The utility of the Center for Epidemiological Studies Depression Scale in older primary care patients

The consequences of depression in older medically ill adults are quite severe. Medically ill and depressed older adults die sooner and are more disabled by their illness than are medically ill older adults who are not depressed. Research demonstrates that early recognition and intervention can prevent negative medical and social consequences of depression in late life. While most older adults who are depressed seek mental health services from their physicians, recognition rates of late-life depression in medical settings are poor. Some have suggested using screening instruments, such as CES-D, to increase physician recognition of geriatric depression. While the CES-D has been found to be a reliable instrument in medical settings and in older adults, the utility of the CES-D and instruments like it has not been tested on older medical patients from different ethnic groups. We analysed the reliability and item functions of the CES-D in a low-income, ethnically diverse population. The results indicate that the CES-D has good internal consistency as a scale, but at the item level the scale does not function similarly across age and ethnic groups.