Background
Methods
Setting, design and procedures
Depression assessment
Concurrent validators
Analyses
Results and discussion
Results
Sample characteristics
Cuba n = 2944
|
Dominican Republic n = 2011
|
P Rico n = 1918
|
Peru urban n = 1381
|
Peru rural n = 552
|
Venezuela n = 1965
|
Mexico urban n = 1003
|
Mexico rural n = 1000
|
China urban n = 1160
|
China rural n = 1002
|
India urban n = 1003
|
India rural n = 999
|
Nigeria n = 914
| |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Response proportion
| 94 % | 95% | 93% | 80% | 88% | 80% | 84% | 86% | 74% | 96% | 72% | 98% | 98% |
Age (years) Mean age | 74.8 | 75.2 | 76.1 | 75.0 | 74.1 | 72.3 | 74.4 | 74.1 | 73.9 | 72.4 | 71.2 | 72.5 | 72.6 |
Missing values | (7) | (0) | (2) | (0) | (0) | (4) | (1) | (0) | (0) | (0) | (2) | (0) | (0) |
Gender
| |||||||||||||
Female | 1913 (64.9) | 1325 (65.9) | 1289 (67.2) | 888 (64.3) | 295 (53.4) | 1226 (63.4) | 666 (66.4) | 602 (60.2) | 661 (56.9) | 556 (55.4) | 571 (57.6) | 545 (54.5) | 539 (58.9) |
Missing values | (0) | (2) | (4) | (0) | (0) | (33) | (0) | (0) | (0) | (0) | (15) | (0) | 0 |
Marital status
| |||||||||||||
Never married | 275(9.3) | 139 (6.9) | 118 (6.1) | 145 (10.5) | 68 (12.3) | 189 (9.8) | 63 (6.2) | 42 (4.2) | 3 (0.2) | 22 (2.2) | 21 (2.1) | 5 (0.5) | 41 (4.8) |
Currently married | 1271(43.2 | 586 (29.3) | 931 (48.5) | 784 (57.1) | 308 (55.9) | 921 (47.9) | 470 (46.8) | 538 (53.8) | 829 (71.4) | 585 (58.3) | 523 (52.2) | 481 (48.1) | 581 (68.6) |
Widowed | 928 (31.6) | 806 (40.3) | 640 (33.3) | 367 (26.7) | 157 (28.4) | 549 (28.5) | 395 (39.3) | 371 (37.1) | 326 (28.1) | 394 (39.3) | 426 (42.5) | 497 (49.7) | 225 (26.5) |
Separated/divorce | 462 (15.7) | 465 (23.3) | 228 (11.8) | 75 (5.4) | 18 (3.2) | 261 (13.5) | 75 (7.4) | 48 (4.8) | 2 (0.1) | 1 (0.1) | 32 (3.1) | 16 (1.6) | 0 (0.0) |
Missing values | 8 | 15 | 4 | 10 | 1 | 45 | 0 | 1 | 0 | 0 | 3 | 0 | 67 |
Education level
| |||||||||||||
Did not complete primary | 730 (24.8) | 1314 (70.9) | 446 (23.1) | 127 (9.1) | 225 (41.3) | 601 (31.2) | 581 (57.4) | 837 (83.7) | 385 (33.1) | 693 (69.0) | 662 (65.9) | 855 (85.5) | 678 (74.1) |
Missing values | 8 | 19 | 0 | 8 | 8 | 40 | 2 | 0 | 0 | 0 | 2 | 0 | 0 |
Mean EURO-D score (SD)
| 2.1 (2.3) | 3.0 (2.6) | 1.7 (2.0) | 2.6 (2.3) | 2.4 (2.0) | 2.5 (2.4) | 2.6 (2.3) | 2.3 (2.2) | 0.5 (1.2) | 0.2 (0.8) | 3.2 (2.5) | 3.2 (3.1) | 2.5 (3.0) |
