The Cornell Scale for Depression in Dementia (CSDD) is widely used to assess depressive symptoms, but its factor structure has not been well explored in assisted living (AL) residents. An appropriate measure of depressive symptoms for this population is crucial to ensure accurate detection of depression. This study tested the CSDD’s factor structure in 511 AL residents from 85 facilities using baseline data from a randomized trial. Confirmatory factor analyses and chi-square difference tests were conducted. Three items were removed due to low factor loadings. The five-factor model fit significantly better (χ2 = 796.08, ∆χ2 = 22.86, ∆df = 4, p < .001) than the four-factor model, although both showed poor fit. These results offer partial support for the modified five-factor CSDD in assessing depression among AL residents. Future research should explore more appropriate depression measures for this population, potentially incorporating items that more accurately capture depressive symptoms in AL residents.
Parent study trial registry name
Dissemination and Implementation of Function Focused Care for Assisted Living (NCT03459118).
AlexopoulosG. S.AbramsR. C.YoungR. C.ShamoianC. A. (1988a). Cornell Scale for Depression in Dementia. Biological Psychiatry, 23(1), 271–284. https://doi.org/10.3109/9780203213896-29
2.
AlexopoulosG. S.AbramsR. C.YoungR. C.ShamoianC. A. (1988b). Use of the Cornell Scale in Nondemented Patients. Journal of the American Geriatrics Society, 36(3), 230–236. https://doi.org/10.1111/j.1532-5415.1988.tb01806.x
3.
AzizR.SteffensD. C. (2013). What are the causes of late-life depression?Psychiatric Clinics of North America, 36(4), 497–516. https://doi.org/10.1016/j.psc.2013.08.001
4.
BalsamoM.CataldiF.CarlucciL.PaduloC.FairfieldB. (2018). Assessment of late-life depression via self-report measures: A review. Clinical Interventions in Aging, 13(1), 2021–2044. https://doi.org/10.2147/CIA.S178943
5.
BandalosD. L.FinneyS. J. (2018). Factor analysis: Exploratory and confirmatory. In HancockG.StapletonL.MuellerR. (Eds.), Reviewer’s guide to quantitative methods in the social sciences (2nd ed., pp. 93–114). Routledge.
6.
BarcaM. L.EngedalK.SelbaekG.KnapskogA. B.LaksJ.CoutinhoE.BenthJ. Š. (2015). Confirmatory factor analysis of the Cornell scale for depression in dementia among patient with dementia of various degrees. Journal of Affective Disorders, 188(1), 173–178. https://doi.org/10.1016/j.jad.2015.08.062
7.
BollenK. A. (1989). Structural equations with latent variables. Wiley-Interscience.
8.
BollenK. A. (1990). Overall fit in covariance structure models: Two types of sample size effects. Psychological Bulletin, 107(2), 256–259. https://doi.org/10.1037//0033-2909.107.2.256
9.
BorsonS.ScanlanJ. M.ChenP.GanguliM. (2003). The Mini-Cog as a screen for dementia: Validation in a population-based sample. Journal of the American Geriatrics Society, 51(10), 1451–1454. https://doi.org/10.1046/j.1532-5415.2003.51465.x
10.
BorzaT.EngedalK.BerghS.BarcaM. L.BenthJ. Š.SelbækG. (2015). The course of depressive symptoms as measured by the Cornell scale for depression in dementia over 74 months in 1158 nursing home residents. Journal of Affective Disorders, 175(1), 209–216. https://doi.org/10.1016/j.jad.2014.12.053
11.
BrownT. A. (2015). Model revision and comparison. In Confirmatory factor analysis for applied research (2nd ed.). Guilford Publications.
12.
BrowneM. W.CudeckR. (1993). Alternative ways of assessing model fit. In BollenK. A.LongJ. S. (Eds.), Testing structural equation models (pp. 136–162). Sage Publications.
13.
GeorgeL. K. (2011). Social factors, depression, and aging. In BinstockR. H.GeorgeL. K. (Eds.), Handbook of aging and the social sciences (pp. 149–162).
14.
HaighE. A. P.BoguckiO. E.SigmonS. T.BlazerD. G. (2018). Depression among older adults: A 20-year update on five common myths and misconceptions. American Journal of Geriatric Psychiatry, 26(1), 107–122. https://doi.org/10.1016/j.jagp.2017.06.011
15.
Harris-KojetinL.SenguptaM.LendonJ.RomeV.ValverdeR.CaffreyC. (2019). Long-term care providers and services users in the United States, 2015–2016. In Vital Health Stat (Vol. 3(43)). National Center for Health Statistics. Available at: https://www.cdc.gov/nchs/data/series/sr_03/sr03_43-508.pdf
16.
HarwoodD. G.OwnbyR. L.BarkerW. W.DuaraR. (1998). The factor structure of the Cornell Scale for Depression in Dementia among probable Alzheimer’s disease patients. American Journal of Geriatric Psychiatry, 6(3), 212–220. https://doi.org/10.1097/00019442-199800630-00004
17.
HuL. T.BentlerP. M. (1999). Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Structural Equation Modeling, 6(1), 1–55. https://doi.org/10.1080/10705519909540118
18.
KalesH. C.GitlinL. N.LyketsosC. G. (2014). Management of neuropsychiatric symptoms of dementia in clinical settings: Recommendations from a multidisciplinary expert panel. Journal of the American Geriatrics Society, 62(4), 762–769. https://doi.org/10.1111/jgs.12730
19.
KokR. M.ReynoldsC. F. (2017). Management of depression in older adults: A review. Journal of the American Medical Association, 317(20), 2114–2122. https://doi.org/10.1001/jama.2017.5706
20.
