Semantic Examination of a Japanese Center for Epidemiologic Studies Depression: A Cautionary Analysis Using Mixed Methods

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Cross-cultural research relies on the linguistic, conceptual, and semantic equivalence of instruments. Widely used translations of the Center for Epidemiologic Studies Depression (CESD) for cross-cultural samples should be analyzed to reaffirm conceptual and semantic equivalence.


This methodological study aimed to discover and resolve problematic translations of a Japanese version of the CESD.


Sequential explanatory mixed method design using spiraling integration.


Sample includes 34 first-generation Japanese women living in the US and 72 community-based women in Japan. Ethnographic analysis of the semantic meanings of items was followed by t tests to compare original and retranslated item means, as well as Cronbach’s reliability and corrected item-total correlations analyses.


Six problematic items were retranslated: bothered, failure, hope, restless sleep, happiness, and “getting going.” Reliabilities for the CESD that included the new CESD item translations were the same; however, most item-scale correlations were higher for the revised translations across the two groups.


We conclude that both failure and “getting going” may be culturally bound items. Implications for cross-cultural and ethnographic nursing research include planning mini-ethnographic analysis when using translations to discover and reconcile cultural differences in connotations, motivations, and goals.

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