Measurement properties of the CESD scale among individuals with spinal cord injury

Abstract

Background: Depression is common after spinal cord injury (SCI), yet it can be difficult and costly to diagnose. Screening tools such as the Center for Epidemiological Studies Depression scale (CESD) can assist with case identification; however, insufficient knowledge of their measurement properties exists to use them in the SCI population. Objectives: To assess the reliability and validity of the CESD-20 and the CESD-10. Setting: Tertiary care centre in Vancouver, British Columbia, Canada. Methods: A 2-week retest study of 47 individuals with traumatic SCI. Subjects ≥19, who had their SCI for ≥1 year and had American Spinal Injury Association Impairment scale ranking of A or B. Short Form-36 (SF-36) subscales and a visual analogue scale for fatigue (VAS-F) were used to assess validity using Pearson's correlations coefficients. Internal consistency was assessed using Cronbach's alpha, retest reliability was assessed using intraclass correlation coefficients (ICCs) and Bland-Altman plots. Normative data are presented based on key demographic and clinical factors. Results: Cronbach's alpha was 0.91 and 0.86 and retest reliability was ICC=0.87 (95% confidence interval (CI) 0.79-0.93) and ICC=0.85 (95% CI 0.75-0.92) for the CESD-20 and CESD-10, respectively. Minimal bias was evident based on the Bland-Altman plots. The strongest correlations were with outcomes representing mental health (r=-0.71), vitality (r=-0.60) and the VAS-F (r=0.57). The weakest correlation was with the physical function score of the SF-36 (r=-0.37). Conclusion: The CESD-20 and CESD-10 are quick and easy to use. This study provides evidence in support of the reliability and validity. © 2008 International Spinal Cord Society All rights reserved.