Adam T. Perzynski, PhD & Aloen Townsend, PhD Presented in 2002 at the Annual Meeting of the Gerontological Society of America.

1. Examining Differences in CES-D
Measurement in The Health and
Retirement Study
Adam T. Perzynski & Aloen
Townsend, Case Western
Reserve University,
Cleveland, OH, 44106,
atp5@po.cwru.edu
NIA Grant R01 AG17546

2. ABSTRACT
This study uses latent variable structural equation modeling to
examine differences in the form of the Center for Epidemiologic
Studies Depression Scale (CES-D) in a sample of HRS older
adult couples. In separate years, the HRS has measured the
CES-D with four response categories and two response
categories. At Wave 2 a subsample responded to both types of
questions. Using the subsample data (N=522), this study
compares structural equation models and three dichotomization
techniques. The latent variables (SEM) approach
demonstrates that different forms of HRS CES-D measurement
closely represent the same underlying depression construct.

3. Revisions to the # of CES-D Items
 Since the initial publication of Lenore Radloff’s 1977 article on
the CES-D scale, proliferation of the CES-D has been
accompanied by a diversification in CES-D operationalization.
Of particular interest for the current paper are the seemingly
unabated revisions of the original 20-item CES-D.
 Studies using 4, 5, 8, 10, 11, 13, and 14 item CES-D scales
have all been reported on in the literature.
 Researchers have also expanded the CES-D by including
additional items for studies of special populations. 23 and 35
item versions have been reported on in the literature.
 Table 1 presents the original twenty CES-D items and
summarizes some of the sets of items used in shortened CES-
D studies.

4. Table 1 Items Used in Shortened Versions of the CES-D
HRS T1 HRS T2- EPESE Iowa Irwin Joseph Melchior Santor
ORIGINAL ITEMS 11 items 8 items 11 items 10 items 5 item 4 item 9 item
Bothered by things X X
Poor appetite X X
Felt blue X
Felt as good as others
Trouble concentrating X X
Felt depressed X X X X X X
Everything an effort X X X X X
Felt hopeful X
Life is a failure
Felt fearful X
Restless sleep X X X X X
Felt happy X X X X X
Talked less
Felt lonely X X X X X
People unfriendly X X
Enjoyed life X X X X
Crying spells X
Felt sad X X X X X
People dislike me X X
Could not get going X X X X

5. Revisions to CES-D Response
Categories
 In addition to the number of items used, investigators
have also taken liberties with the wording of the
introduction, the items and with the CES-D response
categories.
 The original four category CES-D has been
transformed into five, three and two category
versions.
 A summary of the CES-D wording and response
categories used by the HRS is presented in Table 2.

6. Wording and Response Categories
Table 2. HRS CES-D Wording and Response Categories
HRS Wave 1 HRS Wave 2
Please look at the top of page 2 of the Now think about the past week and the
booklet and tell me how often you feelings you have experienced.
have experienced the following Please tell me if each of the following
feelings in the past week. was true for you much of the time this
past week
1 = All or Almost All of the Time 1 = yes
2 = Most of the Time 5 = no
3 = Some of the Time
4 = None or Almost None of the Time

7. CES-D Scoring Methods
 Researchers using HRS and EPESE data
have responded to the problem of different
response categories by using two main
scoring techniques, both of which involve
dichotomizing the 4 category data.
 Table 3 presents Persistence and Presence
scoring methods.

8. Scoring and Dichotomization
Techniques
Table 3. CES-D Dichotomization Techniques
Radloff Persistence Presence
1 = All, Almost All, 1 = All, Almost All,
3 = All or Almost All of the Time or Most of the Most, or Some of
Time the Time
2 = Most of the Time
0 = Some, None, or
1 = Some of the Time Almost None of
the Time
0 = None or Almost None of the Time 0 = None of the Time

9. Persistence Scoring
 The persistence scoring procedure has been used and
evaluated in the existing literature (Gelin, 2001; Kohout et
al, 1993; Santor & Coyne, 1997). In the persistence
method, the original four category measure is split down
the middle. Thus it is only those whose depression
symptoms are “persistent” that are recoded as having a
depressive symptom.
 Those who answered “none of the time”(0) or “some of
the time” (1) are collapsed into “no” (0) indicating that
they do not have a particular depressive symptom.
Those who answered “most of the time” (2) or “all of the
time” (3) are collapsed into “yes” (1) indicating that they
do have a particular depressive symptom.

