Gender bias in the measurement properties of the Center for Epidemiologic Studies Depression Scale (CES-D)

The Eight-Item Center for Epidemiological Studies Depression Scale in the English Longitudinal Study of Aging: Longitudinal and Gender Invariance, Sum Score Models, and External Associations

The disease burden of depression among older populations is high. Detecting changes in late-life depression is predicated on the seldom-examined assumption of longitudinal measurement invariance (MI). Therefore, we investigated longitudinal MI of the 8-item Center for Epidemiological Studies Depression Scale in core members repeatedly assessed in the English Longitudinal Study of Aging, a nine-wave representative study of the English population above 50 years of age (initial N = 11,391). Based on prior literature, we tested MI of a one-factor solution, a one-factor solution with correlated errors of reversely coded items, and a two-factor solution (depressed affect/somatic complaints). For all factor solutions, residual MI was confirmed across nine waves and gender. Sum score models (i.e., all factor loadings constrained to equity) had a good fit. Depression scores correlated with psychiatric diagnoses, ill health, lower life quality, and female gender. Associations slightly differed depending on the factor solutions, signifying their applicability across contexts.

Depression symptoms mediate the association between workplace stress and interleukin 6 in women, but not men: The Whitehall II study

Workplace stress and depression are positively related with inflammation, and each other. Low-grade inflammation and concurrent high levels of workplace stress or depression has been related with future morbidity. The potential pathway between constructs however, remains elusive. For the first time, this study explored the concurrent relationship between workplace stress, depressive symptomology and low-grade inflammation, and considered the role of gender in these relationships. Data from the Whitehall II cohort study (N ​= ​2528, M_age ​= ​57.01, 23.7% females) provided measures of workplace stress (job demand-control; JDC), depressive symptomology (Centre for Epidemiological Studies Depression scale; CES-D) and circulating inflammatory markers, interleukin-6 (IL-6) and C-reactive protein (CRP) collected on the same day from a single time point. Females had higher workplace stress, depressive symptoms and lower serum IL-6 concentrations. For males, higher workplace stress was associated with higher depressive symptoms. For females, higher depressive symptoms were related with elevated IL-6 levels, and both higher workplace stress and IL-6 levels were associated with higher depressive symptoms. Higher depressive symptoms were related with higher CRP levels in men only. Higher depressive symptoms statistically mediated the relationship between higher workplace stress and IL-6 levels in females only, b ​= ​0.016, CI [0.002, 0.039]. Females in this large cohort had higher levels of job strain, depression and lower IL-6 concentrations than males. In females, higher depressive symptoms were associated with higher serum IL-6 levels and workplace stress was not. Considered together, these findings suggest that low job control may be more apparent in females than males, but it is primarily negative affect that drives the positive relationship between work stress and serum IL-6 concentrations in females. Replicating the current design with a suitably proximal follow-up is required to determine if the associations identified are causal.

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Females had higher workplace stress, depressive symptoms and lower IL-6.

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Association between stress, depression and inflammation was stronger in women.

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Among females, depressive symptoms and not stress associated with serum IL-6. .

Dietary inflammatory index (DII®) and the risk of depression symptoms in adults

BACKGROUND & AIMS

Findings from observational studies investigating the association between Dietary Inflammatory Index (DII®) scores and depression symptoms (DepS) are inconsistent. This study aims to assess the association between energy-adjusted DII (E-DII™) and DepS using the North West Adelaide Health Study (NWAHS) cohort as well as update a previous meta-analysis.

METHODS

A total of 1743 (mean ± SD age: 56.6 ± 13.6 years, 51% female) study participants from NWAHS were included in the cross-sectional study and 859 (mean ± SD age: 58.4 ± 12.1 years, 52.6% female) in the longitudinal analyses. The Center for Epidemiological Studies Depression Scale (CES-D) was used for the measurement of DepS. E-DII scores were calculated from the dietary data collected using a validated food frequency questionnaire (FFQ). Data from two stages [Stage 3 (2008-10) and North West 15 (NW15) (2015)] were used. Log- and negative binomial regression were used to assess the association between quartiles of E-DII and DepS. A recent meta-analysis was updated by including 12 publications (six cross-sectional and six cohort studies) on the association between DII and DepS.

RESULTS

In the cross-sectional analysis, a higher E-DII score (i.e., more pro-inflammatory diet) was associated with a 79% increase in odds of reporting DepS [OR_Quartile4vs1: 1.79; 95% CI: 1.14-2.81; p = 0.01; p for trend (p_trend) = 0.03]. Males with higher E-DII had a more than two-fold higher odds of DepS (OR_Quartile4vs1: 2.27; 95% CI: 1.02-5.06; p = 0.045; p_trend = 0.09). Females with higher E-DII had an 81% increase in odds of DepS (OR_Quartile4vs1: 1.81; 95% CI: 1.01-3.26; p = 0.046; p_trend = 0.07). These associations were consistent in the longitudinal analysis. Comparing highest to lowest quintiles of E-DII, the updated meta-analysis showed that a pro-inflammatory diet is associated with a 45% increase in odds of having DepS (OR: 1.45; 95% CI: 1.20-1.74; p < 0.01) with higher odds in females (OR: 1.53; 95% CI: 1.16-2.01; p = 0.01) compared to their male counterparts (OR: 1.29; 95% CI: 0.98-1.69; p = 0.15).

CONCLUSION

The data from the NWAHS and the updated meta-analysis of observational studies provide further evidence that a pro-inflammatory diet is positively associated with increased risk of DepS. These findings support the current recommendation on consuming a less inflammatory diet to improve DepS.

Isolation but Diffusion? A Structural Account of Depression Clustering among Adolescents

Depression can cause people to withdraw from friendships or be avoided by others, protecting others from exposure to that depression. Yet, researchers observe depression contagion, particularly among adolescents. We address this empirical puzzle by examining the role of gender in structuring friendship networks and the implications for isolation and the spreading of depression. Using stochastic actor-based models of friendships among 421 adolescents from mixed-gender, all-girls, and all-boys classrooms in six Taiwanese high schools, we find that networks with only girls are characterized by high reciprocity and low transitivity. This, in turn, facilitates the withdrawal of depressed girls from interactions. In contrast, networks with all boys create more opportunities for depression to spread through interconnected pathways. Our computational experiment further demonstrates that local preferences governing friendship choice influence levels of network connectivity. This, coupled with depression withdrawal and peer influence, shapes depression prevalence at the network level. These findings refine our understanding of the mechanisms through which friendships expose boys and girls unequally to health risks of depression.

Employment Status Change and New-Onset Depressive Symptoms in Permanent Waged Workers

Background

This study aimed to investigate the relationship between changes in employment status and new-onset depressive symptoms through a one-year follow-up of permanent waged workers.

Methods

We analyzed the open-source data from the Korea Welfare Panel Study. Using the 2017 data, we selected 2,314 permanent waged workers aged 19 to 59 years without depressive symptoms as a base group. The final analysis targeted 2,073 workers who were followed up in 2018. In 2018, there were five categories of employment status for workers who were followed up: permanent, precarious, unemployed, self-employed, and economically inactive. Multiple logistic regression was used to determine the association between employment status change and new-onset depressive symptoms.

