USE OF THE CES-D IN AN AMERICAN-INDIAN VILLAGE

In this paper, we examine the performance of a pencil-and-paper screen ing questionnaire on depressive symptoms (the Center for Epidemiologic Studies Depression Scale, or CES-D) in a sample of 120 adult American Indians belonging to a single Northwest Coast tribe. Results of facto r analyses suggest that somatic complaints and emotional distress are not well differentiated from each other in this population. CES-D scor es (which have shown good sensitivity and specifity for depressive dis orders in this sample) also show weak and apparently nonsignificant tr ends to be elevated in the presence of other psychiatric diagnoses (in cluding alcoholism) or general impairment. However, because of the use of a convenience sample (rather than a probability sample), analyses of associations between study factors - including comorbidity - are li able to produce spurious results due to selection bias (including Berk son bias). On this basis, we suggest that the use of probability sampl es should assume a high priority in cross-cultural studies. The study of the entire population of interest is another solution to the sampli ng problem, particularly in small communities.