10. Presence Scoring
 The presence scoring procedure dichotomizes
responses based upon whether any depressive
symptom is present. Those who answered “none of
the time” (0) remain “no” (0) indicating that they do
not have a particular depressive symptom. Those
who answered “some of the time” (1), “most of the
time” (2), or “all of the time” (3) are collapsed into
“yes” (1) indicating that they have a particular
depressive symptom.

11. Data and Measures
 The Health and Retirement Study (HRS), aged 51-61, Waves 1
and 2
 N = 522
– Respondents have complete data.
– All Respondents are married.
– Respondents are part of a random subsample that answered
experimental CES-D items at Wave 2.
 Variables include:
– Eight CES-D items with four categories from Wave 1
– Eight CES-D items with two categories from Wave 2
– Eight CES-D items with four categories from Wave 2 administered
only to the Wave 2 subsample.
– Three CES-D summary measures for the above scales

12. Plot 1. Persistence Scoring
30
Brighter stars represent
higher concentrations
of cases
20
CES-D Module 4 Category
10
0 Rsq = 0.7575
-2 0 2 4 6 8
CES-D Persistence Score

13. Plot 2. Presence Scoring
30
Brighter stars represent
higher concentrations
of cases
20
CES-D Module 4 Category
10
0 Rsq = 0.8621
-2 0 2 4 6 8 10
CES-D Presence Score

14. Bivariate Pearson Correlations
Table 3. Correlations, Original CES-D
and Dichotomized Scales
Presence Persistence CES-D Two
Scoring Scoring Category
CES-D Four
Category 0.928 0.870 0.796
CES-D Two
Category 0.742 0.714 1.000
All correlations
are significant
at p < .01

15. Figure 1. Four Category and Two Category Structural Comparison
.49
e9 depressed depressed e10
.74 .86 .70
.60
e8 lonely .68 lonely e11
.46
.77
.77 .44
e7 sad .64 sad e12
.41
.66
.77 .16
e13 happy 4 cat. CES-D 2 cat. CES-D happy e15
.59 .41
.76
.45
e14 enjoy CMIN = 102.837 .67
.58 df = 34 enjoy e16
CFI = .632
TLI = .513
N = 522 RMSEA = .062
Mood Items Only

16. Figure 2. Four Category and Two Category Structural Comparison
.17
e9 depressed depressed e10
.66 .42
.81 Constrained
.15
e8 lonely .51 lonely e11
.26
.38
1.00 .10
e7 sad .50 sad e12
.25
.31
.80 .04
e13 happy 4 cat. CES-D 2 cat. CES-D happy e15
.63 .21
.75
.15
e14 enjoy CMIN = 111.420 .38
.56 df = 35 enjoy e16
CFI = .591
TLI = .474
N = 522 RMSEA = .065
Mood Items Only

17. Figure 3. Four Category and Two Category Somatic Constructs
.55 .93 .37
e9 effort
.74 .61 effort e10
.81 .71
.90 .84
e8 restless T2 CES-DS T2 CES-D restless e11
.37 .32
e7 get-going .61 CMIN = 110.013 .57 get going e12
df = 8
CFI = .640
TLI = .326
RMSEA = .156
N = 522
Figure 4. Four Category and Two Category Somatic Constructs
.41 1.00 .27
e9 effort
.64 .52 effort e10
.71 .75
.84 .86
e8 restless T2 CES-DS T2 CES-D restless e11
.25 .23
e7 get-going .50 .48 get going e12
CMIN = 112.839
df = 9
CFI = .634 Constrained Model
TLI = .390
RMSEA = .149
N = 522

18. Conclusions
 The latent variables approach can be used to
directly compare different forms of
measurement
 Different forms of CES-D measurement
closely represent the same latent construct
of depressive symptoms.
 For the current data set, if dichotomizing of
responses is necessary, the presence
approach is a better alternative than the
persistence approach