Psychometric validation of the Center for Epidemiological Studies Depression Scale in Head and Neck Cancer patients
Introduction
Depression is a common complication in patients with cancer [1]. Studies have shown that patients with head and neck cancer (HNC) experience higher rates of depression than other groups with an incidence of 15–50% as compared to 15–25% in other cancers [2]. Depression associated with cancer treatment in HNC patients has also been shown to contribute to lower quality of life, high levels of fatigue, low motivation, and higher suicide rates [2]. Early detection of depression and treatment would facilitate better treatment outcomes and quality of life [3]. Currently there are numerous screening tools available to detect depression, however few have been validated for specific use with HNC populations.
The Center for Epidemiological Studies Depression Scale (CES-D) is a tool developed by L.S. Radloff in 1977 to screen for depressive symptomology (depressed mood) in the general population [4]. Currently, the CES-D has demonstrated strong psychometric properties in prior research and is widely utilized as a measure of depression across different populations [5], [6]. This 20-item scale covers four major symptoms of depression including depressed affect, positive affect, somatic and retarded activity, and disturbed interpersonal relationship [4]. Within the scale, items are scored on a 4 - point Likert scale based on the past week’s experiences, resulting in a total score ranging from 0 to 60 with higher scores indicating more symptoms of depression [4]. Inferences and scores from any measurement tool are dependent upon population characteristics and can affect a scale's dimensionality [7]. Given this, disease specific validation is necessary as groups may differ on the underlying construct, effecting the degree to which score inferences and use can be generalized. While the CES-D is considered a robust measure of depression it needs to be psychometrically validated for use in HNC patients.
Given the considerable burden of depression in HNC patients and the lack of a population specific measure for this outcome, we aimed to explore the performance of the CES-D for use with HNC patient samples.
Section snippets
Setting and participants
One hundred and thirty patients with confirmed HNC enrolled in a pre-existing clinical trial evaluating swallowing exercises during radiation therapy were included in the study. Inclusion criteria for this study included: (a) HNC of the oropharyngeal or adjacent regions, confirmed by clinical history and exam, with positive cross-sectional imaging studies and histopathological biopsy excluding other pathology; (b) Patients planned to undergo external beam radiation therapy with or without
Data screening and descriptives
Complete baseline data was available on 116 respondents. Evaluation of missing data and response engagement revealed one unengaged respondent. This subject was removed from the dataset prior to analysis. At the 3-month time point complete data was available on 81 respondents. About 30% of participants’ data was lost to follow up. Evaluation of the data pattern revealed that missing-ness (7%) was at random. To adjust for this missing-ness across 11 items median imputations were carried out.
Conclusion
This study supports the use of the CES-D as a measure of depression in HNC patients. Although our analysis has demonstrated strong reliability and validity for this measure, caution should still be taken in the timing of administration for this tool in the HNC population. Results from this sample suggest that the depressive profile may be emerging across the treatment period and that 3-months post treatment may not be the single best time point to measure depression in HNC patients. Lastly,
Conflict of interest
None declared.
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