The measure and mismeasure of depression in older adults
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Objectives
The 10-item Centre for Epidemiological Studies Depression Scale (CES-D-10) has been used in cohort studies with scores of ≥ 8 and ≥ 10 used to indicate clinically significant symptoms or probable depression. We examined whether observations crossing these thresholds displayed core affective features expected in individuals who might be suffering with a clinically significant major depressive episode.
Methods
This was a descriptive analysis of repeated CES-D-10 assessments in the ASPirin in Reducing Events in the Elderly eXTension (ASPREE-XT) longitudinal cohort study of 19,114 participants. We identified observations of ‘probable depression’, defined as a CES-D-10 score ≥ 8 and then examined scores on item 3 (“I felt depressed”) and item 8 (“I was happy”). The primary outcome was the proportion of threshold-positive CES-D-10 observations with minimally depressed mood and preserved happiness.
Results
Over 13 years, 27,417 observations met the threshold of CES-D-10 ≥ 8. Of these, 13,356 observations (48.7%) had minimally depressed mood and preserved happiness.
Conclusion
A substantial proportion of observations considered ‘probable depression’ had little or no depressed mood, together with preserved happiness. CES-D-10 sum scores should be used with caution as a proxy for major depressive disorder in older adults.
