The effect of gender and race on the measurement properties of the CES-D in older adults

Christopher Callahan, Fredric D. Wolinsky

Research output: Contribution to journalArticle

161 Citations (Scopus)

Abstract

Having observed a three-fold difference in the prevalence of significant symptoms of depression among four race-gender groups of elderly adults attending an urban primary care practice, we investigated the extent to which these differences might be explained by variability in the measurement properties of the Centers for Epidemiologic Studies depression scale (CES-D). Although the internal consistency of the CES-D was acceptable for all groups, 5% of our patients were excluded for inability to complete the minimum required number of CES-D items, and nearly 40% of patients required response imputation for the allowable one to four items that they could not answer. Imputation was most frequently required for items tapping positive affect. Principal components factor analysis was performed separately for respondents answering all items and for respondents with imputed values. In both analyses we found important race-gender differences in factor structure. Moreover, the factor structure for those with imputed values was markedly different from that of respondents answering all items, including a dissolution of the positive affect dimension. Neither the race-gender differences in factor structure nor the differences among those with and without imputed data were resolved by eliminating respondents with poor education, cognitive impairment, or alcoholism, or by varying the assumptions for data imputation. However, the disparities in factor structure were essentially resolved by eliminating five CES-D items, suggesting the need to modify the CES-D in populations like ours. Although eliminating these five items results in a more pure factor structure, it does not resolve the differences in prevalence of depressive symptoms. These differences may, however, be partially due to differential response tendencies among the race-gender groups.

Original languageEnglish
Pages (from-to)341-356
Number of pages16
JournalMedical Care
Volume32
Issue number4
StatePublished - 1994

Fingerprint

Epidemiologic Studies
Depression
gender
gender-specific factors
Group
alcoholism
Principal Component Analysis
Values
factor analysis
Alcoholism
Statistical Factor Analysis
Primary Health Care
Education
Surveys and Questionnaires
education
Population

Keywords

  • Aged
  • Depression
  • Psychiatric status rating scales

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health
  • Nursing(all)
  • Health(social science)
  • Health Professions(all)

Cite this

The effect of gender and race on the measurement properties of the CES-D in older adults. / Callahan, Christopher; Wolinsky, Fredric D.

In: Medical Care, Vol. 32, No. 4, 1994, p. 341-356.

Research output: Contribution to journalArticle

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