Factor structure of the CES-D (Center for Epidemiologic Studies Depression Scale) among Filipino-American adolescents

The present study used factor analytic procedures to examine the factor structure of the CES-D among Filipino-American adolescents residing in rural and small town Hawaii. A total of 243 Filipino-American high school students completed the 20-item scale, and maximum likelihood analyses were employed to obtain a final solution. The results indicated that two factors provide a reasonably good fit: factor I combined depressed affect, somatic-retardation and interpersonal items, and factor II consisted of the remaining four positive affect items. The overlap of depressed affect and somatic symptoms support previous findings found among Asian American adults and other ethnic minority adolescents. The loading of the interpersonal items on the first factor is more unusual and suggests that interpersonal factors are not distinguished from depressed affect for the Filipino-American adolescent group. The usefulness of the CES-D as a tool to gain an understanding of the concept of depression across cultures is discussed. Accepted: 3 December 1998     

Depression in first generation labour migrants in Western Europe: the utility of the Center for Epidemiologic Studies Depression Scale (CES-D)

OBJECTIVE: The number of elderly migrants from Turkish and Moroccan descent in Western Europe will increase sharply in the coming decades. Identifying depressed elderly migrants necessitates a screening instrument that is both acceptable and has good psychometric properties. This study examines the utility of Turkish and Arabic translations of the Center for Epidemiologic Studies Depression Scale (CES-D) among elderly labour migrants from Turkish and Moroccan descent in the Netherlands. METHOD: The data were derived from a community based health survey among 304 native Dutch, 330 Turkish and 299 Moroccan migrants, aged 55-74 years, living in Amsterdam, the Netherlands. Acceptability, reliability, convergent and construct validity were studied. RESULTS: Acceptability of the CES-D was satisfactory, although Moroccan migrants and Turkish females had difficulty answering one or more of the (interpersonal) items from the CES-D. Translated versions of the CES-D proved to be highly internal consistent and have good convergent validity in both Turkish and Moroccan elderly. Depressed and somatic items were much more intermingled in Turkish and Moroccan elderly compared to earlier studies and native Dutch elderly. This fits to the hypothesis that Turkish and Moroccan elderly migrants tend to somatize their depressive symptoms much more than native Western elderly. CONCLUSION: The utility of the CES-D for elderly migrants of Turkish and Moroccan descent was found to be satisfactory.     

Prevalence of Depressive Symptoms and Related Factors in Japanese Employees as Measured by the Center for Epidemiologic Studies Depression Scale (CES-D)

This study aimed to examine the prevalence of depressive symptoms and related factors in Japan. For this purpose, a questionnaire including the Center for Epidemiologic Studies Depression Scale (CES-D) was administered to employees from Akita prefecture, Japan. The cutoff point for CES-D scores was 16 or above (high scorers). We analyzed the results of this survey in order to identify relationships between the prevalence of high scores on the CES-D, sociodemographic status, and employment-related variables. In total, 2,220 employees—of whom 1,069 were men and 1,151, women—satisfactorily responded, and their responses indicated that 45.0 % (41.4 % for men, 48.2 % for women) had high scores on the CES-D. The identified sociodemographic and occupation-related factors from the binomial multivariate logistic regression for high scorers were as follows: a high risk of depression was associated with being women, short and/or long sleep durations, the occasional consumption of alcohol in men, and professional work and over 8 h of work per day in women. Older age groups and non-smoking women were associated with a lower risk. These results can be used in the future as CES-D benchmark values, and might be useful in predicting the occurrence of depressive disorders.     

Evaluating the seven-item Center for Epidemiologic Studies Depression Scale short-form: a longitudinal US community study

Purpose

The current study aims to examine the potential use of the seven-item Center for Epidemiologic Studies Depression Scale (CES-D) short form (CES-D-SF).

Methods

Data were examined from the National Longitudinal Survey of Youth 1979. Participants responded to the 20-item CES-D (n = 8,858) in 1992, and to the 7-item CES-D-SF in 1994 (n = 8,500) and from 1998 to 2010 if aged 40 (n = 7,972) or 50 (n = 1,574) or over. Variables examined in 1979 were race, SES, and sex and in 1981 cognitive functioning. The CES-D-SF was examined for internal and test–retest reliability, unidimensionality with confirmatory factor analysis, and a cutoff score with receiver operator curve characteristics. Survival analysis was used to examine time period of first CES-D-SF suspected major depression episode, multinomial regression to examine the chronicity of CES-D-SF suspected major depression, and the course of depression with a Generalized Estimating Equation model.