Median EURO-D score (25th/75th centile)
| 1 (0/3) | 2 (1/5) | 1 (0/3) | 2 (1/4) | 2 (1/4) | 2 (1/4) | 2 (1/4) | 2 (0/4) | 0 (0/1) | 0 (0/0) | 3 (1/5) | 2 (0/6) | 1 (0/4) |
Cronbach’s alpha
| 0.77 | 0.76 | 0.73 | 0.71 | 0.64 | 0.73 | 0.72 | 0.70 | 0.70 | 0.74 | 0.72 | 0.87 | 0.87 |
EURO-D hierarchical scaling properties
Cuba
|
DR
|
Puerto Rico
|
Peru
|
Venezuela
|
Mexico
|
China
|
India
|
Nigeria
| |
---|---|---|---|---|---|---|---|---|---|
EURO 1 | 0.56 | 0.49 | 0.57 | 0.43 | 0.42 | 0.44 | 0.44 | 0.52* | 0.43 |
Depression | |||||||||
EURO 2 | 0.38 | 0.25 | 0.35 | 0.27 | 0.24 | 0.26 | 0.31 | 0.49 | 0.50 |
Pessimism | |||||||||
EURO 3 | 0.37 | 0.35 | 0.30 | 0.29 | 0.31 | 0.27 | 0.51 | 0.38 | 0.65 |
Wishing death | |||||||||
EURO 4 | 0.25 | 0.25 | 0.23 | 0.23 | 0.17 | 0.18 | 0.47 | 0.22 | 0.53 |
Guilt | |||||||||
EURO 5 | 0.33 | 0.33 | 0.29 | 0.24 | 0.31 | 0.24 | 0.23 | 0.46 | 0.45 |
Sleep | |||||||||
EURO 6 | 0.42 | 0.33* | 0.39 | 0.28 | 0.36* | 0.32 | 0.38 | 0.43 | 0.59 |
Interest | |||||||||
EURO 7 | 0.18* | 0.25* | 0.27 | 0.11* | 0.22 | 0.15 | 0.31 | 0.37 | 0.50 |
Irritability | |||||||||
EURO 8 | 0.29 | 0.28* | 0.20 | 0.22 | 0.18* | 0.18 | 0.25 | 0.43 | 0.26* |
Appetite | |||||||||
EURO 9 | 0.33 | 0.32 | 0.44 | 0.22 | 0.27 | 0.25 | 0.30 | 0.29* | 0.43 |
Fatigue | |||||||||
EURO 10 | 0.25 | 0.18 | 0.20 | 0.22 | 0.27 | 0.19 | 0.09 | 0.30 | 0.56 |
Concentration | |||||||||
EURO 11 | 0.42 | 0.33* | 0.45 | 0.30* | 0.39 | 0.37 | 0.34 | 0.44 | 0.71 |
Enjoyment | |||||||||
EURO 12 | 0.39* | 0.37 | 0.42 | 0.31 | 0.32* | 0.34 | 0.41 | 0.44 | 0.55 |
Tearfulness | |||||||||
Loevinger’s coefficient H
|
0.35
|
0.31
|
0.33
|
0.26
|
0.29
|
0.26
|
0.31
|
0.41
|
0.51
|
Cuba
|
DR
|
Puerto Rico
|
Peru urban
|
Peru rural
|
Venezuela
|
Mexico urban
|
Mexico rural
|
China urban
|
China rural
|
India urban
|
India rural
|
Nigeria
| |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
EURO 1 | 39.6 | 50.5 | 39.7 | 44.0 | 45.6 | 39.5 | 41.5 | 40.7 | 3.6 | 1.6 | 44.0 | 42.9 | 28.5 |
Depression | (1) | (1) | (1) | (1) | (1) | (1) | (1) | (1) | (5) | (5) | (2) | (3) | (4) |
EURO 2 | 25.3 | 23.4 | 11.1 | 15.1 | 11.1 | 24.6 | 29.8 | 28.0 | 6.3 | 0.9 | 33.5 | 46.3 | 20.4 |
Pessimism | (3) | (5) | (6) | (7) | (7) | (6) | (5) | (2) | (4) | (9) | (5) | (2) | (6) |
