LASA025 / LASA225
LASA606 / LASA706 / LASA906
LASEs806 / LASEs906
LASEt606 / LASEt706 / LASEt906
Contact: Almar Kok
Depression is among the most prevalent psychiatric disorders in late-life, but the prevalence appears to shift from a decrease in depressive disorders fulfilling rigorous diagnostic criteria according to DSM criteria, to an increasing prevalence of clinically relevant depressive symptomatology (also: sub threshold or minor depression), which are associated with declines in cognitive functioning, physical performance and conditions, health care utilization and mortality.
Measurement instrument in LASA
Within the LASA depressive symptoms are measured with the Center for Epidemiologic Studies Depression Scale (CES-D; Radloff, 1977). The CES-D is a self-report scale designed to measure depressive symptoms in the general population. The items were chosen to represent depressive symptoms, common in the community. The development of the scale has been described in detail elsewhere (Radloff et al. 1977, 1986; Beekman et al. 1994; 1997). Since its introduction it has been used extensively: at all ages, in more than 15 languages, in both healthy and illness populations and in different health care settings.
The CES-D consists of 20 items covering depressive symptomatology experienced in the past week. Each answer is rated on a 4-point scale ranging from 0 ‘rarely or never’ to 3 ‘mostly or always’. The total score of the 20 items ranges from 0 to 60, higher scores indicating more depressive symptoms.
First, the values for the positive affect items are reverse coded (item 4, 8, 12 and 16). Then, the items scores are summed up to compute the total CES-D score. Missing items are imputed with the rounded average of the available items, to a maximum of 2 items. If more than 2 items are missing, no scale score is computed. Other reasons for missing data include type of interview or a prematurely terminated interview. For respondents who participated in the telephone interview, the total CES-D scores can be found in the files ending with 906.
The CES-D has good psychometric properties in elderly samples (Himmelfarb and Murrell 1983, Radloff et al. 1986, Hertzog et al. 1990). The psychometric properties of the Dutch translation were tested in three groups of older persons prior to its use in LASA. Results were favorable and have been described in detail elsewhere (Beekman et al. 1994; 1997). The factor structure of the Dutch translation of the CES-D as used in the baseline measurement of the LASA study was similar to the factor structure of the original CES-D and to several other translated versions: depressed affect (item: 3, 6, 9, 10, 14, 17, 18), positive affect (item: 4, 8,12, 16), somatic and retarded activity (item: 1, 2, 5, 7, 11, 13, 20) and an interpersonal factor (item 15, 19) (Beekman et al 1994, 1997).
In most studies a score of 16 is used as a cut-off point to identify subjects with clinically relevant levels of depressive symptomatology (Berkman et al. 1986). Using this cut-off, the criterion validity for major depression was very satisfactory (sensitivity 100% and specificity 88%; Beekman et al., 1997).
The CES-D is a self-report symptom rating scale. It has been administered in different ways (face-to-face interview (main interview), telephone interview, self administration). In LASA the effect of different modes of administration were studied. Self-administered CES-D scales were found to yield systematically higher scores than when the scale was administered in a face-to-face interview. This mode effect, including a method to adjust for the mode effect, has been described in a separate paper (Geerlings et al 1999).
The CES-D is also part from the telephone interview (from D on) that is performed when the respondent is not able or willing to perform the whole interview. A short version of the CES-D is part from the telephone interview with the proxy when the respondent is not able perform the (short) interview at all. This short form consists of 4 questions (1, 6, 10 and 14).
LASAB025 / LASAC025 / LASAD025 / LASAE025 / LAS2B025 / LASAF025 / LASAG025 / LASAH025 / LAS3B025 / LASAI025/ LASAJ025 (main interview, in Dutch)
† in C also with respondent
LASEs806 (self-admin. questionnaire, in Dutch)
LASEt606 (telephone interview with PROXY, in Dutch)
LASEt706 (telephone interview with RESP, in Dutch)
LASAB025 / LASAC025 / LASAD025 / LASAE025 / LAS2B025 / LASAF025 / LASAG025 / LASAH025 / LAS3B025 / LASAI025 / LASAJ025;
LASAB225 / LASAC225 / LASAD225 / LASAE225 / LAS2B225 / LASAF225 / LASAG225 / LASAH225 / LAS3B225 / LASAI225/ LASAJ225 (scale scores)
LASAC606 / LASAD606 / LASAE606
LASAD706 / LASAE706 / LASAF706 / LASAG706 / LASAH706 / LASAI706 / LASAJ706;
LASAD906 / LASAE906 / LASAF906 / LASAG906 / LASAH906 / LASAI906 / LASAJ906 (scale scores)
LASEs806 / LASEs906 (scale scores)
LASEt706 / LASEt906 (scale scores)
Availability of information per wave ¹
|CES-D, short form||-||Tp†||Tp||Tp||Tp||-||-||-||-||-||-||-||-|
¹ More information about the LASA data collection waves is available here.
