Factor structure of the CES-D and measurement invariance across gender for low-income Puerto Ricans in a probability sample.

Objective: The authors of this study aimed to evaluate 2-factor structures for the Center for Epidemiologic Studies Depression Scale (CES-D) reported in the literature to determine which one proves to be a better fit with the data on low-income Puerto Ricans living on the island. Method: The sample consisted of 3,504 civilian noninstitutionalized Puerto Ricans, ranging in age from 18 to 64 who were living in low-income areas of Puerto Rico. A confirmatory factor analysis (CFA) was implemented, and model fit was assessed with the Tucker–Lewis Index (TLI), the comparative fit index (CFI), and the root-mean-square error of approximation (RMSEA). Results: The CFA results obtained for the Radloff (1977) and Guarnaccia, Angel, and Worobey (1989) models show that neither model obtained adequate fit indexes. Exploratory factor analysis revealed that the 2-factor structure not only obtained better fit indexes (TLI = .948, CFI = .955, RMSEA = .048) but also reflected a better conceptual organization of the factors (basically divided into 2 components: Negative Affect and Positive Affect). When we assessed the model fit by gender, the model consistently fit the data for the female subsample but not for the male one. Conclusions: Results confirm the need to address the issues related to measurement equivalence for specific cultural and language gaps in assessment of depressive symptoms. Lack of factor invariance across gender also raises the question of the appropriateness of this measure for the male subsample and the need for further research in the manifestation of depression in this group. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Relationship between age and aspects of depression: Consistency and reliability across two longitudinal studies.

In this study, the authors examined cross-sectional and longitudinal age and gender differences in each of the Center for Epidemiological Studies Depression Scale's 4 subscales of depressive symptomatology. Two independent studies (Sample 1 = 2,076; Sample 2 = 943) were used for purposes of establishing stability of findings. Results indicate a reasonable degree of stability among adults under 70 years of age. However, there were significant age-related increases in somatic symptoms and lack of well-being after approximately 70 years of age, whereas symptoms related to depressed affect and interpersonal problems remained stable. Notably, depressive affect symptoms remained stable given significant age-related somatic changes. The addition of comorbid physical illness to the analysis did not reduce the association between age and depressive symptoms, indicating that part of the association was not substantially accounted for by physical health. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Utility of telephone assessments in an older adult population.

Telephone assessments are commonly used in mental health research and may be especially beneficial in older populations. The current study assessed the psychometric properties of the Penn State Worry Questionnaire (T. J. Meyer, M. L. Miller, R. L. Metzger, & T. D. Borkovec, 1990) and the Beck Depression Inventory--II (A. T. Beck, R. A. Steer, & G. K. Brown, 1996), when administered over the telephone in an older adult population. Results indicate no differences in mean symptom level or internal consistency across two modes of administration. Correlations between the in-person and telephone-administered measures and diagnostic categories suggest adequate validity of the telephone-administered measures. With this demonstrated evidence, the telephone assessment method can be applied in a variety of research and clinical settings. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Development and Validation of a Rasch-Derived CES-D Short Form.

The current study presents a Rasch-derived short form of the Center for Epidemiologic Studies-Depression scale (CES-D) for use as a depression screening tool in the general population. In contrast to short forms developed with reliance on classical measurement techniques, those developed using techniques based on item response theory produce a measure that offers true interval scaling, provide enhanced information about responders with extreme scores, and expand understanding of the underlying latent structure. Cross-validation of the Rasch-derived CES-D short form supported its utility and structural validity across samples. Tests of structural validity using latent variable modeling methodology indicated that a hierarchical, single-factor model of depression had the best fit for the original full form and the Rasch-derived short form of the CES-D. This finding challenges depression researchers and theorists to reconsider the interfactor relationships in the study and assessment of depression. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Treatment of depression in low-income older adults.

The purpose of this study was to compare cognitive-behavioral group therapy (CBGT), clinical case management (CCM), and their combination (CBGT + CCM) to treat depression in low-income older adults (60+). Sixty-seven participants with major depressive disorder or dysthymia were randomly assigned and entered into 1 of the 3 treatment conditions for 6 months. They were followed for 18 months after treatment initiation on depression and functional outcomes. CCM and CBGT + CCM led to greater improvements in depressive symptoms than CBGT, but CBGT led to greater improvements in physical functioning. All 3 conditions resulted in similar reduction of needs. Findings suggest that disadvantaged older adults with depression benefit from increased access to social services either alone or combined with psychotherapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychometric properties of the Beck Depression Inventory for Youth in a sample of girls.