Results

Adjusted multiple logistic regression analysis showed that among male workers, workers who went from permanent status to being unemployed (odds ratio: 4.50, 95% confidence interval: 1.19 to 17.06) and from permanent status to being precarious workers (odds ratio: 3.15, 95% confidence interval: 1.30 to 7.65) had significantly high levels of new-onset depressive symptoms compared with those who retained their permanent employment status. There were no significant increases in new-onset depressive symptoms of male workers who went from permanent status to being self-employed or economically inactive. On the other hand, no significant differences were found among female workers.

Conclusion

Our study suggests that the change of employment status to precarious workers or unemployment can cause new-onset depressive symptoms in male permanent waged workers.

[Measurement invariance and normative data of the 8-item short form of the Center of Epidemiological Studies-Depression Scale (CES-D-8)]

Measurement invariance and normative data of the 8-item short form of the Center of Epidemiological Studies-Depression Scale (CES-D-8) Objectives: Female gender is a risk factor for depression. It is questionable whether a given psychometric instrument depicts depressive symptom severity in men and women alike. Therefore, we examined measurement invariance of the Center of Epidemiological Studies Depression Scale-8 (CES-D-8) between women, men and different age groups. Additionally, we aimed providing normative data for CES-D-8. Methods: We assessed depressive symptoms in a German population-based sample (N = 2,507) with the CES-D-8. Gender-distorted items were excluded in the short form. Results: Using confirmatory factor analysis (CFA), we found good model fit for men, women and the overall sample. A multi-group CFA confirmed measurement invariance of CES-D-8 regarding the tested factors and their interaction. Gender- and age-group-specific norms were computed. Conclusion: The use of the CES-D-8 can be recommended in epidemiological contexts, for practice and research. Different values between women and men of different age groups can be compared appropriately from a psychometric perspective.

Patterns of Postdiagnosis Depression Among Late-Stage Cancer Patients: Do Racial/Ethnic and Sex Disparities Exist?

OBJECTIVES

The incidence of depression after a late-stage cancer diagnosis is poorly understood and has not been the subject of intense investigation. We used population-based data to examine trends in postdiagnosis depression incidence among racial/ethnic and sexual groups.

METHODS

We identified 123,066 patients diagnosed with late-stage breast, prostate, lung, or colorectal cancer from 2001 to 2013 in the Surveillance Epidemiology and End Results Medicare-linked database. The primary outcome was the incidence of postdiagnosis depression after a late-stage cancer diagnosis. Trend analysis was performed using the Cochran-Armitage test. Stratified incidence rates were calculated for the racial/ethnic and sexual groups.

RESULTS

The incidence of depression after cancer diagnosis increased from 15.3% in 2001 to 24.1% in 2013, P trend<0.0001. About 50% of depression was reported in the first 3 months of stage IV cancer diagnosis. A total of 19,775 (20.0%) non-Hispanic whites, 1937 (15.9%) non-Hispanic blacks, and 657 (12.7%) Hispanics were diagnosed with depression during a mean follow-up of 2.7 months (interquartile range: 0.9 to 10.2 mo). The incidence of depression is significantly higher among females than males, 22.7% versus 16.3%, P<0.0001. In the multivariable logistic regression, non-Hispanic whites and females were still independent predictors of higher risk of postdiagnosis depression.

CONCLUSIONS

There are significant differences in the incidence of postdiagnosis depression among racial/ethnic and sexual groups in the United States. The consideration of racial/ethnic in depression prevention and diagnosis among cancer patients should be discussed as a matter of importance to ensure that there is no diagnosis bias among non-Hispanic blacks and Hispanics.

Dietary Patterns: A New Therapeutic Approach for Depression?

Introduction:

The field of nutritional psychiatry is a fast-growing one. Although initially, it focused on the effects of vitamins and micronutrients in mental health, in the last decade, its focus also extended to the dietary patterns. The possibility of a dietary cost-effective intervention in the most common mental disorder, depression, cannot be overlooked due to its potential large-scale impact.

Method:

A classic review of the literature was conducted, and studies published between 2010 and 2018 focusing on the impact of dietary patterns in depression and depressive symptoms were included.

Results:

We found 10 studies that matched our criteria. Most studies showed an inverse association between healthy dietary patterns, rich in fruits, vegetables, lean meats, nuts and whole grains, and with low intake of processed and sugary foods, and depression and depressive symptoms throughout an array of age groups, although some authors reported statistical significance only in women. While most studies were of cross-sectional design, making it difficult to infer causality, a randomized controlled trial presented similar results.

Discussion:

he association between dietary patterns and depression is now well-established, although the exact etiological pathways are still unknown. Dietary intervention, with the implementation of healthier dietary patterns, closer to the traditional ones, can play an important role in the prevention and adjunctive therapy of depression and depressive symptoms.

Conclusion:

More large-scale randomized clinical trials need to be conducted, in order to confirm the association between high-quality dietary patterns and lower risk of depression and depressive symptoms.

Depression, food insecurity and diabetic morbidity: Evidence from the Health and Retirement Study

OBJECTIVE

This study examined whether diabetic morbidity mediates the relationship of food insecurity with depression among older adults with diabetes.

METHODS

Data came from the 2010-2014 waves of the Health and Retirement Study and analyses were limited to respondents with diabetes (n = 2951). Depression was indexed by the 8-item Centers for Epidemiologic Studies Depression Scale. Weighted logistic regression was used to examine relationships of food insecurity and diabetic morbidity with depressive symptoms, both cross-sectionally and longitudinally. Path analysis quantified the contribution of diabetic morbidity as a mediation of the relationship of food insecurity with depressive symptoms.

RESULTS

Food insecurity was associated with having poor diabetes control (odds ratio (OR) = 1.7; 95% confidence interval (CI) = 1.1-2.5) and diabetes-related kidney problems (OR = 1.6; 95% CI = 1.1-2.5). Additionally, food insecurity was associated with depression contemporaneously (OR = 2.0, 95% CI = 1.7-2.4) and longitudinally (OR = 1.5, 95% CI = 1.3-1.8). However, food insecurity was no longer associated with depression when adjusting for diabetic morbidity. In path analyses, diabetic morbidity explained 12.7% (p-value = .04) of the association of food insecurity with depressive symptoms in 2012 and 18.5% (p-value = .09) of the association with depressive symptoms in 2014.

CONCLUSION

The relationship of food insecurity with depression was attributable to worse diabetes morbidity. Interventions that reduce food insecurity among older adults with diabetes may improve disease management and reduce depression severity.

The Reliability and Validity of the Center for Epidemiologic Studies Depression Scale (CES-D) for Chinese University Students

Aims: Depression is prevalent among university students worldwide, and the prevalence appears to be increasing. As an intermediate stage between being healthy and having depression, students with subthreshold depression could develop worsening depression or recover with intervention to prevent depression. The Center for Epidemiologic Studies Depression Scale (CES-D) is a useful tool to assess subthreshold depression. The primary purpose of the current study was to evaluate the psychometric characteristics of CES-D in Chinese university students. Secondly, we aimed to describe the prevalence of subthreshold depression among the student sample and examine its demographic correlates. Methods: A total of 2,068 university students participated in the study, and they were asked to respond to the Chinese CES-D, Beck Depression Inventory-II (BDI-II), and Positive and Negative Affect Schedule (PANAS). The factor structure was evaluated by conducting exploratory (EFA) and confirmatory factor analysis (CFA) using a structural equation modeling approach. The reliability was assessed by calculating Cronbach's alpha, inter-item correlation, and item-total correlation coefficients. The prevalence of subthreshold depression was calculated and demographic correlates of gender, grade, and major were examined by multiple regression. Results: The final sample included 1,920 participants. The EFA results suggested extraction of three factors (somatic symptoms, negative affect, and anhedonia) that account for 52.68% of total variance. The CFA results suggested that the newly derived model with 14 items was the best fit for our data. Six items were removed from the original scale (item 9, 10, 13, 15, 17, and 19). The Cronbach's alpha of the 14-item CES-D was 0.87. The prevalence of subthreshold depression among university students reached 32.7% for the 20-item CES-D and 31% for the 14-item CES-D, although there was no significant difference of prevalence in gender, grade, and major. Conclusions: The CES-D has good reliability and validity for assessing subthreshold depression in Chinese university students.

