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Factorial and discriminant validity of the Center for Epidemiological Studies Depression (CES-D) scale

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John G. Orme at University of Tennessee
John G. Orme
Janet Reis at Boise State University
Janet Reis
Elicia J. Herz
Elicia J. Herz
Elicia J. Herz
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Abstract

The factorial and discriminant validity of the Center for Epidemiological Studies Depression (CES-D) scale was examined for a sample of 116 parents who were participating in family support programs designed to prevent child abuse and neglect. Participants' self-reports of depressive symptoms as measured by the CES-D were analyzed in relation to their self-esteem (measured with the Rosenberg Self-Esteem scale) and state and trait anxiety (measured with Spielberger's State-Trait Anxiety Inventory). Factorial validity was adequate, and results indicated a moderate correlation between the CES-D and self-esteem and state anxiety. However, a high correlation was obtained between the CES-D and trait anxiety, which suggests that the CES-D measures in large part the related conceptual psychological domain of predisposition for anxiousness.
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FACTORIAL AND DISCRIMINANT VALIDITY OF THE CENTER
FOR EPIDEMIOLOGICAL STUDIES DEPRESSION (CES-D) SCALE
JOHN
G.
ORME
University
of
Chicago
JANET
REIS
AND ELICIA
J.
HERZ
Center
for
Health Services and Policy Research
North western University
The factorial and discriminant validity of the Center for Epidemiological
Studies Depression (CES-D) scale was examined for a sample of
116
parents
who were praticipating in family support programs designed to prevent child
abuse and neglect. Participants’ self-reports of depressive symptoms as
measured by the CES-D were analyzed in relation to their self-esteem
(measured with the Rosenberg Self-Esteem scale) and state and trait anxiety
(measured with Spielberger’s State-Trait Anxiety Inventory). Factorial
validity was adequate, and results indicated a moderate correlation between
the CES-D and self-esteem and state anxiety. However, a high correlation
was obtained between the CES-D and trait anxiety, which suggests that the
CES-D measures in large part the related conceptual psychological domain
of
predisposition for anxiousness.
The Center for Epidemiological Studies Depression scale (CES-D) (Radloff, 1977)
is a widely used self-report measure designed to provide an index
of
the number and
frequency of depressive symptoms. Since its publication in 1977, at least
50
published
articles have reported use
of
the CES-D as a measure
of
depression, and these include
its use in epidemiological as well as in clinical studies (e.g.,
Brown
&
Lewinsohn, 1984;
Eaton
&
Kessler, 1981; Fava, 1983; Husaini, Neff, Newbrough,
&
Moore, 1982).
The extensive application of the CES-D suggests that it is perceived by many clini-
cians and researchers as a reliable and valid instrument, and, indeed, various aspects
of the reliability and validity of the CES-D have been examined extensively. Results
indicate that the CES-D exhibits good internal consistency reliability across diverse
population subgroups and relatively good short-term test-retest reliability (Aneshensel,
Clark,
&
Frerichs, 1983; Fava, 1983; Radloff, 1977; Roberts, 1980; Ross
&
Mirowsky,
1984). Moreover, the CES-D differentiates fairly well between those in treatment and
those not in treatment for psychological and psychiatric problems in general, and depres-
sion in particular, and CES-D scores have shown improvement for treated populations
(e.g., Boyd, Weissman, Thompson,
&
Myers, 1982; Husaini, Neff, Harrington, Hughes,
&
Stone, 1980; Radloff, 1977; Weissman, Sholomskas, Pottenger, Prusoff,
&
Locke,
1977). Finally, the CES-D correlates well with other scales designed to measure depres-
sion (e.g., Radloff, 1977; Weissman et al., 1977).
Although various aspects of the reliability and criterion and convergent validity
of the CES-D have been examined, and these results appear very promising, to date
the discriminant validity of the CES-D has been less well documented and supported.
Preparation
of
this article was supported in part by National Istitute
of
Mental Health Grant
IT32-MH17053
to John G. Orme and by grants
from
the Illinois Department
of
Children and Family Services and the Pitt-
way Charitable Trust, Chicago, Illinois, to the Center
for
Health Services and Policy Research
of
Northwestern
University.
