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Course of Depressive Symptoms in Patients Undergoing Heart Surgery: Confirmatory Analysis of the Factor Pattern and Latent Mean Structure of the Center for Epidemiologic Studies Depression Scale

From the Departments of Psychology (R.J.C., D.A.B.) and Sociology (E.L.I.), Rutgers, The State University of New Jersey, Piscataway, New Jersey; the Department of Surgery, UMDNJ–Robert Wood Johnson Medical School, New Brunswick, New Jersey (T.J.K.); and the Center of Alcohol Studies, Rutgers, The State University of New Jersey, Piscataway, New Jersey (E.W.L.).

Address correspondence and reprint requests to Richard J. Contrada, PhD, Department of Psychology, Rutgers University, 53 Avenue E, Piscataway, NJ 08854-8040. E-mail: contrada{at}rci.rutgers.edu

Objective: The purpose of this study was to examine the dimensionality, stability, and course of depressive symptoms over the 12-month period beginning approximately 1 week before heart surgery.

Methods: The Center for Epidemiological Studies Depression Scale (CES-D) was administered to 570 patients before heart surgery and 1, 3.5, 6.5, and 12.5 months later.

Results: Confirmatory factor analysis rejected a four-factor model as a result of small variances for two interpersonal items. With their elimination, a three-factor solution (negative affect, low positive affect, somatic/vegetative symptoms) showed good psychometric properties. Except for the somatic/vegetative factor at the 1-month follow up, there was a high degree of stability in the factor pattern over a 12-month period beginning approximately 1 week before heart surgery. Latent mean structure analysis indicated that, apart from elevations in several somatic/vegetative symptoms during the month after surgery, means for all three depressive symptoms declined over time. The recovery of positive affect showed a steeper trajectory toward the end of the follow-up period by comparison with the rates of decline for depressed affect and somatic/vegetative symptoms.

Conclusions: These findings support using 18 CES-D items to measure three depressive symptom dimensions in heart patients and may reflect a normative pattern of adjustment to heart surgery.

Key Words: Center for Epidemiologic Studies Depression Scale • depressive symptoms • coronary artery bypass graft surgery • valve surgery • confirmatory factor analysis • latent mean structure analysis

Abbreviations: CES-D = Center for Epidemiological Studies Depression Scale; CABG = coronary artery bypass graft surgery; CHD = coronary heart disease; MI = myocardial infarction; CFA = confirmatory factor analysis; RWJUH = Robert Wood Johnson University Hospital; UMDNJ = University of Medicine and Dentistry of New Jersey; EM = expectation maximization; MAR = missing at random; DA = depressed affect; PA = positive affect; S/V = somatic/vegetative; RMSEA = root mean square error of approximation; CI = confidence interval; CFI = comparative fit index.

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