Dimensionality of the Center for Epidemiologic Studies Depression Scale: an exploratory bi-factor analytic study

Objective

The Center for Epidemiologic Studies Depression Scale (CES-D) is a widely used instrument for measuring depressive symptoms. Though conventional factor analytic evaluations supported the use of four sub-scales for the CES-D, existing studies have yet to adopt the bi-factor analytic approach in psychometric assessment of the 20-item inventory. The present study aimed to apply both confirmatory factor analysis and exploratory bi-factor analysis to evaluate the dimensionality of the CES-D.

Methods

Current scoring practice of the CES-D (single-factor, four-factor, and second-order models) was tested using confirmatory factor analyses in a sample of 706 Chinese persons with insomnia and depressive symptoms. As an alternative, exploratory bi-factor analysis was conducted to examine the utility of the general depression factor and specific factors.

Results

Existing measurement models on the CES-D did not provide an adequate model fit to the data in terms of model fit indices and discriminant validity. The bi-factor model revealed a general depression factor that accounted for the majority of the item variance. The three specific factors (somatic symptoms, positive affect, and interpersonal problems) provided little unique information over and above the general factor and plausibly represent a methodological artifact rather than a substantive factor.

Conclusion

The present study demonstrated empirical support for the bi-factor model as a realistic representation of the underlying structure of the CES-D. Researchers and clinicians are better served by simply using a single measure of depression.

     

Factorial validity of the effort–reward imbalance scale: evidence from multi-sample and three-wave follow-up studies

Purpose

The present study investigated whether the factor structure of the effort–reward imbalance (ERI) scale (Siegrist et al. Soc Sci Med 58:1483–1499, 2004) remains same across two white-collar samples (i.e., factorial group invariance) and across three measurement times (i.e., factorial time invariance).

Methods

The factorial group invariance was tested using two different samples including 1,301 managers and 758 young white-collar professionals. The factorial time invariance was tested in the latter sample with a four-year three-wave follow-up design.

Results

The confirmatory factor analysis performed supported the theoretically based structure of the ERI scale, that is, the scale included two first-order factors of effort and overcommitment and one second-order factor of reward with first-order factors of esteem, career opportunities, and job security. The factorial group invariance of this structure was also supported. In addition, the factor loadings of all factors remained same across three measurements; thus, lending support for the factorial time invariance.

Conclusion

The ERI scale was found to be a valid tool to measure costs and gains of social exchanges at work as well as individual orientation toward work in these two occupational samples including a longitudinal study design.     

The 9-item Bergen Burnout Inventory: Factorial Validity Across Organizations and Measurements of Longitudinal Data

The present study tested the factorial validity of the 9-item Bergen Burnout Inventory (BBI-9)¹⁾. The BBI-9 is comprised of three core dimensions: (1) exhaustion at work; (2) cynicism toward the meaning of work; and (3) sense of inadequacy at work. The study further investigated whether the three-factor structure of the BBI-9 remains the same across different organizations (group invariance) and measurement time points (time invariance). The factorial group invariance was tested using a cross-sectional design with data pertaining to managers (n=742), and employees working in a bank (n=162), an engineering office (n=236), a public sector organization divided into three service areas: administration (n=102), education and culture (n=581), and social affairs and health (n=1,505). Factorial time invariance was tested using longitudinal data pertaining to managers, with three measurements over a four-year follow-up period. The confirmatory factor analysis revealed that the three-factor structure of the BBI-9 was invariant across cross-sectional samples. The factorial invariance was also supported across measurement times. To conclude, the factorial structure of the BBI-9 was found to remain the same regardless of the sample properties and measurement times.     

Components of depressed mood in married men and women. The Center for Epidemiologic Studies' Depression Scale

The Center for Epidemiologic Studies' Depression Scale (CES-D) was developed to measure depressive symptoms in community populations. To be useful for epidemiologic studies of depression, the scale should measure the same thing in various subgroups. This study examines the psychometric properties of the CES-D among men and women, including its factor structure, reliability, and characteristics of its subscales. A national sample of 1,360 married men and women, collected in 1978, was used. Factor analysis produced four major factors in the CES-D: depressed affect, enervation , lack of positive affect, and interpersonal problems. These factors are generalizable across men and women with two exceptions--crying spells, which are a good indicator of depressed mood for women, do not indicate depressed mood for men; and feeling one's life is a failure is associated with depressed affect for women and with a lack of positive affect for men. The two items in the interpersonal factor (feeling that people dislike you and that people are unfriendly ) do not show the expected pattern of association with gender, since men have significantly more interpersonal symptoms than women. Women have more symptoms of depressed affect, enervation , and lack of positive affect.     

