title: Rasch analysis of the Center for Epidemiologic Studies Depression scale used for the assessment of community-residing patients with stroke.
abstract: OBJECTIVE
  To use Rasch analysis to validate a Center for Epidemiologic Studies Depression scale (CES-D) for measuring the level of depression in community-residing patients with stroke.
  
  
  METHODS
  This study involved 183 community-residing stroke survivors. Depression was measured using the CES-D. The data were analysed with Winsteps version 3.62 using a Rasch model to investigate the unidimentionality of the items' fit, the distribution of items' difficulty and reliability and appropriateness of the rating scale.
  
  
  RESULTS
  Three items for CES-D showed a misfit with the Rasch model. Misfitting items included 'I did not feel like eating; my appetite was poor', 'I felt hopeful about the future' and 'My sleep was restless'. The person separation was 2.58, reliability was 0.87 and the rating scale of the CES-D was appropriate for stroke patients. The cut-off point of 16 out of 60 equated to a logit score of 0.85, which when applied to the 17-item scale (with four categories) equated to a cut-off point of 14.
  
  
  CONCLUSIONS
  At a new cut-off point of 14, the CES-D with 17 items was found to be reliable and valid as a screening tool for assessing depression in community-residing stroke patients. Moreover, it may not be appropriate to use a CES-D as it contains somatic factors for a population with physical dysfunctions.
authors.affiliation: Department of Nursing, College of Medicine, Dankook University, Cheonan, Chungnam, Republic of Korea.
authors.forename: Jung-Hee
authors.initials: JH
authors.lastname: Kim
authors.forename: Eun-Young
authors.initials: EY
authors.lastname: Park
mesh_terms: D000368:Aged; D003863:Depression / Q000175:diagnosis* / Q000209:etiology; D016021:Epidemiologic Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010361:Patients / Q000523:psychology; D011569:Psychiatric Status Rating Scales; D011594:Psychometrics / Q000295:instrumentation* / Q000379:methods; D015203:Reproducibility of Results; D012111:Residence Characteristics; D020521:Stroke / Q000150:complications / Q000503:physiopathology / Q000523:psychology*