EURO 3 | 14.0 | 15.2 | 7.9 | 8.8 | 7.1 | 9.0 | 12.3 | 14.5 | 1.4 | 0.6 | 24.4 | 16.9 | 9.4 |
Wishing death | (7) | (11) | (8) | (11) | (11) | (10) | (9) | (6) | (10) | (11) | (7) | (8) | (12) |
EURO 4 | 3.1 | 4.5 | 6.1 | 9.7 | 8.8 | 5.0 | 9.4 | 7.3 | 0.3 | 0.3 | 7.5 | 3.0 | 12.2 |
Guilt | (12) | (12) | (10) | (10) | (10) | (12) | (10) | (9) | (12) | (12) | (12) | (12) | (9) |
EURO 5 | 33.1 | 39.2 | 22.2 | 26.5 | 10.8 | 35.9 | 30.2 | 25.3 | 10.6 | 1.0 | 34.3 | 41.0 | 22.6 |
Sleep | (2) | (3) | (3) | (5) | (8) | (2) | (4) | (3) | (1) | (8) | (4) | (4) | (5) |
EURO 6 | 9.0 | 18.0 | 3.6 | 11.1 | 8.9 | 10.8 | 6.8 | 7.3 | 3.5 | 2.0 | 9.0 | 8.3 | 34.8 |
Interest | (9) | (9) | (11) | (8) | (9) | (9) | (11) | (9) | (6) | (3) | (10) | (9) | (2) |
EURO 7 | 18.4 | 20.5 | 14.3 | 33.1 | 33.6 | 25.9 | 23.3 | 24.8 | 8.6 | 1.4 | 48.7 | 34.7 | 9.7 |
Irritability | (5) | (6) | (5) | (3) | (2) | (5) | (6) | (4) | (3) | (7) | (1) | (5) | (11) |
EURO 8 | 8.6 | 18.9 | 9.3 | 10.1 | 16.1 | 11.0 | 15.8 | 13.3 | 2.5 | 0.7 | 19.7 | 26.1 | 17.3 |
Appetite | (11) | (8) | (7) | (9) | (6) | (8) | (7) | (7) | (8) | (10) | (8) | (6) | (7) |
EURO 9 | 17.6 | 35.2 | 20.9 | 36.0 | 31.2 | 31.1 | 34.3 | 24.5 | 9.4 | 1.6 | 35.4 | 61.5 | 29.2 |
Fatigue | (6) | (4) | (4) | (2) | (3) | (4) | (2) | (5) | (2) | (5) | (3) | (1) | (3) |
EURO 10 | 10.3 | 17.0 | 7.8 | 23.6 | 25.9 | 21.4 | 15.7 | 10.7 | 2.0 | 6.8 | 18.3 | 7.8 | 12.0 |
Concentration | (8) | (10) | (9) | (6) | (5) | (7) | (8) | (8) | (9) | (2) | (9) | (10) | (10) |
EURO 11 | 9.0 | 19.3 | 2.7 | 6.8 | 7.1 | 8.4 | 5.4 | 5.1 | 2.6 | 1.8 | 7.9 | 6.4 | 39.4 |
Enjoyment | (9) | (7) | (12) | (12) | (11) | (11) | (12) | (11) | (7) | (4) | (11) | (11) | (1) |
EURO 12 | 22.7 | 40.3 | 33.9 | 30.5 | 30.2 | 34.5 | 34.0 | 2.9 | 1.0 | 34.9 | 29.9 | 25.8 | 15.2 |
Tearfulness | (4) | (2) | (2) | (4) | (4) | (3) | (3) | (12) | (11) | (1) | (6) | (7) | (8) |
Cuba
|
DR
|
Puerto Rico
|
Peru urban
|
Peru rural
|
Venezuela
|
Mexico urban
|
Mexico rural
|
China urban
|
China rural
|
India urban
|
India rural
|
Nigeria
| |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Cuba | 1.00 | 0.83** | 0.83** | 0.72** | 0.54 | 0.87*** | 0.80** | 0.67* | 0.56 | 0.19 | 0.82** | 0.74** | 0.05 |
DR | 1.00 | 0.84** | 0.75** | 0.64* | 0.89*** | 0.83** | 0.42 | 0.56 | 0.38 | 0.73** | 0.73** | 0.40 | |
Puerto Rico | 1.00 | 0.83** | 0.74** | 0.93*** | 0.97*** | 0.56 | 0.40 | 0.09 | 0.85** | 0.77** | −0.07 | ||
Peru urban | 1.00 | 0.92** | 0.89*** | 0.87*** | 0.51 | 0.53 | 0.37 | 0.83** | 0.71** | 0.06 | |||
Peru rural | 1.00 | 0.76** | 0.80** | 0.43 | 0.37 | 0.35 | 0.75** | 0.62* | −0.06 | ||||
Venezuela | 1.00 | 0.91*** | 0.56 | 0.59* | 0.33 | 0.83** | 0.77** | 0.12 | |||||
Mexico urban | 1.00 | 0.59* | 0.46 | 0.12 | 0.83** | 0.84** | 0.03 | ||||||
Mexico rural | 1.00 | 0.69* | −0.38 | 0.76** | 0.78** | −0.03 | |||||||
China urban | 1.000 | 0.04 | 0.69* | 0.75** | 0.43 | ||||||||
China rural | 1.00 | 0.03 | −0.07 | 0.35 | |||||||||
India urban | 1.00 | 0.87*** | −0.08 | ||||||||||
India rural | 1.00 | 0.18 |
Factor structure
Country
|
1st Factor items loading > =0.60 and 0.50-0.59 (*)
|
2nd factor items loading > =0.60 and 0.50-0.59 (*)
|
Number of factors with eigenvalues >1.0
|
Items loading on other factors > =0.60 and 0.50-0.59 (*)
| |
---|---|---|---|---|---|
Cuba | KMO = 0.82 | Variance = 29.7 | Variance = 10.4 | 2 | |
Bartlett’s p < 0.001 | Depression, Tearfulness Pessimism, Suicidality* | Enjoyment, Interest | |||
Concentration*, Fatigue* | |||||
Dominican | KMO = 0.80 | Variance = 27.9 | Variance = 10.7 | 3 | Guilt Suicidality |
Republic | Bartlett’s p < 0.001 | Depression, Sleep, Fatigue | Enjoyment, Interest | ||
Appetite*, Tearfulness* | Pessimism* | ||||
Puerto Rico | KMO = 0.78 | Variance = 26.2 | Variance = 11.0 | 3 | Guilt, Suicidality |
Bartlett’s p < 0.001 | Depression, Tearfulness | Enjoyment, Interest | Irritability* | ||
Appetite*, Sleep*, Fatigue* | Concentration* | ||||
Peru | KMO = 0.74 | Variance = 24.3 | Variance = 12.1 | 3 | Irritability |
Bartlett’s p < 0.001 | Depression, Tearfulness | Interest | Guilt* | ||
Suicidality*, Pessimism*, Appetite* | Enjoyment | ||||
Venezuela | KMO = 0.73 | Variance = 26.2 | Variance = 11.1 | 3 | Enjoyment |
Bartlett’s p < 0.001 | Pessimism, Concentration | Depression | Interest | ||
Fatigue*, Sleep*, Irritability* | Tearfulness | ||||
Mexico | KMO = 0.72 | Variance = 24.6 | Variance = 11.8 | 4 | Appetite |
Bartlett’s p < 0.001 | Depression, Tearfulness | Enjoyment | Guilt, Sleep*, Fatigue* | ||
Suicidality, Pessimism | Interest | Irritability*, Concentration* | |||
China | KMO = 0.80 | Variance = 31.2 | Variance = 12.2 | 3 | Sleep, Appetite* |