Validación de dos versiones cortas de la escala para depresión del Centro de Estudios Epidemiológicos en adolescentes colombianos

ObjectiveTo establish the validity and reliability of a Brief and Ultra-short Center for Epidemiological Studies Depression (CES-D) Scale in adolescents.DesignValidation study.SettingSecondary schools in Bucaramanga, Colombia.ParticipantsA total of 474 students were selected through a three stage process; 68 did not agree to participate, 8 were excluded and 8 did not complete the process.Main measurementsAdolescent students were evaluated with CES-D and the clinical interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. The CES-D scale was re-applied 3 to 28 days after the first application. The ten items and the three items with the highest correlation with total score were selected to construct a Brief scale and Ultra-short scale, respectively. Construct validity, criterion validity, test-retest reliability and internal consistency were analyzed.ResultsFor the Brief CES-D Scale the Cronbach's alpha was 0.86 and Lin's coefficient was 0.77. The area under ROC curve was 0.83, with a sensitivity of 77.8%; specificity 74.1%. Two main factors were identified to explain the 55.81% variance. For the Ultra-short Scale the Cronbach's alpha was 0.76 and Lin's coefficient was 0.74. The area under ROC curve was 0.80, with a sensitivity of 75.56%; specificity 70.67%. One main factor was identified to explain the 68.19% of variance.ConclusionsThe Brief and Ultra-Short CES-D Scale are as useful as the original scale for the screening of MDD in adolescents; Ultra-short CES-D Scale does not preserve the original factorial structure.     

Dimensional structure and measurement invariance of the youth self-report across gender and age

PurposeThe aim of the present work was to examine the correlated eight-syndrome model of the Youth Self-Report (YSR) proposed by Ivanova et al [1], using a confirmatory factor analysis for ordinal data. Likewise, we explored the measurement invariance of the YSR across gender and age using multigroup comparisons, and checked whether there were differences in the latent means.MethodsThe sample was made up of 4,868 nonclinical adolescents (47.6% males), with a mean age of 14.6 years (SD = 1.6).ResultsThe correlated eight-syndrome model proposed by Ivanova et al [1] showed a reasonable fit to the data, both for the total sample and by participants' gender and age. Moreover, the factor-equivalence analysis showed that the hypothesized dimensional model was invariant across gender and age. Statistically significant differences were found when comparing latent means between the groups.ConclusionsThese results coincide with those found in the literature and are in support of the replicability, generalizability, and consistency of the eight-syndrome model of the YSR, as well as its measurement invariance across gender and age. Future studies should explore the measurement invariance of this model through multigroup comparisons across cultures.     

Long-Term Effects of Chronic Depressive Symptoms Among Low-Income Childrearing Mothers

Objectives: Longitudinal studies of maternal depression in the postpartum period have demonstrated that a chronic state of depressive symptoms is not rare. In spite of this, however, the characteristics of chronically depressed mothers have rarely been studied. This study examines the demographic and socioenvironmental characteristics across time of childrearing women with chronic depressive symptoms. Methods: A cohort of 476 childrearing lower-income mothers was interviewed from the first trimester of pregnancy through the tenth year postpartum. The Center for Epidemiologic Studies-Depression Scale (CES-D; Radloff, L. (1977) Appl Psychol Meas 1:385–401) was used to define depressive symptomatology. Four groups were defined based on the CES-D scores at 18 months, 3, 6 and 10 years: never-depressed (CES-D < 16), depressed only at one phase (CES-D ≥ 16), chronically mildly depressed (CES-D > 16 and ≤24 at three or more phases), and chronically severely depressed (CES-D ≥ 25 at three or more times). Demographic and socioenvironmental characteristics of the groups were evaluated across time. Results: Chronically depressed women compared to never-depressed women were less likely to be married, had less education, had lower family income, and were more likely to use substances. They reported more frequent arguments with close family members or friends, separation/divorce with partners, financial problems, less social support, and more financial strain. Conclusions: Women who continue to be depressed across the 10 postpartum years have less optimal outcomes compared to women who are not depressed and those who are only intermittently depressed. Pregnancy and delivery and subsequent pediatric visits are important times to identify women who are depressed.     

