Validity of the Center for Epidemiological Studies Depression scale in Type 2 diabetes
Section snippets
Background
Depressive symptoms are more prevalent in people with Type 2 diabetes than in the general population [1]. In Type 2 diabetes, depressive symptoms have been associated with poorer glycemic control [2], [3], the development of diabetes-related complications [4] and mortality [5], [6], [7]. Evidence suggests that treatment of depression with antidepressants can improve clinical outcomes [8], [9]; however, depression in Type 2 diabetes often goes undiagnosed [10], [11], [12] and untreated [10], [11]
Participants
This retrospective analysis included a consecutive cohort of the most recent participants to enter the Diabetes, Exercise and Healthy Lifestyle Program, an exercise-based rehabilitation program tailored for diabetes management, at the University Health Network Toronto Rehabilitation Institute [21], [22]. The University Health Network Research Ethics Board approved this study.
Measures
The CES-D [13] was given to all participants entering rehabilitation at their intake visit by clinical staff and placed
Participant characteristics
We identified 405 consecutive participants with Type 2 diabetes entering the Diabetes, Exercise and Healthy Lifestyle Program between August 2012 and September 2014. We obtained item-level CES-D data on 305 of those participants (mean age 56.9 ± 11.1 years, 44.9% male, HbA1c 0.076 ± 0.014% mmol/mol). Those who did not complete a CES-D questionnaire did not differ in gender (χ21,404 = 0.031, p = 0.860), BMI (F1,400 = 0.864, p = 0.353) or HbA1c (F1,225 = 0.002, p = 0.961) from those who completed a questionnaire,
Discussion
The 14-item, 3-factor structure of the CES-D retained construct validity in this population of relatively healthy adults with Type 2 diabetes, indicating that the scale captured the purported construct of depression. Differential item functioning was detected for one item based on HbA1c, an important diabetes characteristic, indicating stable measurement of depressive symptoms over the range of glycemic control scenarios in this population with the exception of the item (“I felt that everything
Contributors
JC, HCM, PY, BRS, PIO & WS participated in study design. JC, DM, PIO & WS collected the data.
JC, HCM & WS performed the analysis and drafted the manuscript. NH, PY, BRS, AK, JR & PIO participated in interpretation of results and critically revised the manuscript. All authors have contributed to and approved the final article.
Role of the funding source
This project was supported internally by the University Health Network Toronto Rehabilitation Institute Cardiac Rehabilitation Program which receives funding from the Ministry of Health in Ontario. The views expressed do not necessarily reflect those of the Ministry.
The University Health Network Toronto Rehabilitation Institute had no role in study design, analyses or in reporting of the data.
Conflict of interest
The authors report no pertinent conflicts of interest.
Acknowledgement
WS gratefully acknowledges support from The Department of Pharmacology & Toxicology at the University of Toronto, Sunnybrook Health Sciences Centre Department of Psychiatry, Sunnybrook Research Institute Hurvitz Brain Sciences Program, the Centre for Collaborative Drug Research, and from the Canadian Partnership for Stroke Recovery. JC gratefully acknowledges support from the University Health Network Toronto Rehabilitation Institute Cardiac Rehabilitation Program. We gratefully thank Susan
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