A new measure has been developed to assess depressive symptoms, the Beck Depression Inventory for Youth (BDI-Y; J. S. Beck, A. T. Beck, & J. B. Jolly, 2001). This research extends previous validation research of BDI-Y total scores by examining internal consistency and convergent and predictive validity within a school-based sample (n = 859) of girls 9-13 years old by age level and for selected races or ethnic groups. Scores had high internal consistency, and there was support for using the BDI-Y to assess depressive symptoms. Reliability was slightly lower for 9-year-olds, but reliability and validity estimates did not differ by race or ethnic group. Finally, confirmatory factor analysis results provide some support for unidimensionality of scores but also point toward possible refinements. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Assessment of depression in aging contexts: General considerations when working with older adults.

Popular assertions portray depression as an inevitable outcome of aging, a widespread image embraced by many health professionals. Although epidemiological data contradict the prevalent image that depressive syndromes increase with age, the prognosis becomes more negative as one grows older. An early thorough assessment is vital to identify depressive symptoms in older adults, thus promoting the development of tailored interventions and improved recovery rates. The main problems associated with the assessment of depressive symptoms in older adults include a lack of knowledge about changes in the pattern of symptoms, the inadequacy of techniques developed for other age cohorts, the misuse of psychometric instruments, and deficits in additional areas of assessment. The underlying goal of this article is to analyze the obstacles to a successful assessment of depression symptoms in older adults, suggesting strategies to overcome them. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Assessing worry in older adults: Confirmatory factor analysis of the Penn State Worry Questionnaire and psychometric properties of an abbreviated model.

The assessment of worry among older adults typically has involved measures designed with younger cohorts. Because of special concerns in assessing older adults, modifications to existing instruments may be necessary. Addressing equivocal factor analytic data on the Penn State Worry Questionnaire (PSWQ) among younger adults, the authors conducted confirmatory factor analyses to evaluate the generalizability of previous models to older adults with generalized anxiety disorder. Data fit poorly with established single- and two-factor models. The single-factor model was modified, resulting in the elimination of 8 items, strong fit indices, high internal consistency, adequate test-retest reliability, and good convergent and divergent validity. Further psychometric work is required to assess whether the revised model is a more parsimonious method to assess late-life anxiety. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Measurement Equivalence of the Center for Epidemiological Studies Depression Scale for Latino and Anglo Adolescents: A National Study.

The cross-ethnic measurement equivalence of the Center for Epidemiologic Studies Depression Scale (CES-D; L. S. Radloff, 1977) was examined using a subsample of adolescents (N=10,691) from the National Longitudinal Study of Adolescent Health. Configural and metric invariance, as well as functional and scalar equivalence, were examined for Anglo American, Mexican American, Cuban American, and Puerto Rican American youths age 12-18 years. Confirmatory factor analysis (CFA) in each group provided evidence of configural invariance for European and Mexican American adolescents but not for Cuban and Puerto Rican youths. A 2-group CFA for Anglo and Mexican Americans demonstrated partial metric invariance for these groups. Multigroup structural equation modeling indicated similar relations between CES-D scores and self-esteem for all 4 groups, supporting cross-ethnic functional and scalar equivalence. The results have implications for using the CES-D in cross-ethnic research and, more broadly, for the assessment and treatment of depression in Latinos. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychometric Properties of the Spanish Beck Depression Inventory-II in a Medical Sample.

The authors examined the psychometric properties of the Spanish Beck Depression Inventory-II (BDI-II; A. T. Beck, R. A. Steer, & G. K. Brown, 1996) in a sample of individuals undergoing hemodialysis. They performed a confirmatory factor analysis of a previously reported 2 factor solution for the English BDI-II derived from a medical sample. Results indicate that the established model for the English-speaking medical sample provided adequate fit in the present sample. Spanish BDI-II scores were not significantly associated with age or gender in their sample, but they were significantly associated with disease severity. Bilingual participants completed the inventory in both Spanish and English, and their data revealed that BDI-II total scores were similar across language administration. The preliminary data suggest that the Spanish BDIII can be reliably used in medical samples. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The association of anxiety and depressive symptoms with cognitive performance in community-dwelling older adults.

