Cross-national statistical harmonization of the Center for Epidemiologic Studies Depression (CES-D) scale among older adults in China, England, India, Mexico, South Africa, and the United States

IF 7.3 2区医学 Q1 HEALTH CARE SCIENCES & SERVICES

Journal of Clinical Epidemiology Pub Date : 2025-02-01 DOI:10.1016/j.jclinepi.2024.111623

Xuexin Yu , Richard N. Jones , Lindsay C. Kobayashi , Alden L. Gross

{"title":"Cross-national statistical harmonization of the Center for Epidemiologic Studies Depression (CES-D) scale among older adults in China, England, India, Mexico, South Africa, and the United States","authors":"Xuexin Yu , Richard N. Jones , Lindsay C. Kobayashi , Alden L. Gross","doi":"10.1016/j.jclinepi.2024.111623","DOIUrl":null,"url":null,"abstract":"<div><h3>Objectives</h3><div>We examined differential item functioning (DIF) of the Center for Epidemiologic Studies Depression Scale (CES-D) items by country and statistically harmonized common cross-national factor scores for the CES-D to aid further cross-national research.</div></div><div><h3>Study Design and Setting</h3><div>Data were from Harmonized Cognitive Assessment Protocol (HCAP) studies in China (<em>N</em> = 9639), England (<em>N</em> = 1262), India (<em>N</em> = 4048), Mexico (<em>N</em> = 1918), South Africa (<em>N</em> = 631), and the United States (<em>N</em> = 3321). Multiple indicators, multiple causes models were estimated to test DIF in the CES-D items by country. DIF items were defined as having an odds ratio (OR) outside the range of 0.75–1.25 in multiple indicators, multiple causes models. We evaluated DIF impact and identified salient DIF by examining whether the difference between DIF-adjusted factor scores and non-DIF–adjusted factor scores exceeded a threshold of 0.30 standard deviation (SD) units. Confirmatory factor analysis was used to create DIF-adjusted, cross-nationally harmonized CES-D factor scores.</div></div><div><h3>Results</h3><div>Controlling for underlying depressive symptoms, HCAP participants in India had higher odds of reporting being not hopeful about future (OR = 1.38, 95% confidence interval [CI]: 1.34–1.42), not enjoying life (OR = 1.43, 95% CI: 1.38–1.48), and being unhappy (OR = 1.29, 95% CI: 1.25–1.34), compared to HCAP participants in the United States. These identified DIF items artificially increased mean harmonized CES-D factor scores by 0.48 SD units in the India HCAP, with over 50% of the factor scores increased by over 0.30 SD units, indicating salient DIF in the India HCAP.</div></div><div><h3>Conclusion</h3><div>Our findings demonstrate cross-national heterogeneity in the expression of depressive symptoms. We provide DIF-adjusted CES-D factor scores to improve the quality of cross-national comparisons in aging research.</div></div>","PeriodicalId":51079,"journal":{"name":"Journal of Clinical Epidemiology","volume":"178 ","pages":"Article 111623"},"PeriodicalIF":7.3000,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Clinical Epidemiology","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0895435624003792","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"HEALTH CARE SCIENCES & SERVICES","Score":null,"Total":0}

引用次数: 0

Abstract

Objectives

We examined differential item functioning (DIF) of the Center for Epidemiologic Studies Depression Scale (CES-D) items by country and statistically harmonized common cross-national factor scores for the CES-D to aid further cross-national research.

Study Design and Setting

Data were from Harmonized Cognitive Assessment Protocol (HCAP) studies in China (N = 9639), England (N = 1262), India (N = 4048), Mexico (N = 1918), South Africa (N = 631), and the United States (N = 3321). Multiple indicators, multiple causes models were estimated to test DIF in the CES-D items by country. DIF items were defined as having an odds ratio (OR) outside the range of 0.75–1.25 in multiple indicators, multiple causes models. We evaluated DIF impact and identified salient DIF by examining whether the difference between DIF-adjusted factor scores and non-DIF–adjusted factor scores exceeded a threshold of 0.30 standard deviation (SD) units. Confirmatory factor analysis was used to create DIF-adjusted, cross-nationally harmonized CES-D factor scores.

Results

Controlling for underlying depressive symptoms, HCAP participants in India had higher odds of reporting being not hopeful about future (OR = 1.38, 95% confidence interval [CI]: 1.34–1.42), not enjoying life (OR = 1.43, 95% CI: 1.38–1.48), and being unhappy (OR = 1.29, 95% CI: 1.25–1.34), compared to HCAP participants in the United States. These identified DIF items artificially increased mean harmonized CES-D factor scores by 0.48 SD units in the India HCAP, with over 50% of the factor scores increased by over 0.30 SD units, indicating salient DIF in the India HCAP.

Conclusion

Our findings demonstrate cross-national heterogeneity in the expression of depressive symptoms. We provide DIF-adjusted CES-D factor scores to improve the quality of cross-national comparisons in aging research.

查看原文本刊更多论文

流行病学研究中心抑郁症（CES-D）量表在中国、英国、印度、墨西哥、南非和美国老年人中的跨国统计协调。

目的：我们按国家检查流行病学研究中心抑郁量表（CES-D）项目的差异项目功能（DIF），并统计协调CES-D的常见跨国因素得分，以帮助进一步的跨国研究。研究设计和设置：数据来自中国（N=9,639）、英国（N=1,262）、印度（N=4,048）、墨西哥（N=1,918）、南非（N=631）和美国（N=3,321）的统一认知评估方案（HCAP）研究。估计采用多指标、多原因模型（MIMIC）按国家检验CES-D项目中的DIF。DIF项目被定义为在MIMIC中具有0.75-1.25范围外的优势比（OR）。我们评估了DIF的影响，并通过检查DIF调整因子评分与非DIF调整因子评分之间的差异是否超过0.30 SD单位的阈值来确定显著的DIF。验证性因子分析用于创建经dif调整的、跨国家统一的CES-D因子评分。结果：控制潜在的抑郁症状，与美国的HCAP参与者相比，印度的HCAP参与者报告对未来不希望（OR=1.38, 95% CI: 1.34-1.42）、不享受生活（OR=1.43, 95% CI: 1.38-1.48）和不快乐（OR=1.29, 95% CI: 1.25-1.34）的几率更高。这些确定的DIF项目人为地将印度HCAP的平均协调CES-D因子得分提高了0.48个标准差（SD）单位，其中超过50%的因子得分提高了0.30个标准差以上，表明印度HCAP的DIF显著。结论：我们的研究结果显示了抑郁症状表达的跨国异质性。我们提供了dif调整的CES-D因子评分，以提高老龄化研究中跨国比较的质量。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Journal of Clinical Epidemiology 医学-公共卫生、环境卫生与职业卫生

CiteScore

12.00

自引率

6.90%

发文量

320

审稿时长

44 days

期刊介绍： The Journal of Clinical Epidemiology strives to enhance the quality of clinical and patient-oriented healthcare research by advancing and applying innovative methods in conducting, presenting, synthesizing, disseminating, and translating research results into optimal clinical practice. Special emphasis is placed on training new generations of scientists and clinical practice leaders.