Psychometric Limitations of the Center for Epidemiologic Studies-Depression Scale for Assessing Depressive Symptoms among Adults with HIVAIDS: A Rasch Analysis

Abstract EN

The Center for Epidemiological Studies-Depression (CES-D) scale is a widely used measure of depressive symptoms, but its psychometric properties have not been adequately evaluated among adults with HIV/AIDS.

This study used an item response theory approach (Rasch analysis) to evaluate the CES-D’s validity and reliability in relation to key demographic and clinical variables in adults with HIV/AIDS.

A convenience sample of 347 adults with HIV/AIDS (231 males, 93 females, and 23 transgenders; age range 22–77 years) completed the CES-D.

A Rasch model application was used to analyze the CES-D’s rating scale functioning, internal scale validity, person-response validity, person-separation validity, internal consistency, differential item functioning (DIF), and differential test functioning.

CES-D scores were generally high and associated with several demographic and clinical variables.

The CES-D distinguished 3 distinct levels of depression and had acceptable internal consistency but lacked unidimensionality, five items demonstrated poor fit to the model, 15% of the respondents demonstrated poor fit, and eight items demonstrated DIF related to gender, race, or AIDS diagnosis.

Removal of misfitting items resulted in minimal improvement in the CES-D’s substantive and structural validity.

CES-D scores should be interpreted with caution in adults with HIV/AIDS, particularly when comparing scores across gender and racial groups.