Correspondence should be addressed to Janet Reis, Center
for
Health Services and Policy Research, North-
western University,
629
Noyes St., Evanston, Illinois
60201.
28
CES-D
Factorial and Discriminant Validity
29
Previous assessments
of
this issue suggest that the
CES-D
is less successful in measur-
ing the single construct
of
depression than originally thought. Vernon and Roberts (1981),
for example, report that the correlation of the CES-D with the total score of the
Demoralization scale (a broad-band measure of psychological distress that measures anx-
iety, depression, self-esteem, and feelings of helplessness and hopelessness) was as high
as possible given the reliabilities of the two measures. These and other similar results
(e.g., Weissman et al., 1977) suggest that the CES-D might be viewed best as a measure
of nonspecific psychological distress and not interpreted solely as a measure of depression.
The growing popularity of the CES-D and the questions that have been raised as
to its discriminant validity underscore the importance of further exploration of this issue.
In the present study, the relationships among the CES-D and three important, related
psychological constructs
-
self-esteem, trait anxiety, and state anxiety
-
will be examined
in order to assess the CES-D’s discriminant validity.
METHOD
Subjects
The CES-D, along with measures of self-esteem, trait anxiety, and state anxiety,
was completed by
116
individual parents who were participating in family support pro-
grams designed to prevent child abuse and neglect. Data collection took place in five
Illinois service delivery sites. All sites are situated in communities with high rates of
unemployment, poverty, and negative indices of health status. The battery of tests were
administered to the majority of parents by their third program visit. A total of 89%
of the sample were women, 46% were Black, and
50%
were Caucasian. All subjects
were at least 16 years old, and the mean age was 21.30
(SD
=
7.16).
Measures
The CES-D is a 20-item self-report measure that includes questions that pertain
to a wide range of depressive symptoms. Respondents are asked to rate the frequency
of occurrence of each symptom in the past week on a 4-point scale, which ranges from
rarely or none of the time (less than 1 day) to most or all of the time (5-7 days). The
potential range of scores is from
0
to 60; higher scores indicate greater depression. A
score of 16 or greater typically is employed as a cut-off that indicates clinical depression
(e.g., Boyd et al., 1982).
The Rosenberg Self-Esteem scale (Rosenberg, 1969, a well-validated (cf. Eppinger
&
Lambert, 1983) 10-item self-report scale, was used to measure self-esteem. Each item
is a declarative statement for which respondents are asked whether they strongly agree,
agree, disagree, or strongly disagree. The potential range of scores is from
0
to 30, and
higher scores indicate
less
self-esteem.
Spielberger’s State-Trait Anxiety Inventory (STAI) (Spielberger, Gorsuch,
&
Lushene, 1970) was employed to measure state and trait anxiety because it is a well-
validated measure
of
these constructs (cf. Beutler
&
Crago, 1983; Roberts, Aronoff,
Jensen,
&
Lambert, 1983). The STAI is a self-report measure comprised of a 20-item
trait anxiety scale and a 20-item state anxiety scale. For the trait anxiety scale, respondents
are required to rate the frequency with which they usually feel particular anxiety symp-
toms, and for the state anxiety scale respondents are required to rate the intensity of
their anxiety at the time
of
testing. On both scales respondents are required to provide
their ratings on a 4-point scale, and each scale has a potential range of scores from
0
to
60.
Higher scores indicate greater anxiety.
30
Journal
of
Clinical Psychology, January
1986,
Vol.
42,
No.
I
RESULTS
Reliability
As
shown in Table
1,
the internal consistency reliability of each of the four measures
is adequate and consistent with previous results (e.g., Eppinger
&
Lambert, 1983; Radloff,
1977; Spielberger et
al.,
1970). Coefficients alpha ranges from
-80
for self-esteem to
.88
for the CES-D.
Table
1
Scale Reliabilities, Means, and Standard Deviations
(N
=
116)
CES-D Self-esteem Trait anxiety State anxiety
~
cy
M
SD
.88 .so .81 .87
14.31 6.47 12.85 10.30
10.26 4.98 5.95 5.17
Factorial Validity
If the CES-D has good factorial validity, its items should correlate relatively highly
with the CES-D total score and should correlate more highly with its total score than
with self-esteem, trait anxiety, or state anxiety total scores. Such an analysis of item-
total correlations is equivalent to
a
confirmatory multiple-group factor analysis with
units on the main diagonal of the inter-item correlation matrix; the resultant item-total
correlations are equal to factor loadings obtained from such
a
factor analysis (Hudson,
1982; Nunnally, 1978, p. 394).