Determining the optimal clinical cutoff on the CES-D for depression in a community corrections sample

BACKGROUND

Screening instruments are urgently needed to rapidly and efficiently identify those in need of mental health treatment, particularly among underserved populations. Although designed initially for use in research, the CES-D has become a widely used clinical screening tool for the presence of major depression. Despite four decades and three major revisions to the DSM since the CES-D was first introduced, the cutoff score of 16 remains the marker by which individuals are assessed. The present study aims to examine an optimal cutoff score in a low-income, high-risk sample of ethnically diverse adults involved in some phase of the criminal justice system. The utility of the CES-D to detect depression in this population is unknown as these individuals are unlikely to be included in community studies of mental health.

METHODS

A diverse sample of participants under criminal justice supervision (n = 500, ages 19-72) completed the CES-D at up to six time points and the MINI-D at two time-points over a year.

RESULTS

Using receiver operating characteristic (ROC) curves, a cut point of 21 on the CES-D was determined to produce the best overall screening characteristics (sens = 0.82, spec = 0.76) using an efficiency calculation when compared with the gold standard MINI-D, though these results varied by race and gender. The optimal cutoff for women in this sample was determined to be 23 as opposed to 15 for men, and 20 for nonwhites versus 23 for whites.

LIMITATIONS

This study is limited in its generalizability to low-income individuals without criminal justice involvement or those without substance use.

CONCLUSION

Results suggest that the CES-D is a useful screening measure for depressive symptoms among high-risk individuals under criminal justice supervision. However, the current cutoff score of 16 is inadequate for optimizing true positives and false negatives. Possible gender and racial/ethnic bias may limit the utility of this instrument in this population. The current study contributes to the understanding of mental health needs in underserved populations.

Depression in later life: A closer look at the gender gap

Gender differences in depressive symptoms have been extensively documented, with women reporting a higher number of depressive symptoms than men. However, studies offer different explanations for why such a gap exists. The goal of the current paper is to analyze how much of the observed gender gap in depression may be attributed to (1) compositional versus (2) reporting differences or (3) differences in reactivity to adversities. We contribute to this literature by testing, net of compositional differences, whether the relationship between reporting behavior and depressive symptoms is gendered and whether accounting for the possibility of gender-specific reactivity alters the structure of the gender gap at older ages. Our results show that the observed gender gap in depression (1) only partially derives from compositional differences; (2) is not an artifact of a gender-specific reporting style; and remarkably (3) men appear more sensitive to adversities.

Disability and Activity-related Emotion in Later Life: Are Effects Buffered by Intimate Relationship Support and Strain?

We use daily diary data from the Disability and Use of Time supplement to the 2013 Panel Study of Income Dynamics ( n = 1,162) to evaluate (1) the extent to which marital/partner support and strain moderate the effects of disability on five activity-related emotions (happiness, calm, sadness, frustration, worry) and overall negative and positive emotion among older married, cohabiting, and dating persons and (2) whether such patterns differ significantly by gender. Marital support buffers against negative emotions and increases feelings of calm among severely impaired women. By contrast, support intensifies negative emotions and decreases feelings of calm among severely impaired men. Relationship strain also intensifies the effect of severe impairment on men's frustration, sadness, worry, and negative mood but has negligible effects on the negative emotions of men with low impairment and women. Frequent support and criticism may threaten highly impaired older men's sense of autonomy and emotional well-being.

The Center for Epidemiological Studies Depression Scale (CES-D): Measurement equivalence across gender groups in Hispanic college students

BACKGROUND

This study examined among Hispanic college students the factor structure and gender measurement invariance of the Center for Epidemiologic Studies Depression (CES-D) scale. The CES-D's original 20 item four-factor model was compared to a recently proposed 14 item, three-factor model.

METHODS

Participants included 858 Hispanic undergraduates at an ethnically diverse, major research, urban, public university in the Southwest United States (U.S.). Multigroup confirmatory factor analyses (CFAs) and structural equation modeling were used to examine the factor structure, gender invariance, and construct validity of the CES-D scores.

RESULTS

Multigroup CFAs provided support for full configural and metric invariance and partial scalar invariance for the three-factor model across gender groups. Two of the 14 items (#3 and #18) demonstrated different thresholds; women scored higher than men in both items. The pattern of latent correlations of the three depression factors to four stress variables (college academic, social, financial and discrimination stress) demonstrated configural, metric and scalar invariance across gender groups.

LIMITATIONS

About two thirds of the participants were women and most were of Mexican descent and had been born in the U.S. Therefore, findings may not generalize to more gender balanced samples and students from other Latin American countries or immigration generational status.

CONCLUSIONS

Partial scalar invariance in two items may not have a strong impact in the calculation of the overall depression score. Given evidence for functional invariance, results provide support for the use of the14-item, three-factor CES-D scale to assess depression symptoms among Hispanic college students.

Screening for depression in arthritis populations: an assessment of differential item functioning in three self-reported questionnaires

PURPOSE

To determine if persons with arthritis differ systematically from persons without arthritis in how they respond to questions on three depression questionnaires, which include somatic items such as fatigue and sleep disturbance.

METHODS

We extracted data on the Centers for Epidemiological Studies Depression (CES-D) scale, the Patient Health Questionnaire-9 (PHQ-9), and the Kessler-6 (K-6) scale from three large population-based national surveys. We assessed items on these questionnaires for differential item functioning (DIF) between persons with and without self-reported physician-diagnosed arthritis using multiple indicator multiple cause models, which controlled for the underlying level of depression and important confounders. We also examined if DIF by arthritis status was similar between women and men.

RESULTS

Although five items of the CES-D, one item of the PHQ-9, and five items of the K-6 scale had evidence of DIF based on statistical comparisons, the magnitude of each difference was less than the threshold of a small effect. The statistical differences were a function of the very large sample sizes in the surveys. Effect sizes for DIF were similar between women and men except for two items on the Patient Health Questionnaire-9. For each questionnaire, DIF accounted for 8% or less of the arthritis-depression association, and excluding items with DIF did not reduce the difference in depression scores between those with and without arthritis.

CONCLUSIONS

Persons with arthritis respond to items on the CES-D, PHQ-9, and K-6 depression scales similarly to persons without arthritis, despite the inclusion of somatic items in these scales.

Paternal Mental Health: Why Is It Relevant?

