Center for Epidemiologic Studies—Depression scale (CES-D) item response bias found with Mantel-Haenszel method was successfully replicated using latent variable modeling

Abstract

Objective This study reexamines findings reported by Cole et al. of item response bias in the Center for Epidemiologic Studies—Depression (CES-D) scale by age, gender, and race. We use an item response theory–based latent variable conditioning approach. Study Design and Setting We used the multiple indicators, multiple causes (MIMIC) model framework to estimate measurement bias in the CES-D responses of participants in the New Haven Established Populations for the Epidemiologic Studies of the Elderly study ( N = 2,340). Results Measurement bias attributable to race was significant for the following two CES-D items: people “are unfriendly” and “dislike me”. The proportional odds of a higher-category response by blacks relative to whites on these items were 2.35 (95% confidence interval [CI]: 1.65, 3.36) and 3.11 (95% CI: 2.04, 4.76), respectively. The proportional odds were higher among women (2.03 [95% CI: 1.35, 3.06]) relative to men for the CES-D item “crying.” Conclusion Our findings confirm that three items on the CES-D show strong evidence of item response bias. The MIMIC model is preferable to the Mantel–Haenszel approach because it conditions on a latent variable, although the effect estimates can also be interpreted using a proportional odds framework.