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Cardiac Depression Scale: Mokken scaling in heart failure patients

Chantal F Ski1, David R Thompson1*, David L Hare2, Andrew G Stewart2 and Roger Watson3

Author Affiliations

1 Cardiovascular Research Centre, Australian Catholic University, Melbourne, Australia

2 Department of Medicine, University of Melbourne and Department of Cardiology, Austin Hospital, Melbourne, Australia

3 School of Nursing, University of Hull, Hull, United Kingdom

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Health and Quality of Life Outcomes 2012, 10:141  doi:10.1186/1477-7525-10-141

Published: 23 November 2012



There is a high prevalence of depression in patients with heart failure (HF) that is associated with worsening prognosis. The value of using a reliable and valid instrument to measure depression in this population is therefore essential. We validated the Cardiac Depression Scale (CDS) in heart failure patients using a model of ordinal unidimensional measurement known as Mokken scaling.


We administered in face-to-face interviews the CDS to 603 patients with HF. Data were analysed using Mokken scale analysis. Items of the CDS formed a statistically significant unidimensional Mokken scale of low strength (H<0.40) and high reliability (Rho>0.8).


The CDS has a hierarchy of items which can be interpreted in terms of the increasingly serious effects of depression occurring as a result of HF. Identifying an appropriate instrument to measure depression in patients with HF allows for early identification and better medical management.

Cardiac Depression Scale; Heart failure; Depression; Mokken scaling