As
shown in Table 2, the correlated item-total correlations between the CES-D items
and the CES-D total score are all positive. Moreover, with the exception of correlations
for three items (items
2,
4,
and
7),
all of the corrected item-total correlations for the
CES-D exceed .30, and the mean correlation, computed using Fisher’s
Z
transforma-
tion, is .52.
Table
2
Correlations
of
CES-D
Items
with Total Scale Scores
Measures
CES-D items CES-D Self-esteem Trait anxiety State anxiety
__
1
2
3
4
5
6
7
8
9
10
11
~
.5
I
.28
.68
.25
.59
.61
.13
.31
.62
.46
.33
.29
.20
.40
.I7
.38
.38
.06
.I2
.43
.27
.31
.42
.28
.56
.13
.51
.46
.I1
.I6
.43
.43
.51
.29
.10
.34
.16
.46
.39
.
.02
.06
.39
.20
.I8
CES-D
Factorial and Discriminant Validity
31
Table
2
Correlations
of
CES-D Items with Total Scale Scores
Measures
CES-D items CES-D Self-esteem Trait anxiety State anxiety
12 .57 .36 .41 .42
13
.51 .36 .36 .17
14 .68 .44 .52 .26
15
16
17
18
19
.37
.62
.63
.70
.57
.29
.38
.31
.50
.52
.3
1
.39
.49
.55
.52
.12
.38
.23
.36
.2f
20
.49 .43 .44 .I7
Also as shown in Table
2,
the correlations between the CES-D items and the total
scores for self-esteem, trait, and state anxiety are less than the correlations between these
items and the CES-D total score, with only two exceptions (items
2
and
11).
Moreover,
the mean item-total correlation of the CES-D items, as computed using Fisher’s
Z
transformation, is greater for the CES-D
(52)
than for self-esteem
(.34),
trait anxiety
(.41),
or state anxiety
(.25).
However, the CES-D items do load on the self-esteem, trait,
and state anxiety scales, and for some items these correlations are relatively high, espe-
cially with trait anxiety.
Discriminant Validity
The intercorrelations among the scales are displayed in Table
3.
These data indicate
that the CES-D is correlated moderately with self-esteem and state anxiety and correlated
highly with trait anxiety. Correcting for attenuation in reliability, the disattenuated cor-
relation of
-84
between the CES-D and trait anxiety indicates further the especially high
correlations between these two measures.
Table
3
Scale Intercorrelations
Self-esteem Trait anxiety State anxiety
CES-D
.58 .71 .44
Self-esteem
-
.46 .44
Trait anxiety
-
.43
Note.-For each correlation
p
<
.001.
A
stepwise multiple regression analysis was conducted that used the CES-D as the
dependent variable and self-esteem, trait, and state anxiety as independent variables in
order to determine the amount of variance in the CES-D that could be predicted by
self-esteem, trait, and state anxiety. Trait anxiety entered into the equation first (ad-
justed
R2
=
.494,
F(1,
114)
=
113.03,
p
<
.001),
followed by self-esteem (adjusted
R2
change
=
.082,
F(2,
113)
=
22.86,
p
<
.001);
state anxiety did not add a statistically
32
Journal
of
Clinical Psychology, January
1986,
Vol.
42,
No.
1
significant amount of variance beyond that accounted for by trait anxiety and self-esteem.
The total adjusted
R2
=
.582
(F(2,
113)
=
78.79,
p
c
.001).
DISCUSSION
In general, the CES-D scale achieved
a
good level of factorial validity, as evidenced
by the fact that the CES-D items are correlated more highly with the CES-D total score
than with the total scores for self-esteem, state anxiety, or trait anxiety. However, many
of the CES-D items have substantial correlations with these three related but putatively
distinct constructs, and, in particular, strong relationships were observed between the
CES-D items and trait anxiety. Furthermore, bivariate and multiple correlations between
the total score
of
the CES-D and total score measures of self-esteem, state anxiety, and
trait anxiety further underscore the fact that the CES-D does not measure solely the
delimited conceptual domain of depression, as originally intended in the development
of the measure (Radloff, 1977). Therefore, the CES-D appears to measure aspects of
self-esteem, state anxiety, and, especially, trait anxiety in addition to depression.
