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Item Bias in the Center for Epidemiologic Studies Depression Scale

Effects of Physical Disorders and Disability in an Elderly Community Sample

^a Centre for Education & Research on Ageing of the University of Sydney, at RGH Concord, Sydney, Australia
^b Mental Health Research Institute of Victoria and Department of Psychological Medicine, Monash University, Melbourne, Australia
^c Psychiatric Epidemiology Research Centre at the Australian National University, Canberra, Australia

D. A. Grayson, 14 Poplar Grove, Lawson, NSW 2783 Australia E-mail: [email protected].

Decision Editor: Toni C. Antonucci, PhD

The Center for Epidemiologic Studies Depression Scale (CES-D) is frequently used in studies of elderly individuals. One controversy regarding its use turns on the issue of whether the effect of physical disorder on the CES-D total score reflects genuine effects on depression or item-level artifacts. The present article addresses this issue using medical examination data from 506 community-dwelling individuals aged 75 or older. A form of structural equation modeling, the MIMIC model, is used, enabling the effect of a physical disorder on CES-D total score to be partitioned into bias and genuine depression components. The results show substantial physical disorder-related artifacts with the CES-D total score. Caution is required in the use of CES-D (and possibly other) depression scales in groups in which physical disorders are present, such as in elderly individuals.

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