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BMC Psychiatry. 2011; 11: 141.
Published online Aug 24, 2011. doi:  10.1186/1471-244X-11-141
PMCID: PMC3179715
Dimensionality and scale properties of the Edinburgh Depression Scale (EDS) in patients with type 2 diabetes mellitus: the DiaDDzoB study
Evi SA de Cock,#1,2 Wilco HM Emons,#1,3 Giesje Nefs,1 Victor JM Pop,1 and François Pouwercorresponding author1
1Department of Medical Psychology & Neuropsychology, Center of Research on Psychology in Somatic diseases (CoRPS), Tilburg University, Tilburg, The Netherlands
2Department of Developmental and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
3Department of Methodology and Statistics, Tilburg University, Tilburg, The Netherlands
corresponding authorCorresponding author.
#Contributed equally.
Evi SA de Cock: e.s.a.decock/at/uvt.nl; Wilco HM Emons: w.h.m.emons/at/uvt.nl; Giesje Nefs: g.m.nefs/at/uvt.nl; Victor JM Pop: v.j.m.pop/at/uvt.nl; François Pouwer: f.pouwer/at/uvt.nl
Received December 8, 2010; Accepted August 24, 2011.
Abstract
Background
Depression is a common complication in type 2 diabetes (DM2), affecting 10-30% of patients. Since depression is underrecognized and undertreated, it is important that reliable and validated depression screening tools are available for use in patients with DM2. The Edinburgh Depression Scale (EDS) is a widely used method for screening depression. However, there is still debate about the dimensionality of the test. Furthermore, the EDS was originally developed to screen for depression in postpartum women. Empirical evidence that the EDS has comparable measurement properties in both males and females suffering from diabetes is lacking however.
Methods
In a large sample (N = 1,656) of diabetes patients, we examined: (1) dimensionality; (2) gender-related item bias; and (3) the screening properties of the EDS using factor analysis and item response theory.
Results
We found evidence that the ten EDS items constitute a scale that is essentially one dimensional and has adequate measurement properties. Three items showed differential item functioning (DIF), two of them showed substantial DIF. However, at the scale level, DIF had no practical impact. Anhedonia (the inability to be able to laugh or enjoy) and sleeping problems were the most informative indicators for being able to differentiate between the diagnostic groups of mild and severe depression.
Conclusions
The EDS constitutes a sound scale for measuring an attribute of general depression. Persons can be reliably measured using the sum score. Screening rules for mild and severe depression are applicable to both males and females.
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