A
determination of whether correlations of the CES-D with other measures of
depression are higher than correlations with measures of other constructs, such as anx-
iety and self-esteem, would be desirable for a more complete examination of discrimi-
nant validity, but data from the present study do not allow
a
direct answer to this ques-
tion. Results from previous studies (cf. Radloff, 1977; Weissman et al., 1977) do sug-
gest that correlations between the CES-D and other measures of depression generally
are higher than either of the correlations between the CES-D and self-esteem or state
anxiety obtained
in
the present study. However, relative to correlations between the
CES-D and other measures of depression as obtained in these previous studies, as well
as in absolute terms, the correlation obtained here between the CES-D and trait anxiety
suggests that the CES-D measures trait anxiety as much as depression.
Further analysis of the convergent and discriminant validity of the CES-D should
be undertaken. For example, examination of the discriminant and convergent validity
of the CES-D within the context
of
a
carefully designed multi-trait, multi-method analysis
(Campbell
&
Fiske, 1959) might be especially fruitful. In the interim, the present results
recommend caution in using the CES-D as
a
measure of depression in clinical assess-
ment. Further, caution should be exercised in the use of the CES-D in the evaluation
of interventions designed to alleviate depression (e.g., Brown
&
Lewinsohn, 1984) because
it might pose
a
threat to the construct validity
of
the evaluation (Cook
&
Campbell, 1979).
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... Centre for Epidemiological Studies Depression scale (CES-D) (Orme et al., 1986) Determines severity of depression. ...
... Analyses undertaken reinforced that T A B L E 5 Meta-analyses: statistically significant effect sizes. (Beck et al., 1988); CES-D, Centre for Epidemiological Studies Depression scale (Orme et al., 1986); EDE-Q, eating disorder examination questionnaire (Fairburn & Beglin, 1994); EDI/EDI-2, eating disorder inventory (Garner & Olmsted, 1984); GRADE, grades of recommendation, assessment, development and evaluation ratings; I 2 , extent of heterogeneity (inconsistency between studies); NA, not applicable; SMD, standardised mean difference, in this case, Hedges' (adjusted) g; SCL-90R (GSI), Symptom checklist 90R, general symptom index score-general psychopathology/anxiety (Derogatis, 1975); WCS, weight concern scale (Killen et al., 1994). ...
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  • Feb 2024
  • BMC Geriatr
Background There are a variety of determinants that are key to functional disability of older adults. However, little is known regarding the relationship between cognitive frailty and disability among older people. The aims of this study were to examine the associations between cognitive frailty and its six components with instrumental activities of daily living (IADL) functioning in community-dwelling older adults. Methods A total of 313 community-dwelling older adults (aged ≥ 65 years) were recruited from eight community centers in central China. Cognitive frailty was operationalized using the Mini-Mental State Examination for the evaluation of cognitive status and the Fried criteria for the evaluation of physical frailty. The outcome was functional disability assessed by the IADL scale. The association between cognitive frailty, as well as its components, and IADL limitations was identified by conducting binary logistic regression analysis. Results The prevalence of cognitive frailty was 8.9% in this study. The results showed that cognitive frailty (OR = 22.86) and frailty without cognitive impairment (OR = 8.15) were associated with IADL limitations. Subdimensions of cognitive frailty, exhaustion, weakness, low physical activity and cognitive impairment components were independently associated with IADL limitations. Conclusion Cognitive frailty was associated with a higher prevalence of disability. Interventions for improving cognitive frailty should be developed to prevent IADL disability among community-dwelling older adults in China.
