Elsevier

Journal of Psychosomatic Research

Volume 90, November 2016, Pages 91-97
Journal of Psychosomatic Research

Validity of the Center for Epidemiological Studies Depression scale in Type 2 diabetes

https://doi.org/10.1016/j.jpsychores.2016.09.013Get rights and content

Abstract

Objective

Depressive symptoms are common among people with Type 2 diabetes mellitus (T2DM). This study aimed to validate the 3-factor structure of the 14-item Center for Epidemiological Studies Depression (CES-D) scale proposed by Carleton et al. (2013) in a T2DM population.

Methods

The CES-D was administered to consecutive patients with T2DM entering a rehabilitation program. Construct validity was assessed using confirmatory factor analysis. Subscale viability, differential item functioning, and associations with clinical characteristics were tested in bifactor models.

Results

Among adults with T2DM (n = 305, age 56.9 ± 11.1, 44.9% male, duration of diabetes 7.8 ± 7.9 years, HbA1c 0.076 ± 0.014%), the construct validity of Carleton's 3-factor solution (negative affective, positive affective and somatic symptoms) was confirmed, although negative affective and somatic symptoms were highly correlated (r = 0.926). The CES-D items can be summed to arrive at a total score (ωH = 0.869), but not subscale scores (ωS > 0.7). Differential item functioning was not found based on age or body mass index (BMI), but Item 1 (“I was bothered by things that don't usually bother me”) was inflated in women and Item 7 (“I felt that everything I did was an effort”) was inflated in those with higher glycosylated haemoglobin (HbA1c). The general depression factor decreased with age (β =  0.247, p < 0.001) and increased with BMI (β = 0.102, p = 0.041) but not HbA1c = 0.065, p = 0.461). Negative affective symptoms (β = 0.743, p = 0.001), but not other depressive symptoms, were higher in women.

Conclusions

The 14-item CES-D retained construct validity in adults with T2DM. Depressive symptoms were associated with younger age, female gender and BMI, but not with glycemic control.

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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