Of the 614 surveys administered, 4% (n = 25) were dropped because they had more than one missing item from the set of 20 items that make up the CES-D, leaving a total analysis sample of N = 589. The mean age of respondents was 19.7 (SD = 4.0, range = 18 to 53, 95% between 18 and 25). Sixty-seven percent (67%) of the sample were female. Freshmen constituted 63% of the sample; sophomores, 22%; juniors, 11%; and seniors, 4%. Forty-three percent (43%) of the participants reported having lived on the rural Big Island of Hawaii most or all of their lives. Of the Big Island subgroup, 24.3% were European American versus 52.0% in the non-Big-Island subgroup. Participants were asked to report their annual family income as the income of their family of origin if less than 5 years out of high school, or their own family income, if more than 5 years out of high school. Thirteen percent reported an annual family income of $19,999 or less, 28% between $20,000 and $39,999, 38% between $40,000 and $74,999, and 21%, $75,000 or more. Most respondents (90%) were single/living alone, 9% were married, and 1% were divorced or widowed.
Forty-four percent of participants were multiracial, indicating that their ethnoracial background included at least two of the following: African American/Black, American Indian or Alaska Native, European American/White, Hispanic/Latino(a), Native Hawaiian, Other Pacific Islander, Japanese, Chinese, Filipino, Korean, Thai, Other Asian, or Other. Mixed race participants were asked to indicate a primary racial identity. The primary racial/ethnic identities reported by both single- and mixed-race respondents were European American (29%), Native Hawaiian (18%), Japanese (16%), Filipino (11%), Other Asian (12%), and Other Pacific Islander (7%). Seven other categories, including Other, were rarely endorsed (< 3% each, total 7%).
Means and standard deviations for CES-D Total and subscale scores are shown in for all participants, by gender, and by primary racial identification. Also shown are the percent of respondents that scored above two traditional cutoffs for the CES-D total score: 16 or higher, generally construed as indicating mild to moderate levels of depressive symptoms, and 28 or higher, indicating more severe symptoms.33
As shown in , there were no statistically significant differences in depressive symptoms associated with ethnoracial group membership. Additionally, there were no statistically significant differences for different levels of family income or for differing marital status. There were significant differences in the CES-D Total score and some of the subscales for males vs. females: on average, females reported moderately higher (d
= .28, p
< .001) levels of depressive symptoms as measured by the CES-D Total score.
CES-D Scale Scores and Cutoffs by Gender, Ethnoracial Group, Family Income, and Marital Status (N = 589)
Mental Health Treatment
A history of mental health treatment was correlated with current depressive symptoms, as measured by the CES-D Total score (r with treatment during the past 12 months = .29, p < .001; and r with any past treatment = .28, p < .001). As shown in , 23.3% of the sample reported receiving either counseling/psychotherapy, psychiatric medications, or both at some point during their lives; and 8.1% reported treatment at some point during the previous 12 months. Overall, more females (26.3%) than males (16.8%) had a lifetime history of mental health treatment (χ2[1, N = 574] = 6.39, p < .05). However, when the level of current depressive symptoms as measured by the CES-D was controlled, there was no statistically significant difference in the likelihood of past mental health treatment for males versus females, F change (1, 571) = 3.08, p = .08.
Lifetime and 12-Month Prevalence of Mental Health Treatment for all Participants and by Ethnoracial Group (N = 589)
presents data on mental health treatment history for all participants and for each of the six primary ethnoracial groups included in the study. There were no statistically significant differences in mental health treatment rates among the five primary minority ethnoracial groups, either for the past 12 months, χ2(4, N =355) = 1.34, p = .86, or for any past treatment, χ2(4, N =358) = 2.45, p = .66. There was a large difference between the rates of lifetime mental health treatment for European Americans as compared with the five other ethnoracial groups combined: European Americans were 2.3 times more likely than members of the other five groups combined to have received mental health treatment; 38.1% of European Americans had received treatment as compared with 16.8% of members of the other five groups, χ2(1, N =526) = 28.89, p < .001 for differences in lifetime treatment between European Americans and all other groups combined. Ethnoracial differences in treatment during the past 12 months were even more marked: European Americans were 3.7 times more likely than members of the other five groups combined to have received mental health treatment in the past 12 months; 15.6% of European Americans had received treatment as compared with 4.2% of members of the other five groups, χ2(1, N =522) = 20.19, p < .001.
Only 29.3% of the subset of students with high levels of depressive symptoms (CES-D >= 28, n = 61) had received mental health treatment during the past 12 months: 17.2% had received counseling only, 3.4% had received medications only, and 8.6% had received both medications and counseling. There were no differences between the high distress (CES-D >= 28) group and the rest of the students in terms of ethnoracial composition, χ2(5, N =540) = 4.87, p =.43. European Americans in the high depressive symptoms group were 2.6 times more likely than minority students to have received mental health services in the past 12 months: 50.0% of European Americans had received treatment as compared with 19.4% of members of the other six groups, χ2(1, N =54) = 5.4, p < .05.
There was no statistically significant difference in type of treatment received by primary ethnoracial group: There were 123 participants in the six major ethnoracial categories who had a history of mental health treatment, 64 European Americans and 59 who belonged to one of the five other groups; 53.1% of treated European Americans had never received treatment involving medications as compared with 66.1% of the members of the other five groups, χ2(1, N =123) = 2.14, p = .14.