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Assessing frailty amongst older people admitted to hospital in a low-income setting: a multicentre study in northern Tanzania
Article
Full-text available
  • Feb 2024
  • BMC Geriatr
Background Populations are ageing globally and Low- and Middle-Income Countries (LMICs) are experiencing the fastest rates of demographic change. Few studies have explored the burden of frailty amongst older people in hospital in LMICs, where healthcare services are having to rapidly adapt to align with the needs of older people. This study aimed to measure the prevalence of frailty amongst older people admitted to hospital in Tanzania and to explore their demographic and clinical characteristics. Methods This study had a prospective observational design. Over a six-month period, all adults ≥ 60 years old admitted to medical wards in four hospitals in northern Tanzania were invited to participate. They were screened for frailty using the Clinical Frailty Scale (CFS) and the Frailty Phenotype (FP). Demographic and clinical characteristics of interest were recorded in a structured questionnaire. These included the Barthel Index, the Identification of Elderly Africans Instrumental Activities of Daily Living (IADEA-IADL) and Cognitive (IDEA-Cog) screens, the EURO-D depression scale and Confusion Assessment Method. Results 540 adults aged ≥ 60 were admitted, and 308 completed assessment. Frailty was present in 66.6% using the CFS and participants with frailty were significantly older, with lower levels of education and literacy, greater disability, greater comorbidity, poorer cognition and higher levels of delirium. Using the FP, 57.0% of participants were classed as frail though a majority of participants (n = 159, 51.6%) could not be classified due to a high proportion of missing data. Conclusions This study indicates that the prevalence of frailty on medical wards in northern Tanzania is high according to the CFS. However, the challenges in operationalising the FP in this setting highlight the need for future work to adapt frailty screening tools for an African context. Future investigations should also seek to correlate frailty status with long-term clinical outcomes after admission in this setting.
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Movement patterns during gait initiation in older adults with various stages of frailty: a biomechanical analysis
Article
Full-text available
  • Jan 2024
  • EUR REV AGING PHYS A
Background Gait initiation is challenging for older individuals with poor physical function, particularly for those with frailty. Frailty is a geriatric syndrome associated with increased risk of illness, falls, and functional decline. This study examines whether spatial and temporal parameters of gait initiation differ between groups of older adults with different levels of frailty, and whether fear of falling, and balance ability are correlated with the height of lifting the food during gait initiation. Methods Sixty-one individuals aged > 65 years, classified by Fried frailty phenotype, performed five self-paced gait initiation trials. Data was collected using a three-dimensional passive optical motion capture system, consisting of 10 cameras with the ability to perceive reflective markers, and two force plates. The total duration of gait initiation and the duration of its four sub-phases, the first step length, and the maximum foot clearance during the first step were derived, and compared statistically between groups. Additionally, an association analysis was conducted between foot clearance and fear of falling, and confidence in balance in older individuals. Results Frail individuals had significantly longer unloading durations, and total durations of gait initiation compared to non-frail older adults. Additionally, they had shorter first step lengths compared to non-frail older adults. Pre-frail older adults also showed shorter steps compared to the non-frail group. However, there were no significant differences between groups for the maximum foot clearance during the first step. Nevertheless, the maximum foot clearance of older individuals correlated significantly with their fear of falling and confidence in balance. Conclusion Older adults with reduced physical function and signs of frailty mainly display longer duration of gait initiation and decreased first step length compared to non-frail older adults. The release phase is decreased as the double support phase is prolonged in frail patients. This information can guide the development of specialized exercise programs to improve mobility in this challenging motion between static and dynamic balance.