The authors examined the association of anxiety, depressive symptoms, and their co-occurrence on cognitive processes in 102 community-dwelling older adults. Participants completed anxiety and depression questionnaires as well as measures of episodic and semantic memory, word fluency, processing speed/shifting attention, and inhibition. Participants with only increased anxiety had poorer processing speed/shifting attention and inhibition, but depressive symptoms alone were not associated with any cognitive deficits. Although coexisting anxiety and depressive symptoms were associated with deficits in 3 cognitive domains, reductions in inhibition were solely attributed to anxiety. Findings suggest an excess cognitive load on inhibitory ability in normal older adults reporting mild anxiety. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The composition and structure of depressive symptomatology in renal disease.

Renal disease is an increasingly common illness among middle-aged and older adults, and is often associated with depression. The Center for Epidemiologic Studies Depression Scale (CES–D) is a widely used self-report screening measure on which responses generally conform to a 4-factor structure, with each factor loading onto a higher-order Depression factor. The current study examines whether this structure is supported among individuals with renal disease (both predialysis and posttransplant kidney disease patients). Persons with renal disease (n = 225) and healthy control participants (n = 230) were recruited from Vancouver General Hospital and the community. Participants completed the CES–D as part of an extended assessment. Confirmatory factor analytic models were computed for the renal disease and healthy control groups. Results support a 4-factor structure for CES–D responses in persons with renal disease and healthy controls. The hierarchical structure of CES–D responses also appears invariant between groups. Factor structure was similar between groups; only for Depressive Affect was the strength of association with the second-order factor greater among the renal disease than healthy control participants. Findings support similarity of CES–D factor structures between patients with renal disease and healthy individuals. Results suggest that the CES–D's 4 factors contribute to measurement of a higher-order Depression factor in both groups; furthermore, 3 of 4 factors appear invariant between groups. As such, this measure can be used confidently to quantify depressive symptoms in individuals with renal disease. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

The treatment of depression in older adults in the primary care setting: An evidence-based review.

The objective of this study was to conduct an evidence-based review of treatments for depression in older adults in the primary care setting. A literature search was conducted using PsycINFO and Medline to identify relevant, English language studies published from January 1994 to April 2004 with samples aged 55 and older. Studies were required to be randomized controlled trials that compared psychosocial interventions conducted within the primary care setting with "usual care" conditions. Eight studies with older adult samples met inclusion criteria and were included in the review. Two treatment models were evident: Geriatric Evaluation Management (GEM) clinics and an approach labeled integrated health care models. Support was found for each model, with improvement in depressive symptoms and better outcomes than usual care; however, findings varied by depression severity, and interventions were difficult to compare. Further efforts to improve research and clinical care of depression in the primary care setting for older adults are needed. The authors recommend the use of interdisciplinary teams and more implementation of psychosocial treatments shown to be effective for older adults. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Improving quality of life in diverse rural older adults: A randomized trial of a psychological treatment.

The efficacy of home-delivered cognitive-behavioral therapy (CBT) in improving quality of life and reducing psychological symptoms in older adults was examined in this study. One hundred thirty-four participants, predominately African American and characterized as primarily rural, low resource, and physically frail, were randomly assigned to either CBT or a minimal support control condition. Results indicate that CBT participants evidenced significantly greater improvements in quality of life and reductions in psychological symptoms. Mediation of treatment through cognitive and behavioral variables was not found despite the acceptable delivery of CBT by research therapists. These data suggest that treatment can be effective with a disadvantaged sample of older adults and extend efficacy findings to quality of life domains. Creating access to evidence-based treatments through nontraditional delivery is an important continuing goal for geriatric health care. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Maintenance of quality of life improvements in diverse rural older adults.

The maintenance of effects from home-delivered cognitive-behavioral therapy (CBT) was examined. One hundred thirty-four participants, predominantly African American and primarily rural, low-resource, and physically frail, were randomly assigned to either immediate or delayed CBT. The six-month follow-up assessments indicated that among those who remained in the study, participants evidenced significantly improved quality of life and reductions in psychological symptoms at follow-up, relative to pretreatment levels. Posttreatment gains were maintained at follow-up. These data suggest that treatment effects can be achieved and perhaps maintained with a disadvantaged sample of older adults and suggest that evidence-based treatments delivered through nontraditional means can have effects beyond posttreatment. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Predictors of working with older adults in an Australian psychologist sample: Revisiting the influence of contact.