Results

Compared to the CES-D, the CES-D-SF had higher internal consistency, and better unidimensionality based on confirmatory factor analysis. A CES-D-SF cutoff score ≥8 had acceptable specificity (0.97, 95 % CI 0.96, 0.97) and modest sensitivity (0.69, 95 % CI 0.67, 0.71) with the standard CES-D cutoff score of 16. Female sex and lower cognitive functioning were significantly (p < 0.05) associated with more CES-D-SF suspected depression that was more chronic based on a multinomial regression model, and occurred at a younger age based on a Cox regression model.

Conclusions

The seven-item CES-D-SF has acceptable psychometric properties, is associated with exposures documented to be associated with an increased likelihood of depression, and may be used to screen for suspected major depressive disorder in US community studies.     

The Center for Epidemiologic Studies Depression scale (CES-D) in a mixed-mode repeated measurements design: sex and age effects in older adults

In order to obtain repeated measurements of depression in an efficient and relatively inexpensive design, a mixture of face-to-face interviews and mail questionnaires was employed. The aims of the study were to examine mode effects of face-to-face interviews versus mail questionnaires on depression scores and to test potential interactions between mode of data collection and sex and age of the respondents. In the study sample, which at the outset consisted of 327 depressed and 325 non-depressed older adults (55–85 years) drawn from a larger random community based sample in the Netherlands, depression was measured in successive waves (cycles), using the Center for Epidemiologic Studies of Depression scale (CES-D). With mode of data collection and sex and age of the respondents as independent variables, differences in CES-D scores were analysed. The CES-D scores were higher when collected by mail questionnaires than when face-to-face interviews were used. No systematic interactions between sex and age of the respondents with mode of data collection were found. For the scores based on mail questionnaires, a transformation is proposed, resulting in scores that are comparable to those obtained by interviews. In studying depression in older adults, more cost-effective mail questionnaires may be used in addition to face-to-face interviews, provided that a transformation is performed before embarking on the analysis. Copyright © 1999 Whurr Publishers Ltd.     

The criterion validity of the Center for Epidemiological Studies Depression Scale (CES-D) in a sample of self-referred elders with depressive symptomatology

BACKGROUND: The criterion validity of the Center for Epidemiological Studies Depression scale (CES-D) was assessed in a group of elderly Dutch community-residents who were self-referred to a prevention program for depression. METHODS: Paper-and-pencil administration of the CES-D to 318 elders (55-85 years). Criterion validity was evaluated with the Mini International Neuropsychiatric Interview (MINI), a clinical diagnostic interview based on DSM-IV. Sensitivity and specificity for various cut-off scores of CES-D were compared with the DSM-IV major depressive disorder (MDD) and with clinically relevant depression (CRD), a composite diagnosis of MDD, subthreshold depression or dysthymia. Furthermore the characteristics of true versus false positives were analyzed. RESULTS: For MDD, the optimal cut-off score was 25, (sensitivity 85%, specificity 64%, and positive predicted value of 63%). For CRD, the optimal cut-off was 22 (sensitivity 84%, specificity 60%, and positive predicted value 77%). True positives, MDD and CRD, reported significantly more anxiety symptomatology and more co-morbid anxiety disorders, false positives reported more previous depressive episodes. CONCLUSIONS: The criterion validity of the CES-D for MDD and CRD was satisfactory in this semi-clinical sample of elders. Subjects scoring >/=25 constitute a target group for further diagnostic assessment in order to determine appropriate treatment.     

Factor structure of the Center for Epidemiologic Studies Depression Scale in Taiwanese adolescents

BackgroundThe original study of Radloff (Appl Psychol Meas. 1977. 1:385-401) on the Center for Epidemiologic Studies Depression Scale (CES-D) indicated a 4-factor model in the adult population. However, the factor structure of the CES-D in Asian adolescents has not been extensively validated. The aim of this study was to examine the factor structure of the Chinese version of the CES-D in a large representative Taiwanese adolescent population.MethodA total of 10 116 adolescents completed the Chinese version of the CES-D. We used confirmatory factor analysis to examine the adequacy of 5 models of the factor structure in adolescents who were divided into 4 groups by sex and age. We also enrolled the variables of suicide tendency, insomnia, and peer relationships into the confirmatory factor analysis to examine the factor structure of the CES-D and examined the correlations between the CES-D factors and these variables.ResultsThe results of this study indicated that the four-factor model (depressed affect, somatic symptoms, interpersonal problems, and positive affect) had the highest validity in Taiwanese adolescents. We also found that although the 4 factors of the CES-D were correlated with each other, their correlations with suicide tendency, insomnia, and peer relationships were different.ConclusionsThis study supported the usefulness of the Chinese version of the CES-D as a tool to understand the concept of depression in Taiwanese adolescents.     

