2007, Number 5
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ABSTRACTDepression is a mental health condition with a high prevalence in the population, low rates of detection in the health system, and a significant influence in the quality of life of individuals, affecting their family and social contexts. Because of this, research focusing on the development of instruments to measure depression has been an active area of research with a growing development in the Latin American context.
In this paper, we present a brief version of the Center for Epidemiological Studies-Depression Scale (CESD-20), and analyze its psychometric properties, factorial structure, and construct validity in a sample of Spanish adult population. Our aim is to provide researchers and professionals of Spanish-speaking countries with an instrument that allows to obtain relevant information about the mental health of individuals in a reliable and efficient way.
The CESD-20 was originally designed to evaluate the severity of depressive symptomatology in adult population and has shown excellent properties among both adult and adolescent populations. The CESD evaluates depressed mood, positive affect, somatic and retarded activity and negative perception of interpersonal relationships during the last week.
There is extensive literature about the factorial structure of the original instrument. In this sense, there is a general agreement among researches about the usefulness of using a summed up score of the 20 items to reflect depressive symptomatology. This global score is used as an indicator of the individual risk of developing clinic depression rather than to classify depressed individuals. The Spanish version of the original CESD-20 has been consistently validated in different populations, but so far a brief version in this language has not been avaliable to researchers. In this study we explore the internal consistency and factorial structure of a 7-item version (CESD-7), as well as its construct validity. To analyze the construct validity of the CESD-7 we explore the relationships of the scale scores with two variables of the physiological and social context, respectively. On the one hand, we explore the relationship between health perceptions and both the original and brief versions of the CESD. On the other hand, we analyze the relationship between social integration and the two versions of the CESD.
There is extensive empirical evidence about the relationship of depression with physical health and social integration. In this sense, there is a general agreement as to the association between poor health conditions and higher levels of depression over time. Likewise, the levels of social integration have been traditionally regarded as antecedents of depression. Therefore, we expect that both the original and brief versions of the CESD would be negatively associated with physical health and social integration. Moreover, the statistical relationships among these constructs would not be different when analyzed with the original or brief versions of the CESD. This would indicate that the brief version might be used as a substitute of the long one. Method
For this study we used data from a two-wave panel design with repeated measures in a community sample of Spanish adult population. In the first panel, 1051 participants of both sexes with ages ranging from 18 to 80 years completed the questionnaires. Participants in this panel were selected from a cross-section of representative neighbourhoods from a one million metropolitan area (Valencia, Spain). Participants completed questionnaires refering to their mental health, physical health, and social integration. Age, sex, educational level, and household income of participants were also coded.
After six months, almost 75% (N = 740) of the respondents completed the same questionnaires in the second panel. Attrition analyses between respondents and drop-outs showed nonsignificant differences in socio-demographic variables. A 54% of the respondents were women. The mean age was 39 years. Average educational level was high school (full-time education until 18 years) and average household income was 21500 euros (26000 US dollars, approximately).
Original version of the CESD (CESD-20). The original Spanish version of the CESD-20 used in this paper was adapted by the authors in previous works. Previous research with the CESD-20 scores of the translated version showed a high degree of internal consistency and construct validity.
Brief version of the CESD (CESD-7). Based on the available literature, we selected seven items that showed the highest validity to classify cases of depression. Items for the revised measure included dysphoric mood (items 3, 6, and 18), motivation (item 7), concentration (item 5), loss of pleasure (item 16), and poor sleep (item 11 ).
As indicated above, we also measured health perceptions and social integration to further analyze the construct validity of this brief scale. Two instruments were selected:
Health Perception. We used the General Health Perception Questionaire developed by Davies and Ware to obtain information about the health status as appraised by the individual. The GHPQ includes 29 items with five category responses ranging from totally disagree to totally agree (e. g., “My health condition is excellent”) that provides a global score with higher scores indicating better health perceptions.
Social Integration. To measure social integration we used the Social Integration in the Community Scale. This is a five-item scale that measures the sense of belonging and/or identification to a community or neighbourhood (e.g., “I feel identified with my community”). A higher score represents a higher level of social integration.
Results showed that the CESD-7 can be described as undidimensional and that this one-factor structure remains mostly invariant after six months. Internal consistency was adequate (α´s ≥ .82) in both panels. As for the validity of the brief version, we estimated several regression models for both the CESD-20 and CESD-7 as dependent variables. Predictors in these equations were: previous levels of depression, socio-demographic variables, physical health and social integration. Results showed a moderate relationship between measures of depression across time (CESD-20, Β = 0.12, p ‹ .001; CESD-7, Β = 0.13, p ‹ .001), and also that the CESD-20 and CESD-7 scores in panel two were significantly associated with sex, social integration, and physical health almost with the same strength for both versions. Also, non-significant associations were found for age, educational level, and household income for both versions. These results suggested that using the CESD-7 instead of the CESD-20 did not substantially change the results of linear regression models.
The results of this study indicate that the brief version of the CESD (CESD-7) has an adequate reliability and validity and that this brief measure is virtually equivalent to the original version (CESD-20) when used as a dependent variable in several linear regression models. Thus, both the original and brief versions scores were negatively and significantly associated with previous levels of good health conditions (perceived health) and social integration even after controlling for previous levels of depression in panel 1. There is extensive research showing that women report more depressive symptomatology than men. Also, physical health has been related with depression. Regarding social integration, there is also a vast array of empirical evidence relating it to the mental health of the individual. In our study, we found these expected associations both for the original CESD-20 and the brief version (CESD-7). According to the results obtained in this study, we encourage researchers to use this brief measure of depression when survey space is limited or a fast and reliable measure of depression is needed.
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