An item‐level analysis of the Center for Epidemiologic Studies Depression Scale (CES‐D) by race and ethnicity in patients with coronary artery disease

INTRODUCTION: The Center for Epidemiologic Studies Depression Scale (CES-D) is a measure of depressive symptoms that is commonly used in clinical studies. Studies employing this measure often describe variations in aggregate scores. However, few studies have examined variations in response to specific items by race and ethnicity. METHOD: This was a cross-sectional analysis among adults who were ages 50 and older and who were hospitalized for the management of coronary artery disease. Differential item functioning analysis was used to determine whether there were racial and ethnic variations in response to the items on the CES-D. RESULTS: Of the 571 participants, 76% were Caucasian, 12% were African-American, and 8% were Latino-American. After adjusting for age, gender, and education, four items exhibited differential item functioning. The odds of Latinos endorsing the item 'I was bothered by things that usually don't bother me' was 2.5 (95% CL 1.2-5.9); 2.7 (95% CL 1.4-5.1) for the item 'My sleep was restless'; 2.0 (95% CL 1.0-5.0) for the item 'I felt that I was just as good as other people'; and 2.3 (95% CL 1.3-4.5) for the item 'I enjoyed life'. The last two items were scored in reverse therefore; higher scores reflect more depressive symptoms. African-Americans were 3.0 times more likely to endorse the item 'people were unfriendly' (95% CL 1.4-6.5). CONCLUSIONS: In this study, differences in somatic, positive affective and interpersonal symptoms were associated with the higher prevalence of depressive symptoms observed among racial and ethnic minorities when compared to Caucasians.