title: Psychometric Limitations of the Center for Epidemiologic Studies-Depression Scale for Assessing Depressive Symptoms among Adults with HIV/AIDS: A Rasch Analysis.
abstract: The Center for Epidemiological Studies-Depression (CES-D) scale is a widely used measure of depressive symptoms, but its psychometric properties have not been adequately evaluated among adults with HIV/AIDS. This study used an item response theory approach (Rasch analysis) to evaluate the CES-D's validity and reliability in relation to key demographic and clinical variables in adults with HIV/AIDS. A convenience sample of 347 adults with HIV/AIDS (231 males, 93 females, and 23 transgenders; age range 22-77 years) completed the CES-D. A Rasch model application was used to analyze the CES-D's rating scale functioning, internal scale validity, person-response validity, person-separation validity, internal consistency, differential item functioning (DIF), and differential test functioning. CES-D scores were generally high and associated with several demographic and clinical variables. The CES-D distinguished 3 distinct levels of depression and had acceptable internal consistency but lacked unidimensionality, five items demonstrated poor fit to the model, 15% of the respondents demonstrated poor fit, and eight items demonstrated DIF related to gender, race, or AIDS diagnosis. Removal of misfitting items resulted in minimal improvement in the CES-D's substantive and structural validity. CES-D scores should be interpreted with caution in adults with HIV/AIDS, particularly when comparing scores across gender and racial groups.
authors.affiliation: Department of Family Health Care Nursing, University of California San Francisco, San Francisco, CA 94143, USA; Department of Research, Lovisenberg Diakonale Hospital, 0440 Oslo, Norway.
authors.forename: Caryl L
authors.identifier: 0000-0002-6865-6335
authors.initials: CL
authors.lastname: Gay
authors.affiliation: Department of Occupational Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL 60612, USA; Division of Occupational Therapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, 14183 Huddinge, Sweden.
authors.forename: Anders
authors.initials: A
authors.lastname: Kottorp
authors.affiliation: Department of Research, Lovisenberg Diakonale Hospital, 0440 Oslo, Norway; Department of Nursing Science, Institute of Health and Society, Faculty of Medicine, University of Oslo, 0318 Oslo, Norway.
authors.forename: Anners
authors.identifier: 0000-0002-7144-5096
authors.initials: A
authors.lastname: Lerdal
authors.affiliation: Department of Family Health Care Nursing, University of California San Francisco, San Francisco, CA 94143, USA.
authors.forename: Kathryn A
authors.initials: KA
authors.lastname: Lee