Father's mental health is an emerging area of interest that is beginning to be recognized in research, and to a lesser extent in clinical practice and society. Fathers are part of a parenting dyad with 2 partners who are responsible for their children's emotional development. Similar to mothers, the risk for mental health problems increases once a male becomes a father, but there is limited research examining this issue. The purpose of this review is to present the available literature on father's mental health and its effect on child emotional health through various mechanisms. In general, father's mental health was found to be related to increased child internalizing and externalizing behaviors, but each disorder had different risk factors, and a unique effect on parenting behaviors and the child's emotional health. The most developed paternal mental health literature is focused on depression. However, key conceptual and methodological problems exist that may limit our understanding of paternal depression. Additionally, the focus on paternal depression may not accurately represent the largest risk for paternal psychopathology and the resultant child mental health outcomes because men have an increased likelihood of displaying externalizing behaviors. Implications for research, clinical practice, and policy are discussed.

Symptom endorsement in men versus women with a diagnosis of depression: A differential item functioning approach

BACKGROUND

There is some evidence that, in contrast to depressed women, depressed men tend to report alternative symptoms that are not listed as standard diagnostic criteria. This may possibly lead to an under- or misdiagnosis of depression in men.

AIMS

This study aims to clarify whether depressed men and women report different symptoms.

METHODS

This study used data from the 2007 Australian National Survey of Mental Health and Wellbeing that was collected using the World Health Organization's Composite International Diagnostic Interview. Participants with a diagnosis of a depressive disorder with 12-month symptoms (n = 663) were identified and included in this study. Differential item functioning (DIF) was used to test whether depressed men and women endorse different features associated with their condition.

RESULTS

Gender-related DIF was present for three symptoms associated with depression. Depressed women were more likely to report 'appetite/weight disturbance', whereas depressed men were more likely to report 'alcohol misuse' and 'substance misuse'.

CONCLUSION

While the results may reflect a greater risk of co-occurring alcohol and substance misuse in men, inclusion of these features in assessments may improve the detection of depression in men, especially if standard depressive symptoms are under-reported.

Dietary inflammatory index and recurrence of depressive symptoms: Results from the Whitehall II Study

There is a growing interest in understanding the role of inflammation in diet-depression relationship. The present study examined whether the dietary inflammatory index (DII, a measure of the inflammatory potential of individuals' diets) is associated with recurrent depressive symptoms (DepS) (CES-D score>16 or taking antidepressants both at baseline and follow-up) assessed over 5 years in middle-aged men (n=3178) and women (n=1068) from the Whitehall II Study. For each increment of 1 SD of DII score, odds of recurrent DepS increased by 66% (95 % CI:1.30-2.12) in women while no significant association between DII and recurrent DepS was observed in men (OR=1.12, 95 % CI: 0.92-1.36). This association was little attenuated after adjustment for confounders and after taking into account levels of interleukin-6 and C-reactive protein. In conclusion, there is an association between pro-inflammatory diet and recurrent DepS in women which seems not be driven by circulating inflammatory markers.

Adherence to the DASH diet in relation to psychological profile of Iranian adults

INTRODUCTION

Although empirically derived dietary patterns have been examined in relation to depression, limited data are available linking theory-based dietary patterns and psychological health.

OBJECTIVE

We aimed to investigate the association between adherence to DASH-style diet and psychological health among Iranian adults.

METHODS

This cross-sectional study was done among 3846 general public adults in Isfahan, Iran. Dietary assessment was conducted using a validated 106-item dish-based semiquantitative food frequency questionnaire. To investigate participants' adherence to DASH-style diet, we created DASH score based on earlier publications focusing on eight components (fruits, vegetables, nuts and legumes, dairy products, grains, sweetened beverages and sweets, sodium, and red and processed meats). Participants were classified into three categories based on their DASH score [low (≤40), moderate (41-50), and high adherence (≥51)]. This categorization, instead of distribution-based classification, was used due to low adherence to the DASH dietary pattern in the study population. Psychological health was examined by means of validated Hospital Anxiety and Depression Scale and General Health Questionnaire. Depression, anxiety, and psychological distress were defined based on standard criteria.

RESULTS

We found that moderate adherence to DASH-style diet was associated with lower odds of depression (OR 0.73; 95 % CI 0.59-0.90, P _trend = 0.63) compared with those with the lowest adherence. In our stratified analyses, these associations remained significant for women (0.70; 0.54-0.91) and for normal-weight participants (0.70; 0.52-0.92). Moreover, after controlling for potential confounders, an inverse association was observed between high adherence to DASH-style diet and anxiety in normal-weight participants (0.61; 0.37-0.98). Such associations were also seen between moderate adherence to DASH-eating style and anxiety in overweight or obese individuals (0.63; 0.42-0.95). We failed to find any significant association between consumption of DASH-style diet and psychological distress.

CONCLUSION

We found an inverse association between moderate adherence to DASH dietary pattern and depression. Further prospective studies are required to confirm these findings.

Association between depressive symptoms in adolescence and birth outcomes in early adulthood using a population-based sample

BACKGROUND

Adolescent female depressive symptomatology is an unrecognized mood disorder that impairs health in adolescence or adulthood. However, the long-term effects of pre-pregnancy depressive symptoms on birth outcomes in adulthood have not been given adequate empirical assessments.

METHOD

In this study, we assessed the relationship between the life time duration of depressive symptoms over a 14-year period and birth outcomes (LBW and PTB) among a sample of 6023 female respondents who took part in the National Longitudinal Study of Adolescent to Adult Health (Add Health). We used the generalized estimating equation (GEE) models to assess these relationships.

RESULTS

Exposure to elevated depressive symptoms in late adolescence, but not in adulthood, was associated with increased odds of LBW by more than 2-fold in early and young adulthoods (adjusted odds ratio [aOR] = 2.19; 95% confidence interval, CI: 1.56, 3.08). Depressive symptoms in early adulthood were independently associated with increased odds of PTB and were higher for black mothers. Maternal race modified the relationship between consistent reporting of depressive symptoms in adolescence and LBW or PTB in adulthood.

CONCLUSION

This study provides compelling evidence that effects of elevated depressive symptomatology on LBW or PTB appear to be linked to a specific development period in adolescence. National policies to address social inequalities and stratification particularly in health at all stages of human development, will provide an important step in reducing depressive symptoms prior to early adulthood and in pregnancy and childbirth.

Funcionamento Diferencial do Item no Inventário de Depressão Beck

INTRODUÇÃO: Diversos estudos mostram o Funcionamento Diferencial do Item (DIF) em itens do Inventário de Depressão Beck (BDI), ao compararem homens e mulheres. A presença de um grande número de itens com DIF no BDI é uma severa ameaça à validade da medida da intensidade de sintomas depressivos obtida pela Teoria da Resposta ao Item (TRI) e às conclusões baseadas nos escores derivados dos itens com e sem DIF. OBJETIVO: Os objetivos deste estudo foram identificar esses itens do BDI, ajustar o modelo de TRI para itens constrangedores (modelo 2), o qual acomoda itens com a presença de DIF, e comparar esses resultados com os do ajuste do modelo logístico de dois parâmetros tradicional da TRI (modelo 1). MÉTODOS: Os resultados obtidos com ambos os modelos foram comparados. RESULTADOS: Os itens que apresentaram DIF foram: tristeza, sentimento de fracasso, insatisfações, culpa, punição, choro, fatigabilidade e perda da libido. Os resultados do ajuste dos dois modelos são similares quanto à discriminação, gravidade (à exceção dos itens com DIF) e no cálculo de escores para os indivíduos. Apesar disso, o modelo 2 é vantajoso, pois mostra as diferenças em gravidade do sintoma depressivo para os grupos avaliados, trazendo, dessa forma, mais informação ao pesquisador sobre a população estudada. CONCLUSÃO: Esse modelo, que tem um alcance mais amplo em termos de população-alvo, pode ser uma ótima alternativa na identificação e acompanhamento de indivíduos com potencial depressivo.