* IM=interim measurement between E and F (first cohort only);
2B=baseline second cohort;
3B=baseline third cohort;
MB=migrants: baseline first cohort;
K=future wave 2021-2022
† in LASAC606 also with respondent
Ma=data collected in main interview;
Sa=data collected in self-admin. questionnaire;
Tr=data collected in telephone interview with respondent;
Tp=data collected in telephone interview with proxy and in C also with respondent (short form)
Previous use in LASA
– as a dichotomous variable using the generally accepted cut-off for clinically relevant depressive symptoms: CES-D ≥ 16.
– as a continuous variable measuring increasing levels of depressive symptoms.
Within LASA, numerous papers have been written using the CES-D: on the prevalence and risk factors for minor and major depression, on different symptoms profiles in specific risk groups, on the natural course of depression, on the association with different aspects of physical health (iatrogenic depression, pain, cognitive decline, cardiovascular diseases and mortality), on gender differences, on religion, on the comorbidity with anxiety disorders and about health care utilization.
- Beekman ATF, van Limbeek J, Deeg DJH, Wouters L, van Tilburg W (1994). Een screenings-instrument voor depressie bij ouderen in de algemene bevolking: de bruikbaarheid van de Center for Epidemiologic Studies Depression Scale (CES-D). Tijdschr Gerontol Geriatrie, 25, 95-103.
- Beekman ATF, Deeg DJH, van Limbeek J, et al. 1997. Criterion validity of the Center for Epidemiologic Studies Depression scale (CES-D): results from a community based sample of older adults in the Netherlands. Psychol. Med. 27, 231-235.
- Berkman LF, Berkman CS, Kasl SV, et al. (1986) Depressive symptoms in relation to physical health and functioning in the elderly. Am. J. Epidem. 124, 372-388.
- de Beurs E, Comijs HC, Twisk JWR, Sonnenberg C, Beekman ATF, & Deeg DJH. Stability and change in symptoms of depression, anxiety, and general negative affect in late life: modelling of vulnerability profiles. Journal of Affective Disorders, 2005, 84: 53-62.
- Bierman EJ, Comijs HC, Jonker C, & Beekman AT. Symptoms of Anxiety and Depression in the Course of Cognitive Decline. Dem Geriatr Cogn Disord. 2007, 10, 24(3):213-219.
- Braam AW, Hein E, Deeg DJ, Twisk JW, Beekman AT, Van Tilburg W. Religious involvement and 6-year course of depressive symptoms in older Dutch citizens: results from the Longitudinal Aging Study Amsterdam. J Aging Health. 2004;16(4):467-89.
- Braam AW, Beekman AT, Knipscheer CP, Deeg DJ, van den Eeden P, van Tilburg W. Religious denomination and depression in older Dutch citizens: patterns and models. J Aging Health. 1998 Nov;10(4):483-503.
- Bremmer MA, Beekman AT, Deeg DJ, Penninx BW, Dik MG, Hack CE, Hoogendijk WJ. Inflammatory markers in late-life depression: results from a population-based study. J Affect Disord. 2008 Mar;106(3):249-55.
- Comijs HC, Beekman ATF, Smit F, van Tilburg T, & Deeg DJH. The association between recent life events and depressive symptoms in older persons and the interaction with early events. J Affect Disord. 2007, 103(1-3):243-246.
- Comijs HC, van Tilburg T, Geerlings SW, Jonker C, Deeg DJH, van Tilburg W, & Beekman ATF. Do severity and duration of depressive symptoms predict cognitive decline older persons? Results of the Longitudinal Aging Study Amsterdam. Aging Clin Exp Res, 2004, 16 (3): 226-232.
