Skip to main content Accessibility help

Use of item response theory to understand differential functioning of DSM-IV major depression symptoms by race, ethnicity and gender

  • L. A. Uebelacker (a1), D. Strong (a1), L. M. Weinstock (a1) and I. W. Miller (a1)



Psychological literature and clinical lore suggest that there may be systematic differences in how various demographic groups experience depressive symptoms, particularly somatic symptoms. The aim of the current study was to use methods based on item response theory (IRT) to examine whether, when equating for levels of depression symptom severity, there are demographic differences in the likelihood of reporting DSM-IV depression symptoms.


We conducted a secondary analysis of a subset (n=13 753) of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) dataset, which includes a large epidemiological sample of English-speaking Americans. We compared data from women and men, Hispanics and non-Hispanic Whites, African Americans and Whites, Asian Americans and Whites, and American Indians and Whites.


There were few differences overall, although the differences that we did find were primarily limited to somatic symptoms, and particularly appetite and weight disturbance.


For the most part, individuals responded similarly to the criteria used to diagnose major depression across gender and across English-speaking racial and ethnic groups in the USA.


Corresponding author

*Address for correspondence: Dr L. A. Uebelacker, Butler Hospital, 345 Blackstone Boulevard, Providence, RI 02906, USA. (Email:


Hide All
Aggen, SH, Neale, MC, Kendler, KS (2005). DSM criteria for major depression: evaluating symptom patterns using latent trait item response models. Psychological Medicine 35, 475487.
Ahye, BA, Devome, CM, Odoms-Young, AM (2005). Values expressed through intergenerational family food and nutrition management systems among African American women. Family and Community Health 29, 516.
Airhihenbuwa, CO, Kumanyika, S, Agurs, TD, Lowe, A, Saunders, D, Morssink, CB (1996). Cultural aspects of African American eating patterns. Ethnicity and Health 1, 245260.
APA (2000). Diagnostic and Statistical Manual of Mental Disorders, 4th edn, text revision. American Psychiatric Association: Washington, DC.
Asparouhov, T (2005). Sampling weights in latent variable modeling. Structural Equation Modeling 12, 411434.
Ayalon, L, Young, MA (2003). A comparison of depressive symptoms in African Americans and Caucasian Americans. Journal of Cross-Cultural Psychology 34, 111124.
Benjamini, Y, Hochberg, Y (1995). Controlling the false discovery rate: a practical and powerful approach to multiple testing. Journal of the Royal Statistical Society, Series B 57, 289300.
Blazer, DG, Landerman, LR, Hays, JC, Simonsick, EM, Saunders, WB (1998). Symptoms of depression among community-dwelling elderly African-American and white older adults. Psychological Medicine 28, 13111320.
Brown, C, Schulberg, HC, Madonia, MJ (1996). Clinical presentations of major depression by African Americans and whites in primary medical care practice. Journal of Affective Disorders 41, 181191.
Cohen, J (1988). Statistical Power Analysis for the Behavioral Sciences. Lawrence Erlbaum Associates: Hillsdale, NJ.
Cole, SR, Kawachi, I, Maller, SJ, Berkman, LF (2000). Test of item-response bias in the CES-D scale: experience from the New Haven EPESE study. Journal of Clinical Epidemiology 53, 285289.
Das, AK, Olfson, M, McCurtis, HL, Weissman, MM (2006). Depression in African Americans: breaking barriers to detection and treatment. Journal of Family Practice 55, 3039.
Gallo, JJ, Cooper-Patrick, L, Lesikar, S (1998). Depressive symptoms of whites and African Americans aged 60 years and older. Journals of Gerontology Series B: Psychological Sciences and Social Sciences 53, P277P286.
Grant, BF, Dawson, DA, Hasin, DS (2001). The Alcohol Use Disorders and Associated Disabilities Interview Schedule – DSM-IV Version (AUDADIS-IV). National Institute on Alcohol Abuse and Alcoholism: Bethesda, MD.
Grant, BF, Dawson, DA, Stinson, FS, Chou, PS, Kay, W, Pickering, R (2003 a). The Alcohol Use Disorder and Associated Disabilities Interview Schedule-IV (AUDADIS-IV): reliability of alcohol consumption, tobacco use, family history of depression and psychiatric diagnostic modules in a general population sample. Drug and Alcohol Dependence 71, 716.
Grant, BF, Dawson, DA, Stinson, FS, Chou, SP, Dufour, MC, Pickering, RP (2004 a). The 12-month prevalence and trends in DSM-IV alcohol abuse and dependence: United States, 1991–1992 and 2001–2002. Drug and Alcohol Dependence 74, 223234.
Grant, BF, Moore, TC, Shepard, J, Kaplan, K (2003 b). Source and Accuracy Statement: Wave 1 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). National Institute on Alcohol Abuse and Alcoholism: Bethesda, MD.
Grant, BF, Stinson, FS, Dawson, DA, Chou, SP, Dufour, MC, Compton, W, Pickering, RP, Kaplan, K (2004 b). Prevalence and co-occurrence of substance use disorders and independent mood and anxiety disorders: results from the National Epidemiologic Survey on Alcohol and Related Conditions. Archives of General Psychiatry 61, 807816.
Hasin, DS, Goodwin, RD, Stinson, FS, Grant, BF (2005). Epidemiology of major depressive disorder: results from the National Epidemiologic Survey on Alcoholism and Related Conditions. Archives of General Psychiatry 62, 10971106.
Huang, FY, Chung, H, Kroenke, K, Delucchi, KL, Spitzer, RL (2006). Using the Patient Health Questionnaire-9 to measure depression among racially and ethnically diverse primary care patients. Journal of General Internal Medicine 21, 547552.