Bartlett’s p < 0.001 | Tearfulness, Suicidality | Enjoyment, Interest | Fatigue* | ||
Depression | Concentration* | ||||
India | KMO = 0.80 | Variance = 32.2 | Variance = 13.6 | 3 | Guilt |
Bartlett’s p < 0.001 | Depression, Pessimism, Sleep | Enjoyment | |||
Tearfulness, Appetite*, Irritability* | Interest | ||||
Nigeria | KMO = 0.84 | Variance = 42.4 | Variance = 13.1 | 3 | Depression, Tearfulness |
Bartlett’s p < 0.001 | Pessimism, Concentration | Enjoyment | Sleep, Irritability* | ||
Guilt, Suicidality | Interest | ||||
Pooled
| KMO = 0.80 | Variance = 29.5 | Variance = 11.4 | 2 | |
Bartlett’s p < 0.001 | Depression, Tearfulness, | Enjoyment | |||
Pessimism*, Sleep*, Suicidality*, Irritability* | Interest |
Affective suffering factor loading
|
Motivation factor loading
|
Factor correlation
| ||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Country
|
Dep
|
Tear
|
Suic
|
Sleep
|
Guilt
|
Irrit
|
Fatigue
|
Interest
|
Enjoyment
|
Pessimism
|
Conc
| |
Cuba | 1 | 0.77 | 0.44 | 0.48 | 0.09 | 0.25 | 0.40 | 1 | 0.99 | 0.83 | 0.47 | 0.55 |
DR | 1 | 0.91 | 0.47 | 0.64 | 0.12 | 0.46 | 0.60 | 1 | 1.11 | 0.56 | 0.36 | 0.51 |
Peru | 1 | 0.87 | 0.25 | 0.38 | 0.22 | 0.22 | 0.36 | 1 | 0.76 | 0.38 | 0.52 | 0.30 |
Venezuela | 1 | 0.85 | 0.23 | 0.44 | 0.08 | 0.30 | 0.36 | 1 | 0.91 | 0.29 | 0.47 | 0.37 |
Mexico | 1 | 0.84 | 0.28 | 0.35 | 0.14 | 0.24 | 0.38 | 1 | 0.91 | 0.55 | 0.39 | 0.31 |
PR | 1 | 0.84 | 0.24 | 0.39 | 0.15 | 0.31 | 0.34 | 1 | 0.89 | 1.14 | 0.89 | 0.48 |
India | 1 | 0.82 | 0.47 | 0.74 | 0.08 | 0.59 | 0.38 | 1 | 0.88 | 0.42 | 0.37 | 0.31 |
China | 1 | 0.77 | 0.49 | 0.54 | 0.09 | 0.74 | 0.58 | 1 | 0.76 | 0.33 | 0.26 | 0.48 |
Nigeria | 1 | 1.09 | 0.86 | 1.03 | 0.91 | 0.76 | 0.87 | 1 | 1.13 | 0.53 | 0.39 | 0.66 |
Mean (SD) | - | 0.86 (0.10) | 0.41 (0.20) | 0.55 (0.22) | 0.21 (0.27) | 0.43 (0.22) | 0.47 (0.18) | 1 | 0.93 (0.13) | 0.56 (0.27) | 0.46 (0.17) | 0.44 (0.13) |
Mean (SD) omitting Nigeria | - | 0.83 (0.05) | 0.36 (0.12) | 0.50 (0.14) | 0.12 (0.05) | 0.39 (0.19) | 0.43 (0.10) | 1 | 0.90 (0.11) | 0.56 (0.29) | 0.47 (0.19) | 0.41 (0.10) |
Constrained model | 1 | 0.83 | 0.39 | 0.53 | 0.12 | 0.39 | 0.45 | 1 | 0.93 | 0.50 | 0.41 | 0.54 |
Constrained model omitting Nigeria | 1 | 0.82 | 0.37 | 0.50 | 0.11 | 0.37 | 0.42 | 1 | 0.90 | 0.50 | 0.42 | 0.53 |
