Psychometric Validation of the Center for Epidemiological Studies Depression (CES-D) scale in Head and Neck Cancer (HNC) Patients

Introduction – Rates of depression in HNC are high. The CES-D is a 20 item scale developed and validated to screen for depression in the general population however it has not been validated for use with HNC patients.

Objective – To psychometrically evaluate and validate the CES-D scale in HNC patients. 

Methods – The CES-D was applied to 130 subjects from a clinical trial at baseline and 3 months. Psychometric analysis was conducted through face and content validity using expert raters, internal consistency using Cronbach’s alpha, test retest reliability, concurrent validity against the FACT-H&N and Pain disability Index (PDI), and construct validity via exploratory factor analysis.

Results – Patients were Caucasian (94%), male (76.7%) receiving chemo radiation (76.2%) (Table 1). Face validity for measuring depression in HNC was strong (α=0.85). A significant difference was found in the mean score (t= -15.841, p= 0.0001) (95% CI = -17.18,-13.33) between depressed (CES-D cut point ≥16) vs. non-depressed. Internal consistency of the scale was high (α=0.840). Test retest reliability showed moderate-strong correlations (0.512, p=0.0001), however was not sensitive to change across this time. Strong inter-correlations (r = -0.778, 0.515) with FACT-H&N and PDI were noted (Table 2). Factor analysis (baseline) explained 54.92% of variance, with 3 distinct factors; depressed affect, somatic /retarded activity and positive affect. In contrast to general populations, the factor “disturbed interpersonal skill” was not retained.

Conclusion – Findings confirm the reliability and validity of the CES-D and support the use of the CES-D as a measure of depression in HNC populations.