Demographic characteristics do not decrease the utility of depressive symptoms assessments: examining the practical impact of item bias in four heterogeneous samples of older adults

OBJECTIVE

Previous studies have identified differential item function (DIF) in depressive symptoms measures, but the impact of DIF has been rarely reported. Given the critical importance of depressive symptoms assessment among older adults, we examined whether DIF due to demographic characteristics resulted in salient score changes in commonly used measures.

METHODS

Four longitudinal studies of cognitive aging provided a sample size of 3754 older adults and included individuals both with and without a clinical diagnosis of major depression. Each study administered at least one of the following measures: the Center for Epidemiologic Studies Depression scale (20-item ordinal response or 10-item dichotomous response versions), the Geriatric Depression Scale, and the Montgomery-Åsberg Depression Rating Scale. Hybrid logistic regression-item response theory methods were used to examine the presence and impact of DIF due to age, sex, race/ethnicity, and years of education on the depressive symptoms items.

RESULTS

Although statistically significant DIF due to demographic factors was present on several items, its cumulative impact on depressive symptoms scores was practically negligible.

CONCLUSIONS

The findings support substantive meaningfulness of previously reported demographic differences in depressive symptoms among older adults, showing that these individual differences were unlikely to have resulted from item bias attributable to demographic characteristics we examined.

Randomised controlled trial of expressive writing and quality of life in men and women treated for colon or rectal cancer

OBJECTIVE

This randomised trial tested (i) whether a home-based expressive writing (EW) intervention improves quality of life in patients with colorectal cancer (CRC) and (ii) whether the intervention is more beneficial for men or for people who feel constrained in disclosing cancer-related concerns and feelings.

DESIGN

Patients treated for CRC were randomised to an EW (n = 101) or control writing (CW; n = 92) group. Assessments were completed at 1 month pre- and post-intervention. Sex and perceived social constraints on disclosure were evaluated as moderators.

MAIN OUTCOME MEASURES

Primary outcomes were depressive symptoms, sleep problems and quality of life indicators.

RESULTS

Eighty-one per cent of participants completed all writing assignments. Consistent with hypotheses, relative to the CW group, participants in the EW group expressed more negative emotion in writing and rated their writings as more meaningful, personal and emotionally revealing. There were no significant main effects of EW or moderating effects of sex or social constraints on outcomes.

CONCLUSIONS

Although EW is feasible to use with persons who have CRC, it was not effective as a stand-alone psychotherapeutic intervention. Neither was it more effective for men nor for people who felt they could not freely disclose cancer-related concerns and feelings.

The associations between emotional eating and consumption of energy-dense snack foods are modified by sex and depressive symptomatology

In recent years, emotional eating (EmE) has incited substantial research interest as an important psychologic determinant of food intake and overweight. However, little is known about factors that might modulate its relations with dietary habits. The objective of this study was to examine the association between EmE and consumption of energy-dense snack food and assess the 2-way interaction of EmE with sex and depressive symptoms. A total of 7378 men and 22,862 women from the NutriNet-Santé cohort (France, 2009-2013) who completed ≥6 self-reported 24-h food records were included in this cross-sectional analysis. EmE was evaluated via the revised 21-item Three-Factor Eating Questionnaire. Depressive symptoms were assessed by the Center for Epidemiologic Studies Depression Scale. The associations between EmE and energy-dense food consumption were assessed by multivariable logistic and linear regression models adjusted for sociodemographic and lifestyle factors. Higher EmE was associated with higher consumption of energy-dense snacks and, in particular, with consumption of sweet-and-fatty foods across most categories studied. However, these associations were stronger in women with depressive symptoms (e.g., high consumption of chocolate, OR: 1.77, 95% CI: 1.43, 2.20; cakes/biscuits/pastries, OR: 1.81, 95% CI: 1.45, 2.26) compared with those without depressive symptoms (e.g., high consumption of chocolate, OR: 1.52, 95% CI: 1.36, 1.69; cakes/biscuits/pastries, OR: 1.44, 95% CI: 1.29, 1.61). In contrast, the significant positive associations observed in men without depressive symptoms (e.g., high consumption of chocolate, OR: 1.33, 95% CI: 1.16, 1.52; cakes/biscuits/pastries, OR: 1.28, 95% CI: 1.11, 1.48) were not found in men with depressive symptoms. In conclusion, in women, EmE was positively associated with consumption of energy-dense snack food, particularly in those with depressive symptoms. For men, the relation between EmE and energy-dense snack foods was found only in those without depressive symptoms. These findings call for consideration of the psychologic state when targeting unhealthy dietary habits, especially in women. This trial was registered at eudract.ema.europa.eu as 2013-000929-31.

Gender and the children's depression inventory's (CDI) ‘crying’ question

Objectives: Following disruption from students, particularly boys, during the administration of item 10, the ‘feel like crying’ question, of the Children's Depression Inventory (CDI), this study sought to explore the issue of non-response to this question. It was decided that particular attention should be given to gender differences in responses and non-responses, based on the experiences of researchers administering this measure.

Method: Chi-square analysis of non-responses was conducted on CDI items collected from a total sample of 2,297 second year and pre-leaving certificate students from 23 randomly selected schools in the Mid-West region of Ireland.

Results: Analysis identified item 10 as being significantly less likely to be completed than any other item. Further analysis revealed that boys were significantly less likely to respond to this question than girls.

Conclusion: A modification of the wording to item 10 is suggested to ameliorate this difficulty.

Quality of life and cancer-related needs in patients with choroidal melanoma

AIMS

To assess quality of life (QoL) indices and their associations with treatment modality, sociodemographics and cancer-related needs in choroidal melanoma patients.

METHODS

Patients (N=99) treated at the University of California, Los Angeles, for choroidal melanoma within the prior 5 years (M=2.05) completed questionnaires assessing demographics, cancer-related needs, vision-specific QoL, depressive symptoms and concern about recurrence. Visual acuity, comorbidities, treatment modality (radiotherapy, enucleation) and years since diagnosis were gathered from medical records. Primary analyses were multiple regressions.

RESULTS

Although concern about cancer recurrence was elevated, QoL was better than in other oncology samples and comparable with healthy samples on some outcomes. Enucleation was associated with worse vision-specific QoL, and presence of comorbid diseases was associated with worse vision-specific QoL, depressive symptoms and concern about cancer recurring (all p values<0.05). Patients who experienced at least one stressful life event in the past year (vs no events) reported more depressive symptoms (p<0.01). Report of more unmet cancer needs was associated with worse vision-specific QoL, depressive symptoms and more concern about recurrence (all p values<0.05), uniquely explaining 4%-12% of the variance.

CONCLUSIONS

For choroidal melanoma patients, an average of 2 years after treatment, the number of physical comorbidities and unmet cancer needs were the strongest correlates of poorer QoL.