- Geerlings SW, Beekman ATF, Deeg DJH, Smit JH, van Tilburg W (1999) The Center for Epidemiologic Studies Depression scale (CES-D) in a mixed mode, repeated measures design: age and sex differences. Int J Meth Psychiatr Res 8, 102-109.
- Hertzog C, van Alstine J, Usala PD, Hultsch DF, Dixon, R. (1990) Measurement properties of the center for epidemiological studies depression scale (CES-D) in older populations. Psychol. Assess. 2, 64-72.
- Hilderink, P.H., Burger, H., Deeg, D.J.H., Beekman, A.T.F., Oude Voshaar, R.C. (2012). The temporal relation between pain and depression: results from the longitudinal aging study Amsterdam. Psychosom Med., 74, 9, 945-951.
- Himmelfarb S and Murrell SA (1983) Reliability and validity of five mental health scales in older persons. J. Gerontol. 38, 333-339.
- Hoogendijk WJ, Lips P, Dik MG, Deeg DJ, Beekman AT, Penninx BW. Depression is associated with decreased 25-hydroxyvitamin D and increased parathyroid hormone levels in older adults. Arch Gen Psychiatry. 2008 65(5):508-12.
- Janssen J, Beekman AT, Comijs HC, Deeg DJ, & Heeren TJ. Late-life depression: the differences between early- and late-onset illness in a community-based sample. Int J Geriatr Psychiatry. 2006, 21(1):86-93.
- de Jongh RT, Lips PTA, van Schoor NM, Rijs KJ, Deeg DJH, Comijs HC, Kramer MHH, Vandenbroucke JP, Dekkers OM (2011). Endogenous subclinical thyroid disorders, physical and cognitive function, depression, and mortality in older individuals. European Journal of Endocrinology, 165, 545-554.
- van den Kommer TN, Comijs HC, Aartsen MJ, Huisman M, Deeg DJH, Beekman ATF (2013). Depression and Cognition: How Do They Interrelate in Old Age? The American Journal of Geriatric Psychiatry, 21, (4), 398-410.
- Michielsen M, Comijs HC, Semeijn EJ, Beekman ATF, Deeg DJH, Kooij JJS. The comorbidity of anxiety and depressive symptoms in older adults with attention-deficit/hyperactivity disorder: A longitudinal study. Journal of Affective Disorders, 2012, 148, 2-3, 220-22.
- Pronk M, Deeg DJH, Smits C, van Tilburg TG, Kuik DJ, Festen JM, Kramer SE (2011). Prospective effects of hearing status on loneliness and depression in older persons: Identification of subgroups. International Journal of Audiology, 50, 887-896.
- Radloff LS. 1977. The CES-D Scale: A self-report depression scale for research in the general population. Appl. Psychol. Meas. 3, 385-401.
- Radloff LS and Teri L, (1986) Use of the CES-D with older adults. Clin. Gerontol. 5, 119-36.
- Sanders, J.B., Bremmer, M.A., Comijs, H.C., Deeg, D.J.H., Lampe, I.K., Beekman, A.T.F. (2011). Cognitive functioning and the natural course of depressive symptoms in late life. American Journal of Geriatric Psychiatry, 19, 664-672.
- Sonnenberg CM, Beekman AT, Deeg DJ, van Tilburg W. Sex differences in late-life depression. Acta Psychiatr Scand. 2000 101(4):286-92.
- Sonnenberg CM, Deeg DJH, van Tilburg TG, Vink D, Stek ML, Beekman ATF (2013). Gender differences in the relation between depression and social support in later life. International Psychogeriatrics, 25 (1), 61-70.
- Steunenberg B, Beekman AT, Deeg DJ, Kerkhof AJ. Personality and the onset of depression in late life. J Affect Disord. 2006, 92(2-3):243-51.
- Steunenberg B, Beekman AT, Deeg DJ, Bremmer MA, Kerkhof AJ. Mastery and neuroticism predict recovery of depression in later life. Am J Geriatr Psychiatry. 2007, 15(3):234-42.
Date of last update: December, 2019