Item bias in the Center for Epidemiologic Studies Depression Scale: effects of physical disorders and disability in an elderly community sample.
The Center for Epidemiologic Studies Depression Scale (CES-D) is frequently used in studies of elderly individuals. One controversy regarding its use turns on the issue of whether the effect of physical disorder on the CES-D total score reflects genuine effects on depression or item-level artifacts. The present article addresses this issue using medical examination data from 506 community-dwelling individuals aged 75 or older. A form of structural equation modeling, the MIMIC model, is used, enabling the effect of a physical disorder on CES-D total score to be partitioned into bias and genuine depression components. The results show substantial physical disorder-related artifacts with the CES-D total score. Caution is required in the use of CES-D (and possibly other) depression scales in groups in which physical disorders are present, such as in elderly individuals.
Grayson
D A
DA
Centre for Education & Research on Ageing of the University of Sydney, at RGH Concord, Australia. dgrayson@med.usyd.edu.au
Mackinnon
A
A
Jorm
A F
AF
Creasey
H
H
Broe
G A
GA
D000368:Aged; D000369:Aged, 80 and over; D015982:Bias; D003156:Community Mental Health Services; D003866:Depressive Disorder / Q000175:diagnosis* / Q000453:epidemiology; D006233:Persons with Disabilities; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D008954:Models, Biological