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.