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Validity of the Center for Epidemiological Studies Depression Scale in arthritis populations
S J Blalock1, R F DeVellis, G K Brown
1Rehabilitation Program Office, School of Medicine, University of North Carolina, Chapel Hill 27599-7200.
Insights
Certain items on the Center for Epidemiological Studies Depression Scale (CES-D) may reflect rheumatoid arthritis symptoms, not depression. This suggests the CES-D might slightly overestimate depression in arthritis patients.
Area of Science:
- Rheumatology
- Psychiatry
- Epidemiology
Background:
- Rheumatoid arthritis (RA) significantly impacts patients' quality of life.
- Assessing depression in RA patients is crucial for comprehensive care.
- The Center for Epidemiological Studies Depression Scale (CES-D) is commonly used but may be influenced by non-depressive symptoms.
Purpose of the Study:
- To investigate if RA disease processes affect responses to CES-D items.
- To determine the impact of these influenced items on depression prevalence and determinant studies in RA.
Main Methods:
- Analysis of data from three distinct patient studies.
- Examination of specific CES-D items for potential influence by RA symptoms.
- Assessment of the effect of four identified items on depression prevalence and determinant estimations.
Main Results:
- Four CES-D items may be influenced by RA disease activity rather than depression.
- The original CES-D may slightly overestimate depression prevalence and severity in RA patients.
- Excluding these four items is unlikely to alter findings in studies identifying depression determinants in RA.
Conclusions:
- The CES-D may not be a perfectly specific measure for depression in RA populations.
- While a modest bias exists, the overall impact on understanding depression determinants in RA is minimal.
- Further research may refine depression assessment tools for chronic inflammatory conditions.
Abstract:
Using data from 3 studies of patients with rheumatoid arthritis, we examined the extent to which responses to items in the Center for Epidemiological Studies Depression Scale (CES-D) are influenced by aspects of the disease process other than depression. Our findings suggested that 4 CES-D items (i.e., "I felt that everything I did was an effort," "I felt hopeful about the future," "My sleep was restless," and "I could not get going") may be influenced by aspects of the disease process and, thus, are not necessarily indicative of depression among persons with arthritis. The impact that these items have on the interpretation of CES-D scores was assessed in relation to 2 research issues: estimation of the prevalence and severity of depression in arthritis populations and identification of the determinants of depression among individuals with arthritis. Our results suggest that the original CES-D may overestimate the prevalence and severity of depression among patients with arthritis. The magnitude of this bias is modest, however. The results also suggest that in studies designed to identify the determinants of depression among individuals with arthritis, inclusion of the 4 items identified is unlikely to have any effect on study findings.