The composition and structure of depressive symptomatology in renal disease

Renal disease is an increasingly common illness among middle-aged and older adults, and is often associated with depression. The Center for Epidemiologic Studies Depression Scale (CES-D) is a widely used self-report screening measure on which responses generally conform to a 4-factor structure, with each factor loading onto a higher-order Depression factor. The current study examines whether this structure is supported among individuals with renal disease (both predialysis and posttransplant kidney disease patients). Persons with renal disease (n = 225) and healthy control participants (n = 230) were recruited from Vancouver General Hospital and the community. Participants completed the CES-D as part of an extended assessment. Confirmatory factor analytic models were computed for the renal disease and healthy control groups. Results support a 4-factor structure for CES-D responses in persons with renal disease and healthy controls. The hierarchical structure of CES-D responses also appears invariant between groups. Factor structure was similar between groups; only for Depressive Affect was the strength of association with the second-order factor greater among the renal disease than healthy control participants. Findings support similarity of CES-D factor structures between patients with renal disease and healthy individuals. Results suggest that the CES-D's 4 factors contribute to measurement of a higher-order Depression factor in both groups; furthermore, 3 of 4 factors appear invariant between groups. As such, this measure can be used confidently to quantify depressive symptoms in individuals with renal disease.