Psychometric validation of the Center for Epidemiological Studies Depression Scale in Head and Neck Cancer patients

Objective: The Center for Epidemiological Studies Depression Scale (CES-D) is a 20-item tool developed to screen for depression in the general population. To psychometrically evaluate and validate the CES-D scale for use in head and neck cancer (HNC) patients. Methods: The CES-D was applied to 130 subjects at onset of radiation treatment and 3-months following treatment. Analysis was conducted via face and content validity using two expert raters, internal consistency was applied using Cronbach's alpha, test retest reliability comparing baseline to 3-month application, concurrent validity was performed against the FACT-H&N and Pain Disability Index, construct validity was conducted via exploratory factor analysis. Results: The sample was predominantly male receiving chemo radiation. Face validity was strong (alpha = 0.85). Significant difference was found in the mean score between depressed (CES-D cut point=16) vs. non-depressed (t= -15.84, p =. 00) (95% CI = -17.18, - 13.33). Internal consistency of the scale was high (alpha= 0.84). Test retest reliability (p <.001) showed moderate-strong correlations (0.51), however was not sensitive to change in this sample across the study time period. Concurrent validity was strong (r=-0.77, 0.51). Factor analysis at 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: Results confirm the reliability and validity of the CES-D as a measure of depression in HNC populations. Proposed cut off scores remain stable but scale responsiveness suggests caution when evaluating change over time in this population.