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Depression Research and Treatment
Volume 2016 (2016), Article ID 2824595, 11 pages
Research Article

Psychometric Limitations of the Center for Epidemiologic Studies-Depression Scale for Assessing Depressive Symptoms among Adults with HIV/AIDS: A Rasch Analysis

1Department of Family Health Care Nursing, University of California San Francisco, San Francisco, CA 94143, USA
2Department of Research, Lovisenberg Diakonale Hospital, 0440 Oslo, Norway
3Department of Occupational Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL 60612, USA
4Division of Occupational Therapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, 14183 Huddinge, Sweden
5Department of Nursing Science, Institute of Health and Society, Faculty of Medicine, University of Oslo, 0318 Oslo, Norway

Received 29 September 2015; Revised 3 February 2016; Accepted 14 February 2016

Academic Editor: Willem Van Der Does

Copyright © 2016 Caryl L. Gay et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


The Center for Epidemiological Studies-Depression (CES-D) scale is a widely used measure of depressive symptoms, but its psychometric properties have not been adequately evaluated among adults with HIV/AIDS. This study used an item response theory approach (Rasch analysis) to evaluate the CES-D’s validity and reliability in relation to key demographic and clinical variables in adults with HIV/AIDS. A convenience sample of 347 adults with HIV/AIDS (231 males, 93 females, and 23 transgenders; age range 22–77 years) completed the CES-D. A Rasch model application was used to analyze the CES-D’s rating scale functioning, internal scale validity, person-response validity, person-separation validity, internal consistency, differential item functioning (DIF), and differential test functioning. CES-D scores were generally high and associated with several demographic and clinical variables. The CES-D distinguished 3 distinct levels of depression and had acceptable internal consistency but lacked unidimensionality, five items demonstrated poor fit to the model, 15% of the respondents demonstrated poor fit, and eight items demonstrated DIF related to gender, race, or AIDS diagnosis. Removal of misfitting items resulted in minimal improvement in the CES-D’s substantive and structural validity. CES-D scores should be interpreted with caution in adults with HIV/AIDS, particularly when comparing scores across gender and racial groups.