Mental health status among Burmese adolescent students living in boarding houses in Thailand: a cross-sectional study

BACKGROUND

In Tak province of Thailand, a number of adolescent students who migrated from Burma have resided in the boarding houses of migrant schools. This study investigated mental health status and its relationship with perceived social support among such students.

METHODS

This cross-sectional study surveyed 428 students, aged 12-18 years, who lived in boarding houses. The Hopkins Symptom Checklist (HSCL)-37 A, Stressful Life Events (SLE) and Reactions of Adolescents to Traumatic Stress (RATS) questionnaires were used to assess participants' mental health status and experience of traumatic events. The Medical Outcome Study (MOS) Social Support Survey Scale was used to measure their perceived level of social support. Descriptive analysis was conducted to examine the distribution of sociodemographic characteristics, trauma experiences, and mental health status. Further, multivariate linear regression analysis was used to examine the association between such characteristics and participants' mental health status.

RESULTS

In total, 771 students were invited to participate in the study and 428 students chose to take part. Of these students, 304 completed the questionnaire. A large proportion (62.8%) indicated that both of their parents lived in Myanmar, while only 11.8% answered that both of their parents lived in Thailand. The mean total number of traumatic events experienced was 5.7 (standard deviation [SD] 2.9), mean total score on the HSCL-37A was 63.1 (SD 11.4), and mean total score on the RATS was 41.4 (SD 9.9). Multivariate linear regression analysis revealed that higher number of traumatic events was associated with more mental health problems.

CONCLUSIONS

Many students residing in boarding houses suffered from poor mental health in Thailand's Tak province. The number of traumatic experiences reported was higher than expected. Furthermore, these traumatic experiences were associated with poorer mental health status. Rather than making a generalized assumption on the mental health status of migrants or refugees, more detailed observation is necessary to elucidate the unique nature and vulnerabilities of this mobile population.

Depression symptoms and stressful life events among college students in Puerto Rico

BACKGROUND

The transition from adolescence to adulthood is associated with stressful adaptation experiences that may increase symptoms of depression. We explored the prevalence and sex differences of depressive symptoms and suicidal ideation in freshmen Latino college students in Puerto Rico, and identified stressful life events that could contribute to symptoms of depression.

METHODS

Two thousand one hundred sixty-three freshmen college students from the University of Puerto Rico (UPR) public education system were assessed for depression symptoms using the Beck Depression Inventory (BDI) and stressful life events using open questions.

RESULTS

Nine percent of the sample reported depression symptoms at a moderate or severe level (BDI>20). Chi square analyses revealed a significantly higher prevalence for three of the stressful life events in females than males: relocation (10.2% females vs. 7.3% males; X(2) (1)=4.13, p=.042), break-up of a significant relationship (25.3% females vs. 17.8% males; X(2) (1)=13.76, p<.001), and illness (11.2% females vs. 7.3% males; X(2) (1)=7.23, p=.007). The model that best explained the variance of BDI scores among females was the presence of suicide risk, relationship break-up, illness, and relocation for college, whereas for males a similar model without the relationship break-up variable resulted in a better fit.

CONCLUSIONS

Freshmen college students present a broad range of depression symptoms and certain stressful life events are associated with an increased prevalence of depression symptoms. Early detection of depression and tailored prevention programs should be developed to improve both mental health and academic performance among the college population.

Adherence to healthy dietary guidelines and future depressive symptoms: evidence for sex differentials in the Whitehall II study

BACKGROUND

It has been suggested that dietary patterns are associated with future risk of depressive symptoms. However, there is a paucity of prospective data that have examined the temporality of this relation.

OBJECTIVE

We examined whether adherence to a healthy diet, as defined by using the Alternative Healthy Eating Index (AHEI), was prospectively associated with depressive symptoms assessed over a 5-y period.

DESIGN

Analyses were based on 4215 participants in the Whitehall II Study. AHEI scores were computed in 1991-1993 and 2003-2004. Recurrent depressive symptoms were defined as having a Center for Epidemiologic Studies Depression Scale score ≥16 or self-reported use of antidepressants in 2003-2004 and 2008-2009.

RESULTS

After adjustment for potential confounders, the AHEI score was inversely associated with recurrent depressive symptoms in a dose-response fashion in women (P-trend < 0.001; for 1 SD in AHEI score; OR: 0.59; 95% CI: 0.47, 0.75) but not in men. Women who maintained high AHEI scores or improved their scores during the 10-y measurement period had 65% (OR: 0.35%; 95% CI: 0.19%, 0.64%) and 68% (OR: 0.32%; 95% CI: 0.13%, 0.78%) lower odds of subsequent recurrent depressive symptoms than did women who maintained low AHEI scores. Among AHEI components, vegetable, fruit, trans fat, and the ratio of polyunsaturated fat to saturated fat components were associated with recurrent depressive symptoms in women.

CONCLUSION

In the current study, there was a suggestion that poor diet is a risk factor for future depression in women.

Psychometric properties of the Center for Epidemiologic Studies Depression Scale (CES-D) in French clinical and nonclinical adults

BACKGROUND

Previous research on the Center for Epidemiologic Studies Depression Scale (CES-D) has five main limitations. First, no study provided evidence of the factorial equivalence of this instrument across samples of depressive and community participants. Second, only one study included systematic tests of measurement invariance based on confirmatory factor analyses (CFA), and this study did not consider the higher-order factor structure of depression, although it is the CES-D global scale score that is most often used in the context of epidemiological studies. Third, few studies investigated the screening properties of the CES-D in non-English-language samples and their results were inconsistent. Fourth, although the French version of the CES-D has been used in several previous studies, it has never been systematically validated among community and/or depressed adults. Finally, very few studies have taken into account the ordered-categorical nature of the CES-D answer scale. The purpose of the study reported herein was therefore to examine the construct validity (i.e., factorial, reliability, measurement invariance, latent mean invariance, convergence, and screening properties) of the CES-D in a French sample of depressed patients and community adults.

METHODS

A total sample of 469 participants, comprising 163 clinically depressed patients and 306 community adults, was involved in this study. The factorial validity, and the measurement and latent mean invariance of the CES-D across gender and clinical status, were verified through CFAs based on ordered-categorical items. Correlation and receiver operator characteristic curves were also used to test the convergent validity and screening properties of the CES-D.

RESULTS

The present results: (i) provided support for the factor validity and reliability of a second-order measurement model of depression based on responses to the CES-D items; (ii) revealed the full measurement invariance of the first- and second-order measurement models across gender; (iii) showed the partial strict measurement invariance (four uniquenesses had to be freely estimated, but the factor variance-covariance matrix also proved fully invariant) of the first-order factor model and the complete measurement invariance of the second-order model across patients and community adults; (iv) revealed a lack of latent mean invariance across gender and across clinical and community subsamples (with women and patients reporting higher scores on all subscales and on the full scale); (v) confirmed the convergent validity of the CES-D with measures of depression, self-esteem, anxiety, and hopelessness; and (vi) demonstrated the efficacy of the screening properties of this instrument among clinical and nonclinical adults.

CONCLUSION

This instrument may be useful for assessing depressive symptoms or for the screening of depressive disorders in the context of epidemiological studies targeting French patients and community men and women with a background similar to those from the present study.

A very short visual analog form of the Center for Epidemiologic Studies Depression Scale (CES-D) for the idiographic measurement of depression

BACKGROUND

The experience sampling method, also referred to as ecological momentary assessment (ESM-EMA) has recently gained popularity in the study of depression. However, no psychometrically sound multidimensional depression questionnaires specifically designed for the ESM-EMA context are currently available.