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Association of time-varying sleep duration and cognitive function with mortality in the elderly: a 12-year community-based cohort study
Article
Full-text available
  • Dec 2023
  • BMC PSYCHIATRY
Background Sleeping problems and cognitive impairment are common in elders. Baseline sleep duration and cognitive status are predictors of mortality. But few studies have explored whether longitudinal changes in sleep duration and cognitive function are related to mortality in older adults. The present study investigated the time-varying relationships of sleep duration and cognitive function with subsequent mortality among community-dwelling elders by using 12 years of repeated-measure data. Methods Taichung Community Health Study for Elders (TCHS-E) is a retrospective, population-based cohort that started in 2009 (wave 1) with a total of 912 elders aged 65 years or above. Follow up was conducted in 2010 (wave 2), 2018 (wave 3), and 2020 (wave 4). Sleep duration and Mini-Mental State Examination (MMSE) forms were executed at baseline and three visits during follow-up. Time-varying Cox proportional hazards regression estimated adjusted hazard ratios (HRs) of mortality with 95% confidence intervals (CIs). Results During about 12 years (9,396 person-years) follow-up, 329 deaths from all causes were documented, including 102 deaths due to expanded cardiovascular disease (CVD). In the multivariable-adjusted, time-varying Cox proportional hazard model, the adjusted HR values of all-cause mortality were 1.47 (1.02–2.12) for sleep duration > 9 h/day (vs. 7 h/day) and 1.81 (1.26–2.59) for MMSE < 27 (vs. 30). The adjusted HR values of the expanded CVD mortality were 2.91 (1.24–6.83) for MMSE of 29; 2.69 (1.20–6.05) for MMSE of 27–28; and 4.32 (95% CI: 1.92–9.74) for MMSE < 27. The dose-dependent relationship was significant (p < 0.001). The combinations of sleep duration longer than 9 h/day and MMSE < 27 were linked with the highest risks for expanded CVD and all-cause mortality. Conclusions Long sleep duration and low cognitive function were jointly and independently linked with higher risk of mortality in elders residing in community.
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Sexual orientation disclosure and depression among Thai gay, bisexual, and other men who have sex with men: The roles of social support and intimate partner violence
Article
Full-text available
Background Among gay, bisexual, and other men who have sex with men (GBM), sexual orientation disclosure to social groups can act as a significant risk for depression. The primary goal of this research is to understand the association between disclosure and depression, the association of social support and intimate partner violence (IPV) experiences, depression, and disclosure. Methods This project uses a secondary dataset of Thailand from a larger cross-sectional study distributed in the Greater Mekong Sub-Region. This study utilized web-based answers from 1468 Thai GBM respondents between the ages of 15–24 years. Results Prevalence of depression was over 50%. Across the social groups of interest, those who disclosed to everyone had the lowest depression prevalence. This association was statistically significant for all groups ( p <0.050) except for “Family members” ( p = 0.052). There was a statistically significant association illustrated between full disclosure to social groups and increased social support. Most respondents (43.9%) had low social support, and additionally this group had the highest level of depression, compared to those with high social support. There was a statistically significant association for lowered depression outcomes and increased social support. IPV experiences that occurred within the last six months had a statistically significant relationship with depression ( p = 0.002). There was a notable association between those with experiences of being a victim of IPV, alone and in conjunction with experience of being a perpetrator of IPV, which was associated with increased odds of depression. However, the type of IPV experiences an individual had did not differ based on disclosure status. Discussion This study provides strengthened evidence of the impact that differences in supportive networks can have on mental health outcomes. In addition, they provided a wider consideration for how people may have different IPV experiences, either as a perpetrator, victim, or both, and how those shapes health outcomes of depression. GBM communities still face adversity and challenges that affect their long-term health outcomes, even if they do live in what is considered an accepting country.
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Examining the Safety and Effectiveness of a 4-Week Supervised Exercise Intervention in the Treatment of Frailty in Patients with Chronic Kidney Disease
Article
Full-text available
  • Aug 2023
Background The optimal duration of anti-frailty interventions and how best to deliver them to patients with chronic kidney disease (CKD) is unknown. The aim of this study to was to examine the safety, feasibility, and preliminary efficacy of a 4-week supervised exercise intervention on frailty in patients with CKD. Methods We conducted a prospective feasibility study involving patients with ≥ stage 3 CKD (1 patient with stage 3 CKD, 7 patients with stage 4 CKD, and 17 patients with stage 5 CKD) who were either frail or pre-frail according to the physical frailty phenotype and/or had a Short Physical Performance Battery score ≤ 10. The exercise intervention consisted of two supervised outpatient sessions per week for 4 weeks (8 total sessions). Frailty and other study measures were assessed at baseline and after 4-weeks of exercise. Results Of the 34 participants who completed the baseline assessment and were included in the analyses, 25 (73.5%) completed the 4-week assessment. Overall, 64.0% of patients were on dialysis and 64.0% had diabetes mellitus. After 4-weeks of exercise, frailty prevalence, total Short Physical Performance Battery scores, and energy/fatigue scores improved. No adverse study-related outcomes were reported. Conclusions 4-weeks of supervised exercise was safe, associated with an excellent completion rate, and improved frailty parameters in patients with CKD. This study provides important preliminary data for a future larger prospective randomized study.
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Objective assessment of the association between frailty and sedentary behavior in older adults: a cross-sectional study
Article
Full-text available
  • Aug 2023
  • EUR REV AGING PHYS A
Background Given the inconsistent findings of the association between frailty and sedentary behavior in older adults, this cross-sectional study investigated the aforementioned association using four different frailty criteria and two sedentary behavior indices in older adults. Methods Data from older adults (age ≥ 65 y) who participated in health examinations or attended outpatient integrated clinics at a medical center in Taipei, Taiwan, were collected. Frailty was measured using the modified Fried Frailty Phenotype (mFFP), Clinical Frailty Scale in Chinese Translation (CFS-C), Study of Osteoporotic Fractures (SOF) index, and Clinical Frailty-Deficit Count (CF-DC) index; sedentary behavior was assessed with a waist-worn accelerometer. Adjusted linear regression ascertained the association between frailty and both sedentary behavior outcomes. Results Among the 214 participants (mean age 80.82 ± 7.14 y), 116 were women. The average total sedentary time and number of sedentary bouts were 609.74 ± 79.29 min and 5.51 ± 2.09 times per day, respectively. Frail participants had a longer total sedentary time (odds ratio [OR]: 30.13, P = .01 and 39.43, P < .001) and more sedentary bouts (OR: 3.50 and 5.86, both P < .001) on mFFP and CFS-C assessments, respectively. The SOF index revealed more sedentary bouts among frail than in robust participants (OR: 2.06, P = .009), without a significant difference in the total sedentary time. Frail participants defined by the CF-DC index were more likely to have frequent sedentary bouts (OR: 2.03, P = .016), but did not have a longer total sedentary time. Conclusions Regardless of the frailty criteria adopted, frailty was positively associated with the number of sedentary bouts per day in older adults. A significant correlation between frailty and total sedentary time was detected only with mFFP and CFS-C indices. Further research may target decreasing the sedentary bouts in older adults as a strategy to improve frailty.
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A psychoeducational approach to the treatment of depression: Comparison of group, individual, and minimal contact procedures
Article
Full-text available
  • Oct 1984
63 16-65 yr olds exhibiting unipolar depression were assigned to 1 of 4 conditions (i.e., class, individual tutoring, minimal contact, or delayed treatment control) with regard to a course of treatment for coping with depression to investigate the efficacy of a psychoeducational approach in treating unipolar depression. The course addressed specific target behaviors (i.e., social skills, thinking, pleasant activities, relaxation) and more general components hypothesized to be critical to successful cognitive-behavioral therapy for depression. Ss in the immediate-treatment conditions were assessed pre- and posttreatment and at 1- and 6-mo follow-up sessions; the delayed-treatment group was assessed prior to and following an 8-wk waiting period. Results indicate clinical improvement by all of the active treatment conditions, as compared to the delayed-treatment condition. Differences between active-treatment conditions were small, and some differences between high and low responders to treatment were found. (33 ref) (PsycINFO Database Record (c) 2006 APA, all rights reserved).
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Measuring Nonspecific Psychological Distress and Other Dimensions of Psychopathology
Article
  • Nov 1981
  • ARCH GEN PSYCHIAT
• The reliability and validity of the Psychiatric Epidemiology Research Interview (PERI) are examined using data from a triethnic (white, black, and Mexican-American) sample of community respondents. The PERI scales attempt to measure both nonspecific psychological distress and different dimensions of psychopathology. Internal consistency reliability is assessed using Cronbach's coefficient a. Concurrent and discriminant validity are evaluated by comparing the PERI scales with the Center for Epidemiologic Studies Depression Scale and the Bradburn Negative Affect Scale. These scales show high internal consistency reliability in all three ethnic groups. The Demoralization Scale measures a separate dimension from the other psychopathology scales, and the latter scales are distinct from one another. While the criterion validity of the PERI in population samples remains unknown, it is possible to measure important dimensions of psychopathology in the general population. The PERI may constitute one such measure.
