Course of Depressive Symptoms in Patients Undergoing Heart Surgery: Confirmatory Analysis of the Factor Pattern and Latent Mean Structure of the Center for Epidemiologic Studies Depression Scale

Abstract

Objective: The purpose of this study was to examine the dimensionality, stability, and course of depressive symptoms over the 12-month period beginning approximately 1 week before heart surgery. Methods: The Center for Epidemiological Studies Depression Scale (CES-D) was administered to 570 patients before heart surgery and 1, 3.5, 6.5, and 12.5 months later. Results: Confirmatory factor analysis rejected a four-factor model as a result of small variances for two interpersonal items. With their elimination, a three-factor solution (negative affect, low positive affect, somatic/vegetative symptoms) showed good psychometric properties. Except for the somatic/vegetative factor at the 1-month follow up, there was a high degree of stability in the factor pattern over a 12-month period beginning approximately 1 week before heart surgery. Latent mean structure analysis indicated that, apart from elevations in several somatic/vegetative symptoms during the month after surgery, means for all three depressive symptoms declined over time. The recovery of positive affect showed a steeper trajectory toward the end of the follow-up period by comparison with the rates of decline for depressed affect and somatic/vegetative symptoms. Conclusions: These findings support using 18 CES-D items to measure three depressive symptom dimensions in heart patients and may reflect a normative pattern of adjustment to heart surgery. Key words: Center for Epidemiologic Studies Depression Scale, depressive symptoms, coronary artery bypass graft surgery, valve surgery, confirmatory factor analysis, latent mean structure analysis. CES-D ϭ Center for Epidemiological Studies Depression Scale;CABG ϭ coronary artery bypass graft surgery; CHD ϭ coronary heart disease; MI ϭ myocardial infarction; CFA ϭ confirmatory factor analysis; RWJUH ϭ Robert Wood Johnson University Hospital; UMDNJ ϭ University of Medicine and Dentistry of New Jersey; EM ϭ expectation maximization; MAR ϭ missing at random; DA ϭ depressed affect; PA ϭ positive affect; S/V ϭ somatic/ vegetative; RMSEA ϭ root mean square error of approximation; CI ϭ confidence interval; CFI ϭ comparative fit index.

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