The measure and mismeasure of depression in older adults

Objectives: The 10-item Centre for Epidemiological Studies Depression Scale (CES-D-10) has been used in cohort studies with scores of >= 8 and >= 10 used to indicate clinically significant symptoms or probable depression. We examined whether observations crossing these thresholds displayed core affective features expected in individuals who might be suffering with a clinically significant major depressive episode. Methods: This was a descriptive analysis of repeated CES-D-10 assessments in the ASPirin in Reducing Events in the Elderly eXTension (ASPREE-XT) longitudinal cohort study of 19,114 participants. We identified observations of 'probable depression', defined as a CES-D-10 score >= 8 and then examined scores on item 3 ("I felt depressed") and item 8 ("I was happy"). The primary outcome was the proportion of threshold-positive CES-D-10 observations with minimally depressed mood and preserved happiness. Results: Over 13 years, 27,417 observations met the threshold of CES-D-10 >= 8. Of these, 13,356 observations (48.7%) had minimally depressed mood and preserved happiness. Conclusion: A substantial proportion of observations considered 'probable depression' had little or no depressed mood, together with preserved happiness. CES-D-10 sum scores should be used with caution as a proxy for major depressive disorder in older adults.