Confirmatory factor analysis of the short French version of the Center for Epidemiological Studies of Depression Scale (CES-D10) in adolescents

Background

Screening depressivity among adolescents is a key public health priority. In order to measure the severity of depressive symptomatology, a four-dimensional 20 items scale called “Center for Epidemiological Studies-Depression Scale” (CES-D) was developed. A shorter 10-item version was developed and validated (Andresen et al.). For this brief version, several authors supported a two-factor structure – Negative and Positive affect – but the relationship between the two reversed-worded items of the Positive affect factor could be better accounted for by correlated errors.

Objectives

The aim of this study is triple: firstly to test a French version of the CES-D10 among adolescents; secondly to test the relevance of a one-dimensional structure by considering error correlation for Positive affect items; finally to examine the extent to which this structural model is invariant across gender.

Method

The sample was composed of 269 French middle school adolescents (139 girls and 130 boys, mean age: 13.8, SD = 0.65). Confirmatory Factorial Analyses (CFA) using the LISREL 8.52 were conducted in order to assess the adjustment to the data of three factor models: a one-factor model, a two-factor model (Positive and Negative affect) and a one-factor model with specification of correlated errors between the two reverse-worded items. Then, multigroup analysis was conducted to test the scale invariance for girls and boys.

Results

Internal consistency of the CES-D10 was satisfying for the adolescent sample (α = 0.75). The best fitting model is the one-factor model with correlated errors between the two items of the previous Positive affect factor (χ²/dl = 2.50; GFI = 0.939; CFI = 0.894; RMSEA = 0.076). This model presented a better statistical fit to the data than the one-factor model without error correlation: χ²_diff (1) = 22.14, p < 0.001. Then, the one-factor model with correlated errors was analyzed across separate samples of girls and boys. The model explains the data somewhat better for boys than for girls. The model's overall χ²(68) without equality constraints from the multigroup analysis was 107.98. The χ²(89) statistic for the model with equality-constrained factor loadings was 121.31. The change in the overall Chi² is not statistically significant. This result implies that the model is, therefore, invariant across gender. The mean scores were higher for girls than boys: 9.69 versus 7.19; t(267) = 4.13, p < 0.001.

Conclusions

To conclude, and waiting for further research using the French version of the CES-D10 for adolescents, it appears that this short scale is generally acceptable and can be a useful tool for both research and practice. The scale invariance across gender has been demonstrated but the invariance across age must be tested too.     

The sensitivity and specificity of the Center for Epidemiologic Studies Depression Scale in screening for post-stroke depression

The present study examines the sensitivity and specificity of the Center for Epidemiologic Studies Depression Scale (CES-D) as a screening instrument for post-stroke depression. Eighty stroke patients were evaluated by a research nurse over a two-year period using the CES-D and also by a trained psychiatrist using a standardized interview for affective, cognitive, physical and social functioning. CES-D scores correlated significantly with DSM-III diagnoses of depression in-hospital and at three months, six months, and one year follow-up but not at two years follow-up, reflecting the natural course of these depressions, as well as the predictive validity of the CES-D. Furthermore, at a cut-off point of 16, the CES-D was found to have a specificity of 90 percent, a sensitivity of 86 percent and a positive predictive value of 80 percent and thus may be a potentially useful screening instrument for post-stroke depression.     

Measurement of depressive symptoms in cancer patients: evaluation of the Center for Epidemiological Studies Depression Scale (CES-D).

The Center for Epidemiological Studies Depression Scale (CES-D) is commonly used to measure depressive symptomatology in cancer patients, yet there is little known about the psychometric properties of the measure when applied to a cancer population. The aim of this study was to examine the psychometric properties of the CES-D with cancer patients. For purposes of comparison, the psychometric properties of the CES-D were assessed both in women undergoing treatment for breast cancer and women with no history of cancer. The CES-D and other study measures were administered to women undergoing treatment for breast cancer on two occasions: prior to treatment and midway through treatment. The measures were also administered to a group of women similar in age to the cancer patients who had no history of any type of cancer. These healthy comparison subjects were also assessed on two separate occasions. The CES-D was found to have good internal consistency, with alpha coefficients > 0.85 for both groups, as well as adequate test-retest reliability in both groups. Construct validity was demonstrated in two ways, via comparisons between the groups and by comparing the CES-D with measures of fatigue, anxiety, and global mental health functioning. The CES-D was established as a valid and reliable measure of depressive symptomatology in this sample of breast cancer patients. This measure may be appropriate for use in clinical psychosocial research with cancer patients, yet further research is needed to evaluate its usefulness in other cancer populations. The importance of measuring psychological symptoms with standard measures that have been validated with cancer patients is highlighted.     

