Original Article

Spinal Cord (2008) 46, 287–292; doi:10.1038/sj.sc.3102127; published online 2 October 2007

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

W C Miller1,2,3, H A Anton2,4 and A F Townson2,4

  1. 1Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, British Columbia, Canada
  2. 2International Collaboration on Repair Discoveries, Vancouver, British Columbia, Canada
  3. 3GF Strong Rehabilitation Research Lab, Vancouver, British Columbia, Canada
  4. 4Division of Physical Medicine and Rehabilitation, University of British Columbia, Vancouver, British Columbia, Canada

Correspondence: Dr WC Miller, Department of Occupational Science and Occupational Therapy, University of British Columbia, T325-2211 Wesbrook Mall, Vancouver, BC, Canada V6T 2B5. E-mail: bcmiller@telus.net

Received 11 March 2007; Revised 11 August 2007; Accepted 11 August 2007; Published online 2 October 2007.

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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 greater than or equal to19, who had their SCI for greater than or equal to1 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.

Keywords:

CESD, validity, reliability, depression, measurement

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