AIMS

The main objective of the present study was to develop and validate a very short visual analog scale of the Center for Epidemiologic Studies Depression Scales (CES-D-VAS-VS) specifically designed for the ESM-EMA context. To this end, the full French version of the CES-D was adapted for the ESM-EMA context. From this full-length adapted version a very short version was then extracted from this longer instrument and validated.

STUDY DESIGN

A sample comprising 163 patients with a major depressive episode (MDE) and 306 participants without mental disorders was involved in this study.

RESULTS

The obtained results provided support for the factor validity, strong measurement invariance (invariance of the loadings and intercepts of the measurement model) across sex and clinical status groups, reliability and convergent validity of the CES-D-VAS-VS. This instrument comprises 4 items measuring positive affect, depressive affect, somatic complaints and disturbed interpersonal relationships.

CONCLUSION

The present results provide preliminary evidence regarding the construct validity of the CES-D-VAS-VS among patients and community adults sample but also underline the need to rely on latent variables methods in the use of this instrument to account for the differential levels of measurement errors (uniquenessess) that were observed across groups.

A reexamination of the factor structure of the Center for Epidemiologic Studies Depression Scale: is a one-factor model plausible?

The Center for Epidemiologic Studies Depression Scale (CES-D) is one of the most widely used measures of depressive symptoms in research today. The original psychometric work in support of the CES-D (Radloff, 1977) described a 4-factor model underlying the 20 items on the scale. Despite a long history of evidence supporting this structure, researchers routinely report single-number summaries from the CES-D. The research described in this article examines the plausibility of 1-factor model using an initial sample of 595 subjects and a cross-validation sample of 661. After comparing a series of models found in the literature or suggested by analyses, we determined that the good fit of the 4-factor model is mostly due to its ability to model excess covariance associated with the 4 reverse-scored items. A 2-factor model that included a general depression factor and a positive wording method factor loading only on those 4 items had fit that was nearly as good as the original 4-factor model. We conclude that although a 1-factor model may not be the best model for the full 20-item CES-D, it is at least plausible. If a unidimensional set of items is required (e.g., for a unidimensional item response theory analysis), by dropping 5 items, we were able to find a 1-factor model that had very similar fit to the 4-factor model with the original 20 items.

Not saying I am happy does not mean I am not: cultural influences on responses to positive affect items in the CES-D

OBJECTIVES

Given the emphasis on modesty and self-effacement in Asian societies, the present study explored differential item responses for 2 positive affect items (5 = Hopeful and 8 = Happy) on a short form of the Center for Epidemiologic Studies-Depression scale. The samples consisted of elderly non-Hispanic Whites (n = 450), Korean Americans (n = 519), and Koreans (n = 2,030).

METHOD

Multiple Indicator Multiple Cause models were estimated to identify the impact of group membership on responses to the positive affect items while controlling for the latent trait of depressive symptoms.

RESULTS

The data revealed that Koreans and Korean Americans were less likely than non-Hispanic Whites to endorse the positive affect items. Compared with Korean Americans who were more acculturated to mainstream American culture, those who were less acculturated were less likely to endorse the positive affect items.

DISCUSSION

Our findings support the notion that the way in which people endorse depressive symptoms is substantially influenced by cultural orientation. These findings call into question the common use of simple mean comparisons and a universal cutoff point across diverse cultural groups.

Equivalence of French and English Language Versions of the Center for Epidemiologic Studies-Depression Scale (CES-D) among Caregivers of Persons with Dementia

The Center for Epidemiologic Studies-Depression Scale (CES-D) is among the most widely used depression screening measures. Existing research suggests a higher-order factor structure of responses among older adults (factors labelled depressive affect, absence of well-being, somatic symptoms, and interpersonal affect, each loading upon a second-order depression factor). The current study extends this research to ascertain whether this structure is equivalent (or invariant) between the English and French versions of the CES-D. Findings suggest that the number and relative contribution of each factor is similar for both language groups. Furthermore, interpretation of CES-D items is statistically indistinguishable for 16 of 20 items within this randomly identified, national sample of caregivers of persons with dementia. Results of this study support the higher-order factor structure of this measure and provide data in support of the reliability of responses. Furthermore, findings support the use of the CES-D in cross-cultural and comparative research with English- and French-speaking adults.

Changes in sexual function on mood and quality of life in patients undergoing radiation therapy for prostate cancer

PURPOSE/OBJECTIVES

To describe the percentages of men with and without changes in sexual function from the beginning to end of radiation therapy and evaluate for differences in demographic and clinical characteristics, mood states, and quality of life (QOL) among patients who did and did not experience changes in sexual function.

DESIGN

Descriptive, longitudinal.

SETTING

Two radiation therapy departments in northern California.

SAMPLE

70 men with prostate cancer who underwent primary or adjuvant radiation therapy.

METHODS

Self-report questionnaires, medical record reviews, and repeated measures analysis of variance.

MAIN RESEARCH VARIABLES

Changes in sexual function; depression, anxiety, and QOL.

FINDINGS

Patients were categorized into one of four sex groups (No Problem X 2, Problem-No Problem, No Problem-Problem, and Problem X 2) based on their responses to "Is your sexuality impacted by your illness?" at the beginning and end of radiation therapy. About 50% had a problem with sexual function either at the beginning or end of radiation therapy. Overall, men without sexual problems at both the beginning and end of radiation therapy had significantly less anxiety and depression and higher QOL scores than patients who developed a problem at the end and patients who had a problem at both time points.

CONCLUSIONS

Changes in sexual function during the course of radiation therapy affect patients' mood and QOL.

IMPLICATIONS FOR NURSING

Clinicians should evaluate the effects of radiation therapy on sexual function and monitor patients with prostate cancer for depression and anxiety as well as for changes in QOL.

The CES-D in Chinese American women: construct validity, diagnostic validity for major depression, and cultural response bias

Previous studies of the Center for Epidemiologic Studies Depression Scale (CES-D) in Chinese Americans describe internal reliability and factor structure. We report CES-D construct validity and diagnostic validity for major depression in a probability sample of 168 community-dwelling Chinese American women. Internal consistency was satisfactory (Cronbach's alpha=0.86). Good construct validity was indicated by significantly higher mean CES-D scores for respondents who reported lower social support, worse self-perceived general health, or stressful life events, including intimate partner violence. Cultural response bias was found, with positively-stated CES-D items (e.g. "I was happy") producing higher depression scores in immigrants and subjects who preferred to speak Chinese. Diagnostic validity for major depression was assessed using the Composite International Diagnostic Interview. A CES-D cut-off score of 16 had sensitivity of 100% (95% CI: 44% to 100%), specificity of 76% (95% CI: 69% to 82%), PPV of 7% (95% CI: 3% to 19%) and NPV of 100% (95% CI: 97% to 100%). Our findings suggest that the CES-D is useful for screening out non-depressed subjects in a first-stage assessment. However, it should be followed by a diagnostic tool in Chinese American women with scores above the cut-off in order to identify those with clinical depression.