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The CES-D Scale: A Self-Report Depression Scale for Research in the General Population
Article
  • Jun 1977
  • APPL PSYCH MEAS
The CES-D scale is a short self-report scale designed to measure depressive symptomatology in the general population. The items of the scale are symptoms associated with depression which have been used in previously validated longer scales. The new scale was tested in household interview surveys and in psychiatric settings. It was found to have very high internal consistency and adequate test- retest repeatability. Validity was established by pat terns of correlations with other self-report measures, by correlations with clinical ratings of depression, and by relationships with other variables which support its construct validity. Reliability, validity, and factor structure were similar across a wide variety of demographic characteristics in the general population samples tested. The scale should be a useful tool for epidemiologic studies of de pression.
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Depression in Rural Communities: Validating the CES-D Scale
Article
  • Jan 1980
  • J COMMUNITY PSYCHOL
This study of 200 adults receiving outpatient services in rural Middle Tennessee was conducted to provide data on the validity of the CES-D as a measure of depressive symptomatology. Specifically, the study sought to determine the CES-D's ability to discriminate between outpatients and a sample of community residents, between patient groups reflecting different diagnostic classifications and levels of problem severity, and based upon such comparisons, to select cutting points on the CES-D which would indicate levels of depressive symptomatology which denote a need for services. The data indicated that the CES-D distinguished (1) between patients and nonpatients, (2) among various patient groups, and (3) among depressed patients with varying levels of problem severity. Further, the study cites the utility of new cutting points of 17 and 23 to provide an estimate of “possible” and “probable” caseness within the community. The study provides support for the utility of the CES-D in determining levels of depressive symptomatology in the population.
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The stress-buffering role of social support and personal competence among the rural married
Article
  • Oct 1982
  • J COMMUNITY PSYCHOL
This study examines the possible stress-buffering properties of personal competence and social support with regard to depressive symptoms. The hypothesis examined was that individuals lacking both internal and external resources would manifest higher levels of symptoms as a result of increasing number of life events than would individuals possessing such resources. Further, variation by gender was considered. Data on depressive symptoms (CES-D Scale), personal competence, social support, and life events were obtained in a 70-minute interview with randomly selected samples of white married adults (n = 965) from rural counties of Tennessee, Oklahoma, and Ohio. Analyses indicated both the main and buffering effects of personal competence and social support for the total sample. However, these effects varied by sex. While personal competence and life events had consistent main effects for both married males and females–individuals with more stress or lower levels of competence had higher levels of symptoms–effects of social support were more pervasive among the females. Finally, personal competence appeared to have a greater buffering effect than the presence of social support alone. There was also an unanticipated tendency for greater vulnerability to stressors among individuals (particularly males) under conditions of low competence and high support.
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Society And The Adolescent Self-Image
Book
  • Dec 1965
There are few topics so fascinating both to the research investigator and the research subject as the self-image. It is distinctively characteristic of the human animal that he is able to stand outside himself and to describe, judge, and evaluate the person he is. He is at once the observer and the observed, the judge and the judged, the evaluator and the evaluated. Since the self is probably the most important thing in the world to him, the question of what he is like and how he feels about himself engrosses him deeply. This is especially true during the adolescent stage of development.
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Assessing Depressive Symptoms in Five Psychiatric Populations: A Validation Study
Article
  • Oct 1977
  • AM J EPIDEMIOL
Welssman, M. M. (Yale University School of Medicine, Department of Psychiatry, Depression Research Unit, Connecticut Mental Health Center, New Haven, CT 06519), D. Sholomskas, M. Pottenger, B. A. Prusoff and B. Z. Locke. Assessing depressive symptoms in five psychiatric populations: A validation study. Am J Epidemiol 106:203–214, 1977. Data from five psychiatric populations and a community sample are presented on the CES-D, a 20-item self-report depression symptom scale developed by the Center for Epldemlologlc Studies. Results show that the scale is a sensitive tool for detecting depressive symptoms and change in symptoms over time in psychiatric populations, and that it agrees quite well with more lengthy self-report scales used in clinical studies and with clinician interview ratings. Although a symptom scale cannot differentiate between diagnostic groups, the CES-D has demonstrated its validity as a screening tool for detecting depressive symptoms in psychiatric populations.
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