Despite increasing numbers of older people in most global populations and increasing evidence of the efficacy of psychological therapy in older clinical populations, few psychologists work with older clients as compared with other clinical groups. In the present research, the authors examine potential influences on psychologists choosing to specialize in working in the field of aging. The authors surveyed 1,498 psychologists Australia-wide to examine which factors exerted the most influence on choosing to specialize in clinical work with older clients. Clinical exposure to older clients and age-related course content within training programs, together with further education external to formal training, were significantly correlated with specializing in aged care. Holding a more negative attitude toward one's own aging was another predictor of specialist category membership, with interest in working with older clients also being a significant factor based on direct logistic regression analysis. In contrast to previous work, amount or quality of contact with older persons did not appear to relate to working with older adults. These findings highlight the importance of quality training experiences in influencing attitudes toward working with older adults. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Development of a shortened center for epidemiological studies depression scale for assessment of depression in rheumatoid arthritis.

Objective: The purpose was to develop a short-form version of the Center for Epidemiologic Studies Depression Scale (CES-D) for the identification of persons with major depressive disorder (MDD) within a population with rheumatoid arthritis (RA). Study Design: Data were analyzed from 337 persons with RA. Forty-six participants met the diagnostic criteria for MDD; 291 participants were classified in the non-MDD category (including 21 participants with dysthymia and 18 participants with minor depressive disorder). A short-form version of the CES-D was developed, and multiple cutoff scores were examined. Results: A cutoff score of ≥5 from a 9-item, short-form CES-D was found to be generally as efficient as the more commonly used full-scale cutoff score of ≥16 for classifying participants with MDD within an RA population. Although the shortened CES-D scale (cutoff score ≥5) was slightly more sensitive, it also exhibited slightly less specificity than the full-scale cutoff score of ≥16. Conclusion: The results suggest that a short-form CES-D can be used to screen for MDD within an RA sample with a degree of efficiency that is generally comparable to that of the full-scale instrument. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Influences on the efficiency of prospective memory in younger and older adults.

The influence of 4 factors on age-related declines in prospective memory (PM) was considered in 2 experiments. The results of the experiments reveal that age-related differences in PM were not moderated by the degree of match between the nature of processing required in the ongoing activity and the defining features of the PM cue. Age-related differences in the accuracy of PM responses were primarily attributable to an increase in the number of omission errors committed by older adults. Age-related differences in PM were somewhat independent of the ability to recall the PM cues and intentions following task performance and were mediated by the cognitive resources of processing speed, inhibitory control, and working memory. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Depression as a predictor of perceived social support and demand: A componential approach using a prospective sample of older adults.

This study examined the relationship of the cognitive, mood, and somatic components of depression on perceptions of social support and social demand among older adults (n = 851) over two years. Factor-analyses confirmed the factor structure of our multicomponential model of depression. Results supported our proposal that interpersonal specificity, as measured by depressive cognition about self and others, is important to predicting changes in perceived support and demand over time. Each component of depression was related to social support and social demand cross-sectionally, whereas only the cognitive component of depression predicted changes in support and demand prospectively. Future research should consider the pathways linking depressive cognition to perceived support and demand. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

An investigation of the measurement properties of the Spot-the-Word test in a community sample.

Intellectual ability is assessed with the Spot-the-Word (STW) test (A. Baddeley, H. Emslie, & I. Nimmo Smith, 1993) by asking respondents to identify a word in a word-nonword item pair. Results in moderate-sized samples suggest this ability is resistant to decline due to dementia. The authors used a 3-parameter item response theory model to investigate the measurement properties of the STW in a large community-dwelling sample (n=2,480) 60 to 64 years of age. A number of poorly performing items were identified. Substantial guessing was present; however, the number of words correctly identified was found to be an accurate index of ability. Performance was moderately related to a number of tests of cognitive performance and was effectively unrelated to visual acuity and to physical or mental health status. The STW is a promising test of ability that, in the future, may be refined by the deletion or replacement of poorly functioning items. (PsycINFO Database Record (c) 2010 APA, all rights reserved)