Disparities in self-reported geriatric depressive symptoms due to sociodemographic differences: an extension of the bi-factor item response theory model for use in differential item functioning

This study evaluates the measurement noninvariance, or differential item functioning (DIF), in the Center for Epidemiological Studies-Depression (CES-D) items attributable to age, sex, and race/ethnicity among community-dwelling older adults. Participants (N=2773) were from the New Haven site of the Established Populations for Epidemiologic Studies in the Elderly. Statistical analyses included exploratory factor analysis, bi-factor confirmatory factor analysis, and a bi-factor multiple indicator and multiple causes (MIMIC) model to address measurement noninvariance. Blacks, compared with whites, were more likely to endorse items loading on the interpersonal factor, which include "people dislike me" and "people are unfriendly." Women were less likely to endorse the interpersonal items and the "I felt like a failure" item (odds ratio [OR]=0.63, 95% confidence interval [CI]: 0.42, 0.94) than men. But women had a higher proportional odds than men for endorsing the "crying" item (OR=1.86, 95% CI: 1.17, 2.96). Those 75 years and older (relative to those aged 65-74) were less likely to endorse the "I felt like a failure" item (OR=0.65, 95% CI: 0.43, 0.97). However, measurement noninvariance found in both the "crying" and "failure" items were attributable to women and to those aged 75 and older were trivial after controlling for the underlying level of depressive symptomatology. Therefore, the interpersonal items showed measurement noninvariance attributable to sex and race. The bi-factor MIMIC model is useful for examining measurement noninvariance due to sociodemographics in a multidimensional depression instrument.

Confirmatory factor structure of the Center for Epidemiologic Studies-Depression scale (CES-D) in mild-to-moderate traumatic brain injury

PRIMARY OBJECTIVE

The Center for Epidemiologic Studies Depression scale (CES-D) is a frequently-used self-report measure of depressive symptom severity. Brief depression screening measures can be important in the identification and prediction of depression following traumatic brain injury. The objective of this study was to investigate the validity of the CES-D in measuring depressive symptoms in patients with mild-to-moderate TBI as it has been rarely used in neurologically compromised populations.

RESEARCH DESIGN

Inception cohort.

METHODS AND PROCEDURES

The CES-D was administered to 340 participants with mild-to-moderate TBI at 3-months post-injury.

MAIN OUTCOMES AND RESULTS

Confirmatory factor analysis of the CES-D indicated that the data are a reasonable fit similar to that of Radloff 's original 4-factor model.

CONCLUSIONS

These findings suggest that the CES-D may be appropriate for use in patients with mild-to-moderate TBI.

Prospects for the classification of mental disorders in women

Many mental disorders show marked gender differences as regards prevalence, symptomatology, risk factors or course. Other disorders do per definition only occur in women - e.g. premenstrual dysphoric disorder (PMDD) - or are markedly influenced by female specific factors such as hormonal changes over the life cycle or during reproductive processes. Current classification systems have tried to take into account these gender aspects, but some problems will certainly have to be discussed again with the next revisions of the ICD and DSM. As regards gender differences in prevalence and symptomatology questions of gender bias in diagnostic instruments and diagnostic criteria will have to be readdressed. New findings from unselected epidemiological samples, which were analysed by gender, will have to be taken into account as well as new findings from research into gender specific personality traits, which can influence the symptomatology of mental disorders. Decisions will have to be taken whether to revise existing diagnostic criteria and provide alternative diagnostic thresholds for men and women or even to develop alternative criteria sets in certain disorders, or rather to enhance the gender neutrality of criteria. A further question to be addressed will be that of gender specific diagnoses versus diagnostic specifiers. In the whole discussion two main aims of classification should be given priority: the research aim of identifying genuine entities with a common aetiology, which means we should be able to identify specific diagnostic entities with descriptive, construct, and predictive validity quite independently of the influences of gender; and the clinical aim to improve treatment and care for men and women, which often means to offer gender-specific approaches.

Measurement equivalence of the CES-D 8 in the general population in Belgium: a gender perspective

International research consistently finds gender differences in depression, but do women genuinely experience more complaints or are the findings contaminated by group-specific elements unrelated to depression but affecting its measurement? The study of gender differences in depression depends on the measurement quality of the instrument used to evaluate depression. In the present study we test the measurement equivalence of a shorter version of a commonly used instrument in mental health research, the Center for Epidemiologic Studies - Depression Scale (CES-D), using data from the Belgian sample of the third round of the European Social Survey (N = 1794). Evidence for measurement invariance can be established within the multigroup confirmatory factor analysis framework. This method allows us to evaluate a nested hierarchy of hypotheses to test different levels of cross-group measurement invariance: configural, metric, scalar and residual invariance, and clarifies under what conditions meaningful comparisons between the male and female respondents can be made. The best fitting factor model is then used to estimate the 'true' prevalence of depressive symptoms for both groups. In our study measurement equivalence is established at all levels, indicating that the current depression scale allows defensible quantitative gender comparisons. Our data also confirm the epidemiological finding that women report more complaints of depression than men.

Measurement differences in depression: chronic health-related and sociodemographic effects in older Americans

OBJECTIVE

To evaluate the influence of five chronic health conditions (high blood pressure, heart conditions, stroke, diabetes, and lung diseases) and four sociodemographic characteristics (age, gender, education, and race/ethnicity) on the endorsement patterns of depressive symptoms in a sample of community-dwelling older adults.

METHOD

Participants were adults aged >or=65 years from the 2004 Health and Retirement Study (n = 9448). Depressive symptoms were measured with a nine-item Center for Epidemiologic Studies-Depression scale. Measurement differences attributable to health and sociodemographic factors were assessed with a multidimensional model based on item response theory.

RESULTS

Evidence for unidimensionality was equivocal. We used a bifactor model to express symptom endorsement patterns as resulting from a general factor and three specific factors ("dysphoria," "psychosomatic," and "lack of positive affect"). Even after controlling for the effects of health on the psychosomatic factor, heart conditions, stroke, diabetes, and lung diseases had significant positive effects on the general factor. Significant effects due to gender and educational levels were observed on the "lack of positive affect" factor. Older adults self-identifying as Latinos had higher levels of general depression. On the symptom level, meaningful measurement noninvariance due to race/ethnic differences were found in the following five items: depressed, effort, energy, happy, and enjoy life.

CONCLUSIONS

The increased tendency to endorse depressive symptoms among persons with specific health conditions is, in part, explained by specific associations among symptoms belonging to the psychosomatic domain. Differences attributable to the effects of health conditions may reflect distinct phenomenological features of depression. The bifactor model serves as a vehicle for testing such hypotheses.

Factor structure of the 10-item CES-D scale among community dwelling older adults in Singapore

OBJECTIVE

To establish the factor structure, reliability and validity of a brief CESD scale among Community dwelling older adults in Singapore.

METHOD

Data were derived from interviews conducted among 1,013 randomly selected non-institutionalized older adults aged 65 years and above in Singapore. First, Confirmatory Factor Analysis (CFA) was conducted to test three factors in the entire sample: a one-factor model, a two-factor model (Depressed affect, Positive affect) and a three-factor model (Depressed affect, Somatic retardation, and Positive affect). Next, Multi-Group Analysis was conducted to test the scale invariance for male and female older adults.

RESULTS

Findings supported a two-factor model--depressed affect and positive affect for the entire sample. In addition, multi-group analysis showed the two-factor structure to be invariant for male and female older adults.

CONCLUSION

Brief CESD demonstrates adequate reliability and validity. The CESD scores can be used to compare symptoms of depression between male and female older adults.