Purpose Prevalence estimates of depression vary between countries, possibly due to differential functioning of items between settings. This study compared the performance of the widely used Hopkins symptom checklist 15-item depression scale (HSCL-15) across multiple settings using item response theory analyses. Data came from adult populations in the low and middle income countries (LMIC) of Colombia, Indonesia, Kurdistan Iraq, Rwanda, Iraq, Thailand (Burmese refugees), and Uganda (N = 4732). Methods Item parameters based on a graded response model were compared across LMIC settings. Differential item functioning (DIF) by setting was evaluated using multiple indicators multiple causes (MIMIC) models. Results Most items performed well across settings except items related to suicidal ideation and “loss of sexual interest or pleasure,” which had low discrimination parameters (suicide: a = 0.31 in Thailand to a = 2.49 in Indonesia; sexual interest: a = 0.74 in Rwanda to a = 1.26 in one region of Kurdistan). Most items showed some degree of DIF, but DIF only impacted aggregate scale-level scores in Indonesia. Conclusions Thirteen of the 15 HSCL depression items performed well across diverse settings, with most items showing a strong relationship to the underlying trait of depression. The results support the cross-cultural applicability of most of these depression symptoms across LMIC settings. DIF impacted aggregate depression scores in one setting illustrating a possible source of measurement invariance in prevalence estimates.

Objective: To estimate the equivalent cadmium levels in renal cortex and in urine, as based on autopsy analysis of subjects not exposed to cadmium occupationally. Methods: The levels of Cd were determined in renal cortex, liver, urine and urinary bladder of 39 subjects deceased at the age 42+14 years. Flame atomic absorption spectrometry (kidneys, liver) and flameless AAS (urine, bladder) were used. Results: The urinary cadmium level determined post mortem is strongly correlated with the renal Cd levels. Eliminating cases with high urinary proteins and extrapolating from sets of data with elevated urinary protein concentration to its normal range yielded a value of 1.7 mg/g creatinine as equivalent to the renal level of 50 mg/g w.w. Conclusions: It seems possible to use monitoring data for cadmium in urine and in renal cortex in a coherent way.

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To assess the validity of brief multidimensional measures of health, we studied 155 new residents of a long-term care institution. We collected self-reported measures of various aspects of health, as well as performance-based measures of physical and cognitive function. For six similar health dimensions measured using two self-reported methods, the average correlation between paired health dimensions was 0.64 (nonpaired correlation = 0.36). When we compared self-reports and performance on three closely paired health concepts, the average correlation of paired concepts was 0.49 (nonpaired correlation = 0.22). In a factor analysis, similar health dimensions measured using different methods tended to load on the same factor. Except for manual performance, performance-based and self-reported measures of physical and role function loaded on one factor. We conclude that brief measures of health and self-reported physical functioning in very old persons have acceptable validity.