Course of Depressive Symptoms in Patients Undergoing Heart Surgery: Confirmatory Analysis of the Factor Pattern and Latent Mean Structure of the Center for Epidemiologic Studies Depression Scale

Objective: The purpose of this study was to examine the dimensionality, stability, and course of depressive symptoms over the 12-month period beginning approximately 1 week before heart surgery. Methods: The Center for Epidemiological Studies Depression Scale (CES-D) was administered to 570 patients before heart surgery and 1, 3.5, 6.5, and 12.5 months later. Results: Confirmatory factor analysis rejected a four-factor model as a result of small variances for two interpersonal items. With their elimination, a three-factor solution (negative affect, low positive affect, somatic/vegetative symptoms) showed good psychometric properties. Except for the somatic/vegetative factor at the 1-month follow up, there was a high degree of stability in the factor pattern over a 12-month period beginning approximately 1 week before heart surgery. Latent mean structure analysis indicated that, apart from elevations in several somatic/vegetative symptoms during the month after surgery, means for all three depressive symptoms declined over time. The recovery of positive affect showed a steeper trajectory toward the end of the follow-up period by comparison with the rates of decline for depressed affect and somatic/vegetative symptoms. Conclusions: These findings support using 18 CES-D items to measure three depressive symptom dimensions in heart patients and may reflect a normative pattern of adjustment to heart surgery. CES-D = Center for Epidemiological Studies Depression Scale; CABG = coronary artery bypass graft surgery; CHD = coronary heart disease; MI = myocardial infarction; CFA = confirmatory factor analysis; RWJUH = Robert Wood Johnson University Hospital; UMDNJ = University of Medicine and Dentistry of New Jersey; EM = expectation maximization; MAR = missing at random; DA = depressed affect; PA = positive affect; S/V = somatic/vegetative; RMSEA = root mean square error of approximation; CI = confidence interval; CFI = comparative fit index.