Yu Xuexin, Jones Richard N, Kobayashi Lindsay C, Gross Alden L
Center for Social Epidemiology and Population Health, Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA; Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA.
Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, RI, USA.
J Clin Epidemiol. 2025 Feb;178:111623. doi: 10.1016/j.jclinepi.2024.111623. Epub 2024 Dec 4.
We examined differential item functioning (DIF) of the Center for Epidemiologic Studies Depression Scale (CES-D) items by country and statistically harmonized common cross-national factor scores for the CES-D to aid further cross-national research.
Data were from Harmonized Cognitive Assessment Protocol (HCAP) studies in China (N = 9639), England (N = 1262), India (N = 4048), Mexico (N = 1918), South Africa (N = 631), and the United States (N = 3321). Multiple indicators, multiple causes models were estimated to test DIF in the CES-D items by country. DIF items were defined as having an odds ratio (OR) outside the range of 0.75-1.25 in multiple indicators, multiple causes models. We evaluated DIF impact and identified salient DIF by examining whether the difference between DIF-adjusted factor scores and non-DIF-adjusted factor scores exceeded a threshold of 0.30 standard deviation (SD) units. Confirmatory factor analysis was used to create DIF-adjusted, cross-nationally harmonized CES-D factor scores.
Controlling for underlying depressive symptoms, HCAP participants in India had higher odds of reporting being not hopeful about future (OR = 1.38, 95% confidence interval [CI]: 1.34-1.42), not enjoying life (OR = 1.43, 95% CI: 1.38-1.48), and being unhappy (OR = 1.29, 95% CI: 1.25-1.34), compared to HCAP participants in the United States. These identified DIF items artificially increased mean harmonized CES-D factor scores by 0.48 SD units in the India HCAP, with over 50% of the factor scores increased by over 0.30 SD units, indicating salient DIF in the India HCAP.
Our findings demonstrate cross-national heterogeneity in the expression of depressive symptoms. We provide DIF-adjusted CES-D factor scores to improve the quality of cross-national comparisons in aging research.
我们按国家对流行病学研究中心抑郁量表（CES-D）项目的差异项目功能（DIF）进行了检查，并对CES-D的通用跨国因子得分进行了统计协调，以助力进一步的跨国研究。
数据来自中国（N = 9639）、英国（N = 1262）、印度（N = 4048）、墨西哥（N = 1918）、南非（N = 631）和美国（N = 3321）的统一认知评估协议（HCAP）研究。估计了多指标多原因模型，以按国家检验CES-D项目中的DIF。DIF项目被定义为在多指标多原因模型中优势比（OR）超出0.75 - 1.25范围。我们通过检查DIF调整后的因子得分与非DIF调整后的因子得分之间的差异是否超过0.30标准差（SD）单位，来评估DIF影响并确定显著的DIF。使用验证性因子分析来创建DIF调整后的、跨国协调的CES-D因子得分。
在控制潜在抑郁症状的情况下，与美国的HCAP参与者相比，印度的HCAP参与者报告对未来不抱有希望（OR = 1.38，95%置信区间[CI]：1.34 - 1.42）、不享受生活（OR = 1.43，95% CI：1.38 - 1.48）以及不开心（OR = 1.29，95% CI：1.25 - 1.34）的几率更高。这些确定的DIF项目在印度HCAP中人为地使平均协调后的CES-D因子得分提高了0.48 SD单位，超过50%的因子得分提高了超过0.30 SD单位，表明印度HCAP中存在显著的DIF。
我们的研究结果表明抑郁症状表达存在跨国异质性。我们提供了DIF调整后的CES-D因子得分，以提高衰老研究中跨国比较的质量。