Cross-national and longitudinal investigation of a short measure of workaholism

Abstract: The present study investigated the factor structure of the 10-item version of the Dutch Work Addiction Scale (DUWAS). The DUWAS-10 is intended to measure workaholism with two correlated factors: working excessively (WE) and working compulsively (WC). The factor structure of the DUWAS-10 was examined among multi-occupational samples from the Netherlands (n=9,010) and Finland (n=4,567) using confirmatory factor analysis (CFA). CFAs revealed that the expected correlated two-factor solution showed satisfactory fit to the data. However, a second-order factor solution, where WE comprised the first-order factors “working frantically” and “working long hours”, and WC the first-order factors “obsessive work drive” and “unease if not working”, showed significantly better fit to the data. The expectation of factorial group invariance of the second-order factor structure between the Dutch and Finnish samples was also supported. Moreover, factorial time invariance was observed across a two-year time lag in a sub-sample of Finnish managers (n=459). In conclusion, the DUWAS-10 was found to be a comprehensive measure of workaholism, meeting the criteria of factorial validity in multiple settings, and can thus be recommended for use in both research and practice.     

Longitudinal measurement invariance of the Dutch Outcome Questionnaire-45 in a clinical sample

Purpose

In the absence of measurement invariance across measurement occasions, change scores based on pretest–posttest measurements may be inaccurate representations of real change on the latent variable. In this study, we examined whether measurement invariance held in the Dutch version of Outcome Questionnaire-45 (OQ-45).

Method

Using secondary data analysis of a sample of N?=?540 Dutch outpatients, we tested the stability of the factorial structure (gamma change) and the metric and scalar invariance (beta change) across pretest and posttest measurements using a combination of factor analysis and item response theory methodology.

Results

Results revealed a stable factorial structure from pretest to posttest and minor violations of metric invariance for two items in the Dutch OQ-45.

Conclusion

Even though for two items the assumption of invariance was violated, results suggest that the effects of these violations on practical change assessment using the OQ-45 were negligible.

     

Factorial invariance and latent mean structure of questionnaires measuring social-cognitive determinants of physical activity among black and white adolescent girls.

BACKGROUND: We previously developed questionnaires based on contemporary theories to measure physical activity determinants among youth [Motl et al., Prev Med 2000; 31:584-94]. The present study examined the factorial invariance and latent mean structure of unidimensional models fit to the questionnaires measuring attitude, subjective norm, perceived behavioral control, and self-efficacy about physical activity among black and white adolescent girls. METHODS: Black (n = 896) and white (n = 823) girls in the 8th grade completed the questionnaires measuring attitude, subjective norm, perceived behavioral control, and self-efficacy about physical activity. The responses were subjected to analyses of factorial invariance and latent mean structure using confirmatory factor analysis with full-information maximum likelihood estimation in AMOS 4.0. RESULTS: The unidimensional models of the four questionnaires generally demonstrated invariance of the factor structure, factor loadings, and factor variance across race but not invariance of the variance-covariance matrices or item uniquenesses. The analyses of latent mean structure demonstrated that white girls had higher latent mean scores on the measures of attitude and self-efficacy than black girls; there were similar, but smaller, differences between white and black girls on the measures of subjective norm and perceived behavioral control. CONCLUSIONS: The questionnaires can be employed in interventions to test the mediating influences of attitude, subjective norm, perceived behavioral control, and self-efficacy on participation in physical activity by black and white adolescent girls.     

Validity of the Center for Epidemiologic Studies Depression Scale as a screening instrument of major depressive disorder among Japanese workers

BACKGROUND: The Center for Epidemiologic Studies Depression Scale (CES-D) is used at workplaces to screen depressive disorders. The aim of this study was to examine the validity of the CES-D for depression in a workplace. METHODS: The CES-D was administered to 2,219 workers (84.2% men; age 21-68 years) at a manufacturing company in Japan. Concomitantly all workers had an interview with the Mini International Neuropsychiatric Interview (MINI) as a gold standard for diagnosing major depressive disorder (MDD). The validity was evaluated by a receiver operating characteristic (ROC) curve. RESULTS: The area under the ROC curve of the CES-D was 0.96 [95% Confidence Interval (CI): 0.94-0.99]. The optimal cut-off score of MDD was 19 for screening. CONCLUSIONS: The validity of CES-D is confirmed and it is a valid instrument for detecting MDD in working populations in Japan.     

