Adaptation of the Korean version of the EURO-D scale for middle-aged men with depression

Middle-aged men are at high risk of depression and related mental health problems. The purpose of this study is to develop a Korean version of the European Union initiative to compare symptoms of depression (EURO-D) scale and verify its reliability and validity to assess the severity of depression in middle-aged men. The Korean version of the EURO-D tool, and Patient Health Questionnaire-9 were employed. Item difficulty was evaluated by item response theory, and we found that there were neither very easy nor difficult items. Test-retest reliability was high. Convergent validity and discriminant validity were both confirmed. The application of the Korean version of the EURO-D scale can guide the screening, diagnosis and treatment of depression in middle-aged men and provide insights for mental health research, as well as clinical practice.

Male menopause; Depression; Factor analysis; Statistical; Validation study; EURO-D scale

[1] World Health Organization. Depressive disorder (depression). 2023. Available at: https://www.who.int/news-room/fact-sheets/detail/depression (Accessed: 30 July 2024).

[2] Korea Disease Control and Prevention Agency. Korea health statistics 2020: Korea national health and nutrition examination survey (KNHANES VIII-2). 2022. Available at: https://kosis.kr/statHtml/statHtml.do?orgId=101&tblId=DT_1SSHE130R&conn_path=I2&language=en (Accessed: 30 July 2024).

[3] Kaji T, Mishima K, Kitamura S, Enomoto M, Nagase Y, Li L, et al. Relationship between late-life depression and life stressors: large-scale cross-sectional study of a representative sample of the Japanese general population. Psychiatry and Clinical Neurosciences. 2010; 64: 426–434.

[4] Arias de la Torre J, Vilagut G, Ronaldson A, Dregan A, Ricci-Cabello I, Hatch SL, et al. Prevalence and age patterns of depression in the United Kingdom. A population-based study. Journal of Affective Disorders. 2021; 279: 164–172.

[5] Cho GY, Seo MK. Relationship between andropause syndrome and health-related quality of life in middle-aged males in South Korea: family bond as a mediator. Korean Journal of Adult Nursing. 2022; 34: 424–434.

[6] Lee HY, Park JY. A study on the influence of married middle-aged men’s family resilience upon the stress coping behaviour. Korea Association of Family Relationships. 2011; 16: 160–192.(In Korean)

[7] Bhasin S, Cunningham GR, Hayes FJ, Matsumoto AM, Snyder PJ, Swerdloff RS, et al. Testosterone therapy in men with androgen deficiency syndromes: an Endocrine Society clinical practice guideline. The Journal of Clinical Endocrinology and Metabolism. 2010; 95: 2536–2559.

[8] Park SJ, Lim YS. Challenges and experiences of men who have undergone andropause: insights from a focus group study. Korean Journal of Adult Nursing. 2023; 35: 290–301. (In Korean)

[9] Kwon YE. Factors affecting quality of life in middle-aged men experiencing andropause symptoms. Journal of the Korea Academia-Industrial Cooperation Society. 2022; 23: 146–154.(In Korean)

[10] Mohammadi M, Allahverdipour H, Ghanbari Moghaddam A, Matlabi H. The prevalence of andropause and its relationship with sexual quality of life among older Iranian men. American Journal of Men’s Health. 2023; 17: 15579883231161050.

[11] Oyama H, Sakashita T. Effects of universal screening for depression among middle-aged adults in a community with a high suicide rate. The Journal of Nervous and Mental Disease. 2014; 202: 280–286.

[12] Radloff LS. The CES-D Scale: A self-report depression scale for research in the general population. Applied Psychological Measurement. 1977; 1: 385–401.

[13] Kroenke K, Spitzer RL. The PHQ-9: a new depression diagnostic and severity measure. Psychiatric Annals. 2002; 32: 509–515.

[14] Li A, Wang D, Lin S, Chu M, Huang S, Lee CY, et al. Depression and life satisfaction among middle-aged and older adults: mediation effect of functional disability. Frontiers in Psychology. 2021; 12: 755220.

[15] Prince MJ, Reischies F, Beekman AT, Fuhrer R, Jonker C, Kivela SL, et al. Development of the EURO-D scale—a European Union initiative to compare symptoms of depression in 14 European centres. British Journal of Psychiatry. 1999; 174: 330–338.

[16] Olsen CDH, Möller S, Ahrenfeldt LJ. Sex differences in quality of life and depressive symptoms among middle-aged and elderly Europeans: results from the SHARE survey. Aging & Mental Health. 2023; 27: 35–42.

[17] Roxo L, Silva M, Perelman J. Gender gap in health service utilisation and outcomes of depression: a cross-country longitudinal analysis of European middle-aged and older adults. Preventive Medicine. 2021; 153: 106847.

