title: A multiple indicators multiple causes model of late-life depression in Latin American countries.
abstract: BACKGROUND
  The Euro-D depression scale consists of symptom clusters that may be differentially related to demographic and cognitive characteristics in older adults. This hypothesis needs further investigation and the role of measurement bias on substantive conclusions remains to be established.
  
  
  METHODS
  The study sample comprised 10,405 community-dwelling older adults from six Latin American countries. We applied a Multiple Indicators Multiple Causes (MIMIC) model for a concurrent investigation of measurement bias and of the association between Euro-D symptom clusters and background variables.
  
  
  RESULTS
  The factorial validity of Euro-D, with a two-dimensional structure--affective suffering and motivation disturbance, was consistently supported in all countries. Although complete measurement invariance could not be assumed across countries, measurement bias was minor. Both Euro-D factors were unrelated to age, but related to gender, as well as to impairment in memory and verbal fluency. Gender differences were larger for affective suffering than for motivation disturbance, whereas differences in verbal fluency impairment were more strongly related to motivation disturbance.
  
  
  CONCLUSIONS
  Our analytic strategies could only examine invariance at the level of indicator thresholds. The generalisability of current findings needs to be examined in clinical populations. A wider set of cognitive tests is needed. We did not examine the compositional factors that could have accounted for the variation in Euro-D scores across countries, as this was beyond the aims of the paper.
  
  
  CONCLUSIONS
  The current study adds evidence for the construct validity of Euro-D and for the possible differential association of depression symptom-clusters with gender and verbal fluency in older adults. An understanding of the heterogeneity of late-life depression may carry clinical implications for the diagnosis and treatment of depression in old age.
authors.affiliation: Department of Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK. Electronic address: brailean.anamaria@gmail.com.
authors.forename: Anamaria
authors.initials: A
authors.lastname: Brailean
authors.affiliation: Department of Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Institute of Memory, Depression and Disease Risk, Avda Constructores 1230, Lima 12, Peru; Peruvian University, Cayetano, Heredia, Lima, Peru.
authors.forename: Mariella
authors.initials: M
authors.lastname: Guerra
authors.affiliation: Department of Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
authors.forename: Kia-Chong
authors.initials: KC
authors.lastname: Chua
authors.affiliation: Department of Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
authors.forename: Martin
authors.initials: M
authors.lastname: Prince
authors.affiliation: Department of Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
authors.forename: Matthew A
authors.initials: MA
authors.lastname: Prina
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003863:Depression / Q000175:diagnosis* / Q000523:psychology; D005260:Female; D006801:Humans; D007843:Latin America; D008297:Male; D008875:Middle Aged; D008960:Models, Psychological; D009042:Motivation; D011569:Psychiatric Status Rating Scales; D012307:Risk Factors; D063189:Symptom Assessment
keywords: Cognitive function; Depression; Measurement invariance; Multiple indicators multiple causes model; Older adults