Iwata, N, Buka, S (2002). Race/ethnicity and depressive symptoms: a cross-cultural/ethnic comparison among university students in East Asia, North and South America. Social Science and Medicine 55, 22432252.
Iwata, N, Turner, RJ, Lloyd, DA (2002). Race/ethnicity and depressive symptoms in community-dwelling young adults: a differential item functioning analysis. Psychiatry Research 110, 281289.
Kahler, CW, Strong, DR, Stuart, GL, Moore, TM, Ramsey, SE (2003). Item functioning of the alcohol dependence scale in a high-risk sample. Drug and Alcohol Dependence 72, 183192.
Kessler, RC, Berglund, P, Demler, O, Jin, R, Walters, EE (2005 a). Lifetime prevalence and age-of-onset distribution of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry 62, 593602.
Kessler, RC, Chiu, WT, Demler, O, Walters, EE (2005 b). Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry 62, 617627.
Khan, AA, Gardner, CO, Prescott, CA, Kendler, KS (2002). Gender differences in the symptoms of major depression in opposite-sex dizygotic twin pairs. American Journal of Psychiatry 159, 14271429.
Kirmayer, LJ (2001). Cultural variations in the clinical presentation of depression and anxiety: implications for diagnosis and treatment. Journal of Clinical Psychiatry 62 (Suppl. 13), 2228.
Kirmayer, LJ, Robbins, JM, Dworkind, M, Yaffe, MJ (1993). Somatization and the recognition of depression and anxiety in primary care. American Journal of Psychiatry 150, 734741.
Lesser, IM, Castro, DB, Gaynes, BN, Gonzalez, J, Rush, AJ, Alpert, JE, Trivedi, M, Luther, JF, Wisniewski, SR (2007). Ethnicity/race and outcome in the treatment of depression: results from STAR*D. Medical Care 45, 10431051.
Lewis-Fernandez, R, Das, AK, Alfonso, C, Weissman, MM, Olfson, M (2005). Depression in US Hispanics: diagnostic and management considerations in family practice. Journal of the American Board of Family Practice 18, 282296.
Lord, FM (1980). Applications of Item Response Theory to Practical Testing Problems. Erlbaum: Hillsdale, NJ.
Muthen, LK, Muthen, BO (1998–2007). Mplus User's Guide, 5th edn. Muthen & Muthen: Los Angeles, CA.
Myers, HF, Lesser, I, Rodriguez, N, Mira, CB, Hwang, WC, Camp, C, Anderson, D, Erickson, L, Wohl, M (2002). Ethnic differences in clinical presentation of depression in adult women. Cultural Diversity and Ethnic Minority Psychology 8, 138156.
Rowe, R, Pickles, A, Simonoff, E, Bulik, CM, Silberg, JL (2002). Bulimic symptoms in the Virginia Twin Study of Adolescent Behavioral Development: correlates, comorbidity, and genetics. Biological Psychiatry 51, 172182.
Salokangas, RK, Vaahtera, K, Pacriev, S, Sohlman, B, Lehtinen, V (2002). Gender differences in depressive symptoms. An artifact caused by measurement instruments? Journal of Affective Disorders 68, 215220.
Santor, DA, Ramsay, JO, Zuroff, DC (1994). Nonparametric item analyses of the Beck Depression Inventory: evaluating gender item bias and response option weights. Psychological Assessment 6, 255270.
Silverstein, B (1999). Gender difference in the prevalence of clinical depression: the role played by depression associated with somatic symptoms. American Journal of Psychiatry 156, 480482.
Silverstein, B (2002). Gender differences in the prevalence of somatic versus pure depression: a replication. American Journal of Psychiatry 159, 10511052.
Silverstein, B, Lynch, AD (1998). Gender differences in depression: the role played by paternal attitudes of male superiority and maternal modeling of gender-related limitations. Sex Roles 38, 539555.
Simon, GE, Von Korff, M (2006). Medical comorbidity and validity of DSM-IV depression criteria. Psychological Medicine 36, 2736.
Steinberg, L, Thissen, D (2006). Using effect sizes for research reporting: examples using item response theory to analyze differential item functioning. Psychological Methods 11, 402415.
Thissen, D (1991). MULTILOG User's Guide: Version 6. Scientific Software, Inc.: Chicago, IL.
Thissen, D (2001). IRTLRDIF v.2.0b: Software for the Computation of the Statistics Involved in Item Response Theory Likelihood-Ratio Tests for Differential Item Functioning (
Thissen, D, Steinberg, L, Kuang, D (2002). Quick and easy implementation of the Benjamini–Hochberg procedure for controlling the false positive rate in multiple comparisons. Journal of Educational and Behavioral Statistics 27, 7783.
Thissen, D, Steinberg, L, Wainer, H (1993). Detection of differential item functioning using the parameters of item response models. In Differential Item Functioning (ed. Holland, P. W. and Wainer, H.), pp. 67113. Lawrence Erlbaum Associates: Hillsdale, NJ.
Wenzel, A, Steer, RA, Beck, AT (2005). Are there any gender differences in frequency of self-reported somatic symptoms of depression? Journal of Affective Disorders 89, 177181.
Yen, S, Robins, CJ, Lin, N (2000). A cross-cultural comparison of depressive symptom manifestation: China and the United States. Journal of Consulting and Clinical Psychology 68, 993999.
Young, MA, Scheftner, WA, Fawcett, J, Klerman, GL (1990). Gender differences in the clinical features of unipolar major depressive disorder. Journal of Nervous and Mental Disease 178, 200203.


Use of item response theory to understand differential functioning of DSM-IV major depression symptoms by race, ethnicity and gender

  • L. A. Uebelacker (a1), D. Strong (a1), L. M. Weinstock (a1) and I. W. Miller (a1)


Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed