Validity of the center for epidemiological studies depression scale in arthritis populations

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.

What Is the Relationship Between Depressive Symptoms and Pain During Functional Tasks in Persons Undergoing TKA? A 6-year Perioperative Cohort Study

“…The CES-D is a 20-item validated scale with a score range from 0 to 60 with a score of 16 or higher generally accepted as the cut score indicating probable clinical depression [3,9,11,19]. The CES-D is often used to study community-based, elderly persons and has recently been endorsed by Smarr and Keefer [24] for use in patients with arthritis.…”

“…Despite high surgical success rates, as many as 25% of patients report compromised postoperative functioning and persistent pain although having a stable implant [2]. Recent research has indicated that psychologically based impairments and disorders such as pain catastrophizing, anxiety, and depression increase the risk of poor patient outcomes after TKA [3]. Measures of depressive symptoms tap the underlying construct of depression, but they also capture related symptoms such as anxiety and general emotional distress, which may manifest as difficulty sleeping, poor concentration, and negative feelings in patients.…”

Association of tumor necrosis factor α polymorphism, but not the shared epitope, with increased radiographic progression in a seropositive rheumatoid arthritis inception cohort

“…On these questionnaires, patients reported changes in demographic data, health, medications, pain levels (100-mm VAS), global assessment of disease activity (100-mm VAS), the Disability Index (DI) of the Health Assessment Questionnaire (HAQ) (46), and the Center for Epidemiologic Studies Depression scale (CES-D) (47).…”

Assessment of depression in rheumatoid arthritis: A modified version of the center for epidemiologic studies depression scale

“…Given the unique features of RA, items included on this shortened scale may not discriminate well between individuals with and without MDD who also have RA. Prior research indicates that 2 of the CES-D items included on the shortened version of the scale ("I felt that everything I did was an effort" and "My sleep was restless") may be influenced by aspects of RA and thus not necessarily due to depression (3,16). These items were included in the present study because the purpose of the project was to assess the efficiency of the overall shortened scale developed by Santor and Coyne.…”

“…Thus, the commonly used CES-D cutoff scores often result in a high percentage of false positives, with numerous individuals being categorized as depressed who, in fact, do not meet the criteria for MDD. A high number of false positives may be especially problematic in populations experiencing RA because symptoms that are attributable to the condition may overlap the symptoms of MDD (3,16).…”