THE EFFECT OF GENDER AND RACE ON THE MEASUREMENT PROPERTIES OF THE CES-D IN OLDER ADULTS

Having observed a three-fold difference in the prevalence of significa nt symptoms of depression among four race-gender groups of elderly adu lts attending an urban primary care practice, we investigated the exte nt to which these differences might be explained by variability in the measurement properties of the Centers for Epidemiologic Studies depre ssion scale (CES-D). Although the internal consistency of the CES-D wa s acceptable for all groups, 5% of out patients were excluded for inab ility to complete the minimum required number of CES-D items, and near ly 40% of patients required response imputation for the allowable one to four items that they could not answer. Imputation was most frequent ly required for items tapping positive affect. Principal components fa ctor analysis was performed separately for respondents answering all i tems and for respondents with imputed values. In both analyses we foun d important race-gender differences in factor structure. Moreover, the factor structure for those with imputed values was markedly different from that of respondents answering all items, including a dissolution of the positive affect dimension. Neither the race-gender differences in factor structure nor the differences among those with and without imputed data were resolved by eliminating respondents with poor educat ion, cognitive impairment, or alcoholism, or by varying the assumption s for data imputation. However, the disparities in factor structure we re essentially resolved by eliminating five CES-D items, suggesting th e need to modify the CES-D in populations like ours. Although eliminat ing these five items results in a more pure factor structure, it does not resolve the differences in prevalence of depressive symptoms. Thes e differences may, however, be partially due to differential response tendencies among the race-gender groups.