[18] Castro-Costa E, Dewey M, Stewart R, Banerjee S, Huppert F, Mendonca-Lima C, et al. Prevalence of depressive symptoms and syndromes in later life in ten European countries: the SHARE study. British Journal of Psychiatry. 2007; 191: 393–401.

[19] Guerra M, Ferri C, Llibre J, Prina AM, Prince M. Psychometric properties of EURO-D, a geriatric depression scale: a cross-cultural validation study. BMC Psychiatry. 2015; 15: 12.

[20] Prajwal V, Arun V, Ramya MC, Nagaraj S, Krishnaveni GV, Kumaran K, et al. Validation of EURO-D, a geriatric depression scale in South India: findings from the Mysore study of Natal effects on Ageing and Health (MYNAH). Journal of Affective Disorders. 2021; 295: 939–945.

[21] DeVellis R. Scale development theory and applications. 4th edn. Sage: Thousand Oaks, USA. 2017.

[22] Wang L, Kroenke K, Stump TE, Monahan PO. Screening for perinatal depression with the Patient Health Questionnaire depression scale (PHQ-9): a systematic review and meta-analysis. General Hospital Psychiatry. 2021; 68: 74–82.

[23] Baker FB. The basics of item response theory. 2001. Available at: https://files.eric.ed.gov/fulltext/ED458219.pdf (Accessed: 02 June 2023).

[24] Gwet KL. Computing inter‐rater reliability and its variance in the presence of high agreement. British Journal of Mathematical and Statistical Psychology. 2008; 61: 29–48.

[25] Maskileyson D, Seddig D, Davidov E. The EURO-D measure of depressive symptoms in the aging population: comparability across European countries and Israel. Frontiers in Political Science. 2021; 3: 665004.

[26] Portellano-Ortiz C, Garre-Olmo J, Calvó-Perxas L, Conde-Sala JL. Factor structure of depressive symptoms using the EURO-D scale in the over-50s in Europe. Findings from the SHARE project. Aging & Mental Health. 2018; 22: 1477–1485.

[27] Tomás JM, Torres Z, Oliver A, Enrique S, Fernández I. Psychometric properties of the EURO-D scale of depressive symptomatology: evidence from SHARE wave 8. Journal of Affective Disorders. 2022; 313: 49–55.

[28] Handing EP, Strobl C, Jiao Y, Feliciano L, Aichele S. Predictors of depression among middle-aged and older men and women in Europe: a machine learning approach. The Lancet Regional Health—Europe. 2022; 18: 100391.

[29] Chung S, Kim J. Social determinants of depression among Korean adults: results from a longitudinal study. Mental Health and Social Work. 2021; 49: 229–258.(In Korean)

[30] Mendorf S, Schönenberg A, Heimrich KG, Prell T. Prospective associations between hand grip strength and subsequent depressive symptoms in men and women aged 50 years and older: insights from the survey of health, aging, and retirement in Europe. Frontiers in Medicine. 2023; 10: 1260371.

[31] Son YH, Oh SS, Jang SI, Park EC, Park SH. Association between commensality with depression and suicidal ideation of Korean adults: the sixth and seventh Korean National Health and Nutrition Examination Survey, 2013, 2015, 2017. Nutrition Journal. 2020; 19: 131.

[32] Jönsson H, Michaud M, Neuman N. What is commensality? A critical discussion of an expanding research field. International Journal of Environmental Research and Public Health. 2021; 18: 6235.

[33] Delgado-Alonso C, Valles-Salgado M, Delgado-Álvarez A, Yus M, Gómez-Ruiz N, Jorquera M, et al. Cognitive dysfunction associated with COVID-19: a comprehensive neuropsychological study. Journal of Psychiatric Research. 2022; 150: 40–46.

[34] Oud FMM, Spies PE, Braam RL, van Munster BC. Recognition of cognitive impairment and depressive symptoms in older patients with heart failure. Netherlands Heart Journal. 2021; 29: 377–382.

[35] Yang NM, Lee EK, Choung JC, Song MK. The mediation effects of anger expression between trait-anger and depression in Korea middle aged men. The Journal of Humanities and Social science. 2020; 11: 2139–2152. (In Korean)

[36] Hu T, Zhao X, Wu M, Li Z, Luo L, Yang C, et al. Prevalence of depression in older adults: a systematic review and meta-analysis. Psychiatry Research. 2022; 311: 114511.

[37] Jirapramukpitak T, Darawuttimaprakorn N, Punpuing S, Abas M. Validation and factor structure of the Thai version of the EURO-D scale for depression among older psychiatric patients. Aging & Mental Health. 2009; 13: 899–904.

[38] Rim SJ, Hahm BJ, Seong SJ, Park JE, Chang SM, Kim BS, et al. Prevalence of mental disorders and associated factors in Korean adults: national mental health survey of Korea 2021. Psychiatry Investigation. 2023; 20: 262–272.