The children's DEBQ for assessment of restrained, emotional, and external eating in 7- to 12-year-old children

OBJECTIVE: Construct an age adapted version of the Dutch Eating Behaviour Questionnaire (DEBQ) for measurement of restrained, emotional and external eating in 7- to 12-year-old children: the DEBQ-C. METHOD: The DEBQ-C was constructed and tested for its reliability, factorial validity, factorial invariance for sex, overweight (BMI-status), and age, and correlations with measures for unhealthy life style in one sample (382 boys and 387 girls). In a second sample (252 boys and 263 girls) correlations were obtained with measures for body dissatisfaction and parental feeding styles. Single and multigroup confirmatory factor analyses were used. RESULTS: The fit measures for the three factor model and the factorial invariance models with respect to sex, BMI-status, and age were satisfactory. In the (sub) samples of the 7- to 12-year-olds Cronbach's alpha's ranged from .73 to .82 and there were satisfactory correlations (p < .01) with other measures. CONCLUSION: The DEBQ-C should provide a useful measure for young children's emerging dietary restraint and overeating tendencies. The low prevalence of emotional eating indicates that most young children show the natural reaction to emotional stressors (loss of appetite when feeling lonely, depressed or afraid) and that emotional (over) eating at this age is quite abnormal.     

Psychometric evaluation and predictive validity of Ryff's psychological well-being items in a UK birth cohort sample of women

Background

Investigations of the structure of psychological well-being items are useful for advancing knowledge of what dimensions define psychological well-being in practice. Ryff has proposed a multidimensional model of psychological well-being and her questionnaire items are widely used but their latent structure and factorial validity remains contentious.

Methods

We applied latent variable models for factor analysis of ordinal/categorical data to a 42-item version of Ryff's psychological well-being scales administered to women aged 52 in a UK birth cohort study (n = 1,179). Construct (predictive) validity was examined against a measure of mental health recorded one year later.

Results

Inter-factor correlations among four of the first-order psychological well-being constructs were sufficiently high (> 0.80) to warrant a parsimonious representation as a second-order general well-being dimension. Method factors for questions reflecting positive and negative item content, orthogonal to the construct factors and assumed independent of each other, improved model fit by removing nuisance variance. Predictive validity correlations between psychological well-being and a multidimensional measure of psychological distress were dominated by the contribution of environmental mastery, in keeping with earlier findings from cross-sectional studies that have correlated well-being and severity of depression.

Conclusion

Our preferred model included a single second-order factor, loaded by four of the six first-order factors, two method factors, and two more distinct first-order factors. Psychological well-being is negatively associated with dimensions of mental health. Further investigation of precision of measurement across the health continuum is required.     

Assessing measurement invariance in the EORTC QLQ-C30

Purpose

We aimed to investigate measurement invariance (MI) in the European Organisation for research and treatment of cancer quality of life questionnaire core 30 (EORTC QLQ-C30) in a heterogeneous sample of patients with cancer.

Methods

Data from 12 studies within the PROFILES registry were used for secondary analyses (n?=?7007). We tested MI by successive restrictions on thresholds, loadings, and intercepts across subgroups based on primary cancer sites, age, sex, time since diagnosis, and life stage, using multigroup confirmatory factor analysis (MGCFA) for ordered categorical measures. We also evaluated the impact of potentially miss-specified parameter equality across groups on latent factor means by releasing threshold and loading equality constraints for each item at a time.

Results

Results showed that the highest level of MI (invariance of thresholds, loadings, and intercepts) was found across groups based on time since diagnosis and life stage and to a lesser extent across groups based on sex, age, and primary tumor site. On item level, however, changes in the item’s associated factor means were relatively small and in most cases canceled each other out to some extent.

Conclusions

Given only a few instances of non-invariance in our study, there is reason to be confident that valid conclusions can be drawn from between-group comparisons of QLQ-C30 latent means as operationalized in our study. Nonetheless, further research into MI between other subgroups for the QLQ-C30 (i.e., treatment effects and ethnicity) is warranted. We stress the importance of including MI evaluations in the development and validation of measurement instruments.

     

Vitamin B6 Is Associated with Depressive Symptomatology in Massachusetts Elders

Objective: We examined the cross-sectional relationship between dietary vitamin B₆ and plasma pyridoxyl-5′-phosphate concentrations (PLP) with depressive symptomatology among a representative sample of 618 elderly Caribbean Hispanics, and a neighborhood based comparison group of 251 non-Hispanic white (NHW) older adults in Massachusetts.

