Depressive symptoms in elderly women with chronic conditions: measurement issues.
OBJECTIVE
Depression is highly prevalent in elderly women with chronic conditions and measuring depressive symptoms is complicated by co-occurring chronic illnesses. The 20-item Center for Epidemiological Studies Depression (CES-D) Scale is commonly used with elders, but its length may result in missing data. Twelve short four to 16 item CES-D forms exist, but their psychometric properties have not been systematically evaluated.


METHODS
This study of 250 elderly women compared reliability and validity estimates for the 20-item CES-D and its 12 short forms; all scales used four response alternatives. The study also investigated whether women with varying numbers of chronic conditions would be similarly classified as depressed based on standardized cut scores.


RESULTS
Cronbach's alpha was 0.84 for the 20-item CES-D and alphas ranged from 0.53 to 0.83 for the short forms. Correlations between the 20-item CES-D and the short forms ranged from 0.77 to 0.96. Using the established 20-item CES-D cut score, 12% of the elderly women would be classified with clinically significant depressive symptoms. The shortest scales (four and five item) identified the greatest percentages of women as depressed while the 16-item scale identified the lowest. All 12 short forms showed a trend where more women were classified as depressed as their number of chronic conditions increased.


CONCLUSIONS
The findings indicate a need for cautious interpretation of findings when shorter forms of the CES-D are used, particularly since shorter forms are less reliable and appear to over-identify women with chronic conditions as having clinically relevant depressive symptoms.
Zauszniewski
Jaclene A
JA
Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA. jaz@case.edu
Bekhet
Abir K
AK
D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease / Q000523:psychology*; D003430:Cross-Sectional Studies; D003866:Depressive Disorder / Q000175:diagnosis* / Q000523:psychology*; D005163:Factor Analysis, Statistical; D005260:Female; D006801:Humans; D008875:Middle Aged; D009820:Ohio; D011569:Psychiatric Status Rating Scales / Q000592:standards*; D011594:Psychometrics; D016387:Women's Health