Item bias on the geriatric depression scale (GDS): investigating the quality and generalizability of GDS on Chinese and Korean community-dwelling elderly population

In Hye Park,Yustika Sya’Bandari,Yang Liu

doi:10.1186/s12877-021-02516-z

Abstract

BackgroundAlthough some previous studies have reported the impact of cultural factors on individuals’ cognition and decision making, a shortage of research has led to this comparison study for Chinese and Korean elderly, a growing population with depression. This study aimed to explore depression levels in Chinese and South Korean elderly individuals by focusing on testing the generalizability of the Geriatric Depression Scale (GDS).MethodsThe data of 493 community-dwelling Chinese and Korean elderly individuals over the age of 60 years were used to examine GDS. To test the dimensionality, item quality, and reliability of the GDS, the item response theory, Rasch analysis was performed. The detection of differential item functioning (DIF) of the GDS between the two countries was determined by performing a hybrid ordinal logistic regression.ResultsThe four-dimensional framework of the GDS, categorized into agitation, cognitive concerns, dysphoria, and vigor/withdrawal was fit for measuring depression levels in Chinese and Korean elderly individuals. In addition, good item quality and reliability of the GDS indicate that almost all items in this scale contribute to measuring the intended trait. Meanwhile, 18 out of 28 items of the GDS were detected as country-related DIF with five items having a large effect size.ConclusionsAlthough China and Korea are close geographically and culturally, the item bias shown by severe country-related DIF implies that different cultural backgrounds impact how the elderly interpret GDS items. The cultural issues related to the specific DIF items, the implication to accuracy of individual scores estimation, and the optimal decision to treat individuals were discussed.

Highlights

Some previous studies have reported the impact of cultural factors on individuals’ cognition and decision making, a shortage of research has led to this comparison study for Chinese and Korean elderly, a growing population with depression
The four-dimensional framework suggested by Haavisto and Boron [42], was the best fit for Chinese elderly population, showing low final deviance and Akaike information criterion (AIC) values than those of other models
The dimensionality model proposed by Kim et al [43], showed a greater fit with Korean elderly population

Summary

Introduction

Some previous studies have reported the impact of cultural factors on individuals’ cognition and decision making, a shortage of research has led to this comparison study for Chinese and Korean elderly, a growing population with depression. The main attributions of depression in the elderly population include decreased physical functioning, aging-associated diseases, reduced social roles due to retirement, decreased economic status, and isolation or loneliness from the loss of loved ones [1, 3, 4]. Negative health consequences associated with depression have shown an increased risk of physical and cognitive dysfunction, dementia, cardiovascular and neurologic disorders, suicidal ideation from social isolation, and mortality [3, 5]. Considering the current situation of a rapidly increasing aging population [12,13,14], accurate diagnosis of depression and effective treatment planning based on the assessment are essential

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Conclusion