One factor solution omitting Nigeria | 1 | 0.81 | 0.48 | 0.63 | 0.12 | 0.46 | 0.55 | 0.40 | 0.35 | 0.68 | 0.31 | - |
Two factor solution
|
One factor solution
| ||||
---|---|---|---|---|---|
Model 1
|
Model 2
|
Model 3
|
Model 4
|
Model 5
| |
Unconstrained
|
Constrained
|
Unconstrained (excluding Nigeria)
|
Constrained (excluding Nigeria)
|
Constrained (excluding Nigeria)
| |
X2 | 7594.7 | 9148.1 | 6314.6 | 7438.6 | 13760.2 |
DF | 387 | 459 | 344 | 407 | 422 |
AIC | 8008.7 | 9418.1 | 6682.6 | 7680.6 | 13972.2 |
TLI | 0.77 | 0.77 | 0.79 | 0.79 | 0.62 |
RMSEA | 0.03 | 0.03 | 0.03 | 0.03 | 0.04 |
Model comparison | 2 vs 1 | 4 vs 3 | 5 vs 4 | ||
X2 change | 1553.4 | 1124.0 | 6321.6 | ||
DF change | 72 | 63 | 15 | ||
X2 change/DF change | 21.6 | 17.8 | 421.4 |
Calibration against clinical diagnoses
ICD-10 depressive episode
| ||||
---|---|---|---|---|
AUROC
1
|
Optimal cutpoint
2
(Youden’s index)
|
Sensitivity at 4/5 cutpoint (%)
|
Specificity at 4/5 cutpoint (%)
| |
Cuba | 0.97 (0.96-0.98) | 4/5 0.85 | 97.2 | 87.7 |
DR | 0.95 (0.94-0.96) | 4/5 0.78 | 93.5 | 84.0 |
Puerto Rico | 0.97 (0.96-0.98) | 4/5 0.90 | 97.9 | 91.6 |
Peru urban | 0.94 (0.93-0.96) | 4/5 0.77 | 92.0 | 84.5 |
Peru rural | 0.96 (0.94-0.98) | 4/5 0.87 | 100.0 | 87.0 |
Venezuela | 0.95 (0.94-0.97) | 4/5 0.79 | 94.4 | 84.7 |
Mexico urban | 0.93 (0.91-0.96) | 4/5 0.74 | 89.4 | 84.1 |
Mexico rural | 0.94 (0.92-0.97) | 4/5 0.76 | 88.9 | 87.0 |
China urban | 1.00 (0.99-1.00) | 6/7 0.99 | 100.0 | 97.8 |
China rural | 1.00 (0.99-1.00) | 4/5 0.87 | 85.7 | 99.6 |
India urban | 0.95 (0.92-0.98) | 5/6 0.74 | 97.4 | 74.1 |
India rural | 0.89 (0.86-0.91) | 3/4 0.63 | 91.3 | 69.5 |
Nigeria | 0.93 (0.87-0.98) | 4/5 0.79 | 100.0 | 79.3 |
Concurrent validity
Global self-rated health
|
Disability (WHODAS 2.0)
|
Happiness
| |
---|---|---|---|
Cuba | −0.36 | +0.41 | −0.49 |
DR | −0.43 | +0.48 | −0.32 |
Peru urban | −0.45 | +0.46 | −0.41 |
Peru rural | −0.20 | +0.37 | −0.17 |
Venezuela | −0.42 | +0.47 | −0.24 |
Mexico urban | −0.36 | +0.33 | −0.43 |
Mexico rural | −0.32 | +0.32 | −0.42 |
Puerto Rico | −0.43 | +0.41 | −0.42 |
India urban | −0.35 | +0.37 | −0.30 |
India rural | −0.27 | +0.42 | −0.39 |
China urban | −0.10 (p = 0.001) | +0.42 | −0.05 (p = 0.12) |
China rural | −0.06 (p = 0.06) | +0.15 | −0.01 (p = 0.70) |
Nigeria | −0.34 | +0.38 | +0.01 (p = 0.68) |