KørnerA.LauritzenL.AbelskovK.GulmannN.Marie BrodersenA.Wedervang-JensenT.Marie KjeldgaardK. (2006). The Geriatric Depression Scale and the Cornell Scale for Depression in Dementia. A validity study. Nordic Journal of Psychiatry, 60(5), 360–364. https://doi.org/10.1080/08039480600937066
21.
KroenkeK.SpitzerR. L.WilliamsJ. B. W. (2001). The PHQ-9: Validity of a brief depression severity measure. Journal of General Internal Medicine, 16(9), 606–613. https://doi.org/10.1046/j.1525-1497.2001.016009606.x
22.
KurlowiczL. H.EvansL. K.StrumpfN. E.MaislinG. (2002). A psychometric evaluation of the Cornell Scale for Depression in Dementia in a frail, nursing home population. American Journal of Geriatric Psychiatry, 10(5), 2. https://doi.org/10.1016/j.jaci.2012.05.050
23.
LinJ. N.WangJ. J. (2008). Psychometric evaluation of the Chinese version of the cornell scale for depression in dementia. Journal of Nursing Research, 16(3), 202–210. https://doi.org/10.1097/01.JNR.0000387307.34741.39
OwnbyR. L.HarwoodD. G.AcevedoA.BarkerW.DuaraR. (2001). Factor structure of the Cornell Scale for Depression in Dementia for Anglo and Hispanic patients with dementia. American Journal of Geriatric Psychiatry, 9(3), 217–224.
26.
ParkS. H.ChoY. S. (2022). Predictive validity of the Cornell Scale for depression in dementia among older adults with and without dementia: A systematic review and meta-analysis. Psychiatry Research, 310(1), 1. https://doi.org/10.1016/j.psychres.2022.114445
27.
RadloffL. S. (1977). The CES-D Scale : A self-report depression scale for research in the general population. Applied Psychological Measurement, 1(3), 385–401.
28.
ResnickB.BoltzM.GalikE.FixS.HolmesS.ZhuS.BarrE. (2021). Testing the implementation of function-focused care in assisted living settings. Journal of the American Medical Directors Association, 22(8), 1706–1713. https://doi.org/10.1016/j.jamda.2020.09.026
29.
RosseelY. (2012). lavaan: An R package for structural equation modeling. Journal of Statistical Software, 48(2), 1–36. https://doi.org/10.18637/jss.v048.i02
30.
SchmittT. A. (2011). Current methodological considerations in exploratory and confirmatory factor analysis. Journal of Psychoeducational Assessment, 29(4), 304–321. https://doi.org/10.1177/0734282911406653
31.
SchreinerA. S.MorimotoT. (2002). Factor structure of the Cornell Scale for Depression in Dementia among Japanese poststroke patients. International Journal of Geriatric Psychiatry, 17(8), 715–722. https://doi.org/10.1002/gps.684
32.
SenguptaM.LendonJ. P.CaffreyC.MelekinA.SinghP. (2022). Post-acute and long-term care providers and services users in the United States, 2017-2018. National Center for Health Statistics.
33.
SheikhJ. I.YesavageJ. A. (1986). Geriatric Depression Scale (GDS): Recent evidence and development of a shorter version. Clinical Gerontologist, 5(1–2), 165–173. https://doi.org/10.1300/J018v05n01_09
34.
ShiD.LeeT.Maydeu-OlivaresA. (2019). Understanding the model size effect on SEM fit indices. Educational and Psychological Measurement, 79(2), 310–334. https://doi.org/10.1177/0013164418783530
35.
ShwartzS. K.MorrisR. D.PennaS. (2019). Psychometric properties of the Saint Louis University Mental Status Examination. Applied Neuropsychology: Adultspan, 26(2), 101–110. https://doi.org/10.1080/23279095.2017.1362407
36.
StensvikG. T.HelvikA. S.NakremS.HauganG. (2021). Cornell’s Depression for Dementia Scale: A psychometric study among Norwegian nursing home residents. Archives of Gerontology and Geriatrics, 93(2), 1–9. https://doi.org/10.1016/j.archger.2020.104325
37.
TariqS. H.TumosaN.ChibnallJ. T.PerryM. H.MorleyJ. E. (2006). Comparison of the Saint Louis University Mental Status examination and the Mini-Mental State Examination for detecting dementia and mild neurocognitive disorder - A pilot study. American Journal of Geriatric Psychiatry, 14(11), 900–910. https://doi.org/10.1097/01.JGP.0000221510.33817.86
38.
TegelerC.BeyerA. K.HoppmannF.LudwigV.KesslerE.-M. (2020). Current state of research on psychotherapy for home-living vulnerable older adults with depression. Journal of Gerontology and Geriatrics, 53(8), 721–727. https://doi.org/10.1007/s00391-020-01805-3
39.
VolicerL.FrijtersD. H. M.van der SteenJ. T. (2012). Relationship between symptoms of depression and agitation in nursing home residents with dementia. International Journal of Geriatric Psychiatry, 27(7), 749–754. https://doi.org/10.1002/gps.2800
40.
VolicerL.van der SteenJ. T.FrijtersD. H. M. (2009). Modifiable factors related to abusive behaviors in nursing home residents with dementia. Journal of the American Medical Directors Association, 10(9), 617–622. https://doi.org/10.1016/j.jamda.2009.06.004
41.
WongpakaranN.WongpakaranT.Van ReekumR. (2013). Discrepancies in cornell scale for depression in dementia (CSDD) items between residents and caregivers, and the CSDD’s factor structure. Clinical Interventions in Aging, 8(1), 641–648. https://doi.org/10.2147/CIA.S45201
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
