Psychometrics of the Depressive Cognition Scale in Caregivers of Persons with Autism Spectrum Disorders

Caregivers of persons with autism spectrum disorders (ASD) are prone to depression, and early identification of cognitive depressive symptoms is important to prevent the development of clinical depression. The Depressive Cognition Scale (DCS) can be used for early detection, but the scale's psychometrics has not been tested in caregivers of persons with ASD. In this study, 95 caregivers of persons with ASD completed the eight-item DCS and measures of caregiver burden and resourcefulness. A Cronbach's alpha of . 90 indicated internal consistency. Construct validity was supported by significant correlations with caregiver burden (.59) and resourcefulness (− .57). Principal component factor analysis produced a single factor with 58% of the variance explained. The findings suggest the DCS is useful for early detection of depression in caregivers of persons with ASD. In the United States, 2.8 million people have autism spectrum disorder (ASD) (Rice, 2009), a complex developmental disability that affects a person's ability to communicate and to interact socially. Persons with ASD can be aggressive, anxious, overactive, and self-injurious (Hoffman et al., 2008, Matson and Fodstad, 2009). ASD symptoms emerge before age three (APA, 2000), and caregiving for these children is demanding, and often overwhelming, and can affect family caregivers' physical and psychological well-being (Altiere and Von Kluge, 2009, Baker et al., 2005, Benson, 2006, Benson et al., 2008, Gray, 2006, Phetrasuwan and Miles, 2009). Caregiver burden results from the child's problem behaviors, life-long dependency, and lack of social interactions, as well as financial difficulties, frustration, anxiety, reduction in leisure activities, and worry about the future (Baker et al., 2005, Benderix et al., 2006, Benson, 2006, Carbone et al., 2010, Montes and Halterman, 2007). Previous research has indicated that caregivers report depressive symptoms associated with the burden of providing care to persons with ASD (Benson, 2006, Benson and Karlof, 2009, Carter et al., 2009, Ekas et al., 2010). In addition, recent research indicates that persons with ASD themselves may experience anxiety and depression (Strang et al., 2012), which can in turn increase caregivers' depression and anxiety. Parents of persons with ASD have been shown to be at higher risk for developing depression than parents of normally developed children (Benson, 2006). In turn, caregiver depression can be a factor in chronic illnesses such as heart disease, diabetes, and cancer (Steptoe, 2007). The Center for Epidemiological Studies Depression Scale is the scale most widely used scale to assess depressive symptoms among caregivers of persons with ASD (CES-D; Radloff, 1977) (Benson and Karlof, 2009, Carter et al., 2009, Davis and Carter, 2008, Ekas et al., 2010, Ekas and Whitman, 2010, Ekas et al., 2009, Magana and Ghosh, 2010, Smith et al., 2008). In addition, the SelfRating Depression Scale by Zung (1965) has been used to assess depressive symptoms in mothers of children with autism and compared these depressive symptoms to mothers of children without autism (Tunali & Power, 2002). The Hospital Anxiety and Depression scale (HADS; Zigmond & Snaith, 1983) is also used to assess parents of children with ASD mental health (Hastings et al., 2005, Lloyd and Hastings, 2009). However, although these scales are widely used and they have acceptable reliability and validity, they all measure a constellation of symptoms that may reflect clinical depression; none of the scales measure the cognitive symptoms that may precede clinical depression. Therefore, there is an urgent need to assess depressive cognitions in order to ensure early detection and treatment and prevent severe depression among caregivers of persons with ASD. This study therefore measured the psychometric properties of the Depressive Cognition Scale among caregivers of persons with ASD. The Depressive Cognition Scale: conceptual basis, description, and uses The Depressive Cognition Scale (DCS) was developed originally by Zauszniewski (1995), based on Beck's cognitive theory, which suggests that cognitive symptoms of depression develop before clinical depression (Beck, 1991). The scale is also based on Erikson's psychosocial stages of development, and each of the eight depressive cognition items on the scale reflects unsuccessful resolution of one of the stages outlined by Erikson (Erickson, 1994, Zauszniewski, 1995); thus the DCS measures depressive cognitions when scoring is reversed. The DCS has been used with various populations, including older adults (Bekhet et al., 2008, Zauszniewski, 1995, Zauszniewski, 1997), African-American women (Zauszniewski, Picot, Debanne, Wykle, & Roberts, 2002), caregivers of persons with serious mental illness (Zauszniewski & Suresky, 2010), and females with type 2 diabetes (Zauszniewski, Chung, Krafcik, & Sousa, 2001). The eight-item DCS has also been translated into many languages including Arabic (Bekhet et al., 2011, Bekhet and Zauszniewski, 2010), Portuguese (Sousa et al., 2008, Sousa et al., 2005), Korean (Yeun, Kwon, & Kim, 2012), and Thai (Bunthumporn, 2012).