Family Panel Studies (CFPS). Chinese Sociological Review, 47(1), 3–29. https://doi.org/10.2753/CSA2162-0555470101.2014.11082908.
Yang, F., Gardner, C. O., Bigdeli, T., Gao, J., Zhang, Z., Tao, M., et al. (2015). Clinical features of and risk factors for major depression with history of postpartum episodes in Han Chinese women: a retrospective study. Journal of Affective Disorders, 183, 339–346. https://doi.org/10.1016/j.jad.2015.05.033.
Yeung, A., Howarth, S., Chan, R., Sonawalla, S., Nierenberg, A. A., & Fava, M. (2002). Use of the Chinese version of the Beck Depression Inventory for screening depression in primary care. J Nerv Ment Dis, 190(2), 94–99. https://doi.org/10.1097/00005053-200,202,000-00005.
Yeung, A., Chang, D., Gresham, R. L., Nierenberg, A. A., & Fava, M. (2004). Illness Beliefs of Depressed Chinese American Patients in Primary Care. The Journal of Nervous and Mental Disease, 192(4), 324–327. https://doi.org/10.1097/01.nmd.0000120892.96624.00.
Ying, Y. W. (1988). Depressive symptomatology among Chinese-Americans as measured by the CES-D. Journal of Clinical Psychology, 44(88), 739–746.
Zhang, Y., Wang, Y., & Qian, M. (1990). Reliability and validity of the Beck Depression Inventory (BDI) examined in Chinese samples. Chinese Mental Health Journal, 4(4), 22–26 in Chinese.
Zhang, J., Sun, W., Kong, Y., & Wang, C. (2012). Reliability and validity of the Center for Epidemiological Studies Depression Scale in 2 special adult samples from rural China. Comprehensive Psychiatry, 53(8), 1243–1251. https://doi.org/10.1016/j.comppsych.2012.03.015.
We would like to express our sincere gratitude to colleagues at Inner Mongolia Mental Health Center for their collaboration, as well as colleagues at the University of Edinburgh in providing administrative support.
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The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.
This study has not received any funding sources. The manuscript is a part of the PhD thesis by Ho Nam Cheung.
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Cheung, H.N., Williams, J.M. & Chan, S.W.Y. A cultural validation of the Chinese version of multidimensional depression assessment scale (MDAS) in clinically depressed patients in Inner Mongolia. Curr Psychol 41, 5948–5958 (2022). https://doi.org/10.1007/s12144-020-01107-2