Validation of a Revised Version of the Center for Epidemiologic Depression Scale for Youth with Intellectual Disabilities (CESD-ID-R)

Journal of Autism and Developmental Disorders - This study proposes a revision (R) of the Center for Epidemiologic Studies Depression Scale for youth with ID (CESD-ID) in English and French. 346...     

Factorial structure of a short version of the Center for Epidemiologic Studies Depression Scale

OBJECTIVE: To investigate the factor structure of a ten-item version of the Center for Epidemiologic Studies Depression Scale (CESD-10). METHOD: Two hundred and thirty-one Chinese persons aged 60-92 were individually interviewed with the CESD-10. The data were subject to confirmatory factor analysis testing several competing models. The one-factor model hypothesizes that all ten items are loaded on a single factor. In the two-factor model, positive affect items are loaded on one factor, and the remaining items on the other. The three-factor model distinguishes between positive affect, depressed affect, and somatic symptoms. RESULTS: The three-factor model was the best fitting model, with a comparative fit index of 0.95 and a standardized root mean square residual of 0.06. Depressed affect and somatic symptoms were highly correlated, and both were moderately correlated with positive affect. Nonetheless, all three factors appeared to tap a common underlying construct of depression-when a higher-order construct of depression was allowed to explain the intercorrelations of the three factors, depressed affect loaded at 0.88, somatic symptoms loaded at 0.92, and positive affect loaded at 0.51, on the higher-order construct. CONCLUSION: The data provided support for the factorial validity of the CESD-10.     

An adaptation of the Center for Epidemiologic Studies Depression Scale for use in non-psychiatric Spanish populations

To adapt the Center for Epidemiologic Studies Depression Scale for use in non-psychiatric Spanish populations, a Spanish translation of the scale was interviewer-administered to 554 subjects aged 18-34 years (65.9% women) and the ratings so obtained were compared with the SCID-CV-based diagnoses of expert clinicians. The internal consistency of the scale was satisfactory (Cronbach's alpha=0.89). Four factors identified by exploratory factor analysis (Depressive/Somatic, Positive Affect, Retarded Activity and Interpersonal Relations) accounted for 55.9% of the variance. A score of 26 was identified as a suitable cut-off for screening purposes, affording a sensitivity of 0.906 and a specificity of 0.918.     

The Center for Epidemiologic Studies Depression Scale in older Chinese: thresholds for long and short forms

OBJECTIVE: No study has examined the diagnostic validity of the Center for Epidemiologic Studies Depression Scale (CES-D) in the Chinese elderly. This study aims to determine appropriate cutoffs for the 20- (CESD-20) as well as a ten-item (CESD-10) version of the instrument. Data were also provided, based on simulated scoring, for the diagnostic performance of the scales when using dichotomous instead of 4-point rating scales. METHODS: Three hundred and ninety eight persons aged 60 +referred for psychiatric assessment by a physician were administered the CES-D as well as given an independent psychiatric assessment. A spectrum of depression diagnosis as the criterion was used to assess the diagnostic validity of the CES-D. RESULTS: The ten and the 20-item version of the CES-D, regardless of scoring method, produced essentially identical performance indices. The optimal thresholds were 12 and 22 for CESD-10 and CESD-20 respectively, and based on these thresholds, sensitivity, specificity, positive predictive value and negative predictive value were 0.76, 0.55, 0.57 and 0.74 for CESD-10, and 0.75, 0.51, 0.55 and 0.72 for CESD-20. With both ends of the rating scale collapsed to create dichotomous items, the optimal thresholds became 4 for CESD-10 and 7 for CESD-20, and the corresponding performance indices were 0.67, 0.58, 0.56 and 0.69 for CESD-10, and 0.70, 0.58, 0.57 and 0.70 for CESD-20. CONCLUSIONS: The ten-item version can be used in lieu of the 20-item version, and a dichotomous response format would probably work as well as the original four-point format, in order to simplify administration for elderly persons.     

