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.

Depression and survival outcomes after emergency department cancer pain visits

“…Previous research suggests that the CES-D may be biased when assessing individuals of racial and ethnic minorities. For example, African–Americans may be more likely to adhere to the negative interpersonal items on the CES-D 22. However, we found that although a slightly higher proportion of non-whites had CES-D scores ≥10 relative to whites (18.1% vs 21%, respectively), this finding was not statistically significant.…”

Confirmatory Factor Analysis of the 12-Item Center for Epidemiologic Studies Depression Scale among Blacks and Whites

“…Thus, our study is not the first to report psychometric limitations of the CES-D scale when applied to multiple racial groups. Previous studies warned that CES-D scale scores should be interpreted with caution in different populations, particularly when comparing scores across racial groups (59, 60). …”

East African HIV care: depression and HIV outcomes

“…We note recent analyses of depression in HIV-infected populations that question the validity of the CESD when used with heterogeneous samples of diverse genders (including transgender) and racial groups ( n = 347) (Gay et al ., 2016 ). Given the larger sample size and greater homogeneity in this East African, care-engaged study population, we believe the results to be a valid indication of the associations among depression, HIV viral load and cognition.…”