Abstract
BackgroundThe Euro-D depression scale consists of symptom clusters that may be differentially related to demographic and cognitive characteristics in older adults. This hypothesis needs further investigation and the role of measurement bias on substantive conclusions remains to be established. MethodThe study sample comprised 10,405 community-dwelling older adults from six Latin American countries. We applied a Multiple Indicators Multiple Causes (MIMIC) model for a concurrent investigation of measurement bias and of the association between Euro-D symptom clusters and background variables. ResultsThe factorial validity of Euro-D, with a two-dimensional structure – affective suffering and motivation disturbance, was consistently supported in all countries. Although complete measurement invariance could not be assumed across countries, measurement bias was minor. Both Euro-D factors were unrelated to age, but related to gender, as well as to impairment in memory and verbal fluency. Gender differences were larger for affective suffering than for motivation disturbance, whereas differences in verbal fluency impairment were more strongly related to motivation disturbance. LimitationsOur analytic strategies could only examine invariance at the level of indicator thresholds. The generalisability of current findings needs to be examined in clinical populations. A wider set of cognitive tests is needed. We did not examine the compositional factors that could have accounted for the variation in Euro-D scores across countries, as this was beyond the aims of the paper. ConclusionThe current study adds evidence for the construct validity of Euro-D and for the possible differential association of depression symptom-clusters with gender and verbal fluency in older adults. An understanding of the heterogeneity of late-life depression may carry clinical implications for the diagnosis and treatment of depression in old age.
Highlights
The clinical picture of late-life depression differs in several aspects from that observed in early-life depression
In contrast to the study by (Castro-Costa et al, 2008) which suggested that the affective suffering factor had stronger measurement invariance than the motivation factor across European countries, our results indicate that Latin American countries differ more in their response behaviour to affective suffering items than motivation items
We found that females had higher levels of motivation than males, the magnitude of the gender difference was much larger for affective suffering
Summary
The clinical picture of late-life depression differs in several aspects from that observed in early-life depression. The Euro-D depression scale consists of symptom clusters that may be differentially related to demographic and cognitive characteristics in older adults. This hypothesis needs further investigation and the role of measurement bias on substantive conclusions remains to be established. Complete measurement invariance could not be assumed across countries, measurement bias was minor Both Euro-D factors were unrelated to age, but related to gender, as well as to impairment in memory and verbal fluency. Conclusion: The current study adds evidence for the construct validity of Euro-D and for the possible differential association of depression symptom-clusters with gender and verbal fluency in older adults. An understanding of the heterogeneity of late-life depression may carry clinical implications for the diagnosis and treatment of depression in old age
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