Screening for depression in stroke patients: the reliability and validity of the Center for Epidemiologic Studies Depression Scale

This study examined the inter-observer reliability and validity of the Center for Epidemiologic Studies Depression Scale (CES-D) as a measure of depressive symptomatology in stroke patients, and its utility as a screening tool for depression in this population. The CES-D Scale is a brief questionnaire originally designed for use in community surveys. Twenty-seven non-aphasic patients enrolled in the Stroke Data Bank at the University of Maryland were interviewed by a research nurse using the CES-D. On the same day, each patient was independently evaluated by a research assistant using a psychiatric battery for depression and measures of cognitive, physical, and social functioning. Forty-one percent (11/27) of the patients were depressed according to clinical criteria for major or minor depression. With a cutpoint corresponding to the upper (most severe) 20% in community surveys, the CES-D Scale picked up 73% (8/11) of the depressed patients. In this sample no nondepressed patient scored over 16 on the CES-D (no false positives). The CES-D Scale scores correlated significantly with the other depression measures (r = .57 to r = .82, p less than .002) and did not correlate with the measures of cognitive, physical, or social functioning. Based on 24 patients who received a CES-D Scale score from both the nurse and the research assistant, inter-rater reliability was high (r = .76, p less than .001). Thus, the CES-D was found to be reliable and valid as a screening tool for assessing depression in stroke patients.     

Reliability, Validity and Psychometric Properties of the Greek Translation of the Center for Epidemiological Studies-Depression (CES-D) Scale

Introduction  

The aim of the current study was to assess the reliability, validity and psychometric properties of the Greek translation of the Center for Epidemiological Studies- Depression Scale (CES-D).     

The Center for Epidemiologic Studies Depression Scale: factor validity and reliability in a French sample of adolescents with Intellectual Disability

The purpose of this study was to test the factor validity and reliability of the Center for Epidemiologic Studies Depression Scale (CES-D) within a sample of adolescents with mild to moderate Intellectual Disability (ID). A total sample of 189 adolescents (121 boys and 68 girls), aged between 12 and 18 years old, with mild to moderate ID were involved in two studies. In study 1, the content, phrasing and answering format of the CES-D were adapted for adolescents with ID. This instrument was renamed CES-D for ID (CES-D-ID) and two different versions based on two alternative answer scales (Likert and Likert-graphical) were developed and their psychometric properties were verified in study 2. The results provided support for the factor validity, reliability and invariance across gender and age of a 14-item version of the CES-D-ID based on a Likert-graphical answer scale.     

Detecting depression in Chinese adults with mild dementia: findings with two versions of the Center for Epidemiologic Studies Depression Scale

This study investigates the extent to which the diagnostic performance of the Center for Epidemiologic Studies Depression Scale (CES-D; both 20- and 10-item versions) varies with cognitive status, and whether the same threshold can be applied regardless of cognitive status. Three hundred and ninety-six persons aged 60+ referred for psychiatric assessment were broken down into four groups depending on age (< 70 and ≥ 70) and dementia status (mild vs. none). All were independently interviewed using the CES-D before their first evaluation by a psychiatrist. Receiver operating characteristic curves showed that both versions of the CES-D produced essentially identical results, regardless of age and dementia status. Both versions were more or less robust to the effect of mild dementia but were vulnerable to the effect of age itself. Furthermore, the optimal threshold for the 20-item version varied somewhat across the different age–dementia groups, and no clear-cut threshold existed in old-old persons with dementia. On the contrary, the same threshold of 12 can be adopted for the 10-item version, regardless of age and dementia status. Compared with the full 20-item scale, the 10-item version has the added advantage of an identical threshold across age and cognitive status.     

Assessment of depression in childhood and adolescence: an evaluation of the Center for Epidemiological Studies Depression Scale for Children (CES-DC)

Psychometric characteristics of the Center for Epidemiological Studies Depression Scale for Children (CES-DC) were evaluated with 148 child and adolescent psychiatric inpatients. Test-retest reliability, internal consistency, and concurrent validity were adequate. Principal components analysis identified three distinct factors: behavioral and cognitive components of depression and a happiness dimension. However, subsequent factor scores and CES-DC total scores were unable to discriminate DSM-III diagnoses, including depressive and nondepressive categories. The CES-DC showed poor reliability and validity in the children alone but had good psychometric properties for the adolescents. More validational research is required before standard clinical use can be recommended.