Methods: Depressive symptomatology was assessed with the Center for Epidemiologic Studies Depression Scale (CES-D). 41% of Hispanics and 22.6% of NHWs had CES-D scores greater than 16, indicating depressive caseness. Dietary intake was calculated from a semi-quantitative food frequency questionnaire (FFQ) designed for this population.

Results: PLP was significantly associated with CES-D score and depressive caseness in the total sample and in non-supplement users. Deficient levels of plasma PLP (plasma PLP < 20 nmol/L) approximately doubled the likelihood of depressive caseness. Total intake (diet + supplement) of vitamin B₆ was not associated with these outcomes. However, dietary vitamin B₆ was significantly associated with CES-D score and depressive caseness.

Conclusion: Longitudinal studies are needed to clarify the direction of causality between vitamin B₆ and depressive symptoms.     

Factorial invariance of pediatric patient self-reported fatigue across age and gender: a multigroup confirmatory factor analysis approach utilizing the PedsQL™ Multidimensional Fatigue Scale

Objectives

In order to compare multidimensional fatigue research findings across age and gender subpopulations, it is important to demonstrate measurement invariance, that is, that the items from an instrument have equivalent meaning across the groups studied. This study examined the factorial invariance of the 18-item PedsQL? Multidimensional Fatigue Scale items across age and gender and tested a bifactor model.

Methods

Multigroup confirmatory factor analysis (MG-CFA) was performed specifying a three-factor model across three age groups (5–7, 8–12, and 13–18 years) and gender. MG-CFA models were proposed in order to compare the factor structure, metric, scalar, and error variance across age groups and gender. The analyses were based on 837 children and adolescents recruited from general pediatric clinics, subspecialty clinics, and hospitals in which children were being seen for well-child checks, mild acute illness, or chronic illness care.

Results

A bifactor model of the items with one general factor influencing all the items and three domain-specific factors representing the General, Sleep/Rest, and Cognitive Fatigue domains fit the data better than oblique factor models. Based on the multiple measures of model fit, configural, metric, and scalar invariance were found for almost all items across the age and gender groups, as was invariance in the factor covariances. The PedsQL? Multidimensional Fatigue Scale demonstrated strict factorial invariance for child and adolescent self-report across gender and strong factorial invariance across age subpopulations.

Conclusions

The findings support an equivalent three-factor structure across the age and gender groups studied. Based on these data, it can be concluded that pediatric patients across the groups interpreted the items in a similar manner regardless of their age or gender, supporting the multidimensional factor structure interpretation of the PedsQL? Multidimensional Fatigue Scale.     

中文版癌症后生育忧虑量表跨癌症类型的测量不变性

目的 确定中文版癌症后生育忧虑量表(Reproductive Concerns After Cancer Scale，RCACS)的因子结构，并检验其在女性不同癌症类型群体间的测量不变性。 方法 对乌鲁木齐市975名18~40岁的女性癌症患者进行调查，在妇科恶性肿瘤、甲状腺癌和乳腺癌人群中分别采用探索性因子分析，以确定中文版RCACS的因子结构。应用多组验证性因子分析，以检验RCACS跨癌症类型的测量不变性。 结果 RCACS在妇科恶性肿瘤、甲状腺癌和乳腺癌人群中分别进行探索性因子分析，均提取出6个公因子；多组验证性因子分析结果显示，中文版RCACS具有跨癌症类型的测量不变性（形态不变性、单位不变性、强不变性、严格不变性）。 结论 中文版RCACS具有稳定的因子结构，在不同癌症类型的群体间具有测量不变性，可用于评估乌鲁木齐市女性癌症患者的生育忧虑水平。     

Factorial validity and invariance of questionnaires measuring social-cognitive determinants of physical activity among adolescent girls

BACKGROUND: There are few theoretically derived questionnaires of physical activity determinants among youth, and the existing questionnaires have not been subjected to tests of factorial validity and invariance. The present study employed confirmatory factor analysis (CFA) to test the factorial validity and invariance of questionnaires designed to be unidimensional measures of attitudes, subjective norms, perceived behavioral control, and self-efficacy about physical activity. METHODS: Adolescent girls in eighth grade from two cohorts (N = 955 and 1,797) completed the questionnaires at baseline; participants from cohort 1 (N = 845) also completed the questionnaires in ninth grade (i.e., 1-year follow-up). Factorial validity and invariance were tested using CFA with full-information maximum likelihood estimation in AMOS 4.0. Initially, baseline data from cohort 1 were employed to test the fit and, when necessary, to modify the unidimensional models. The models were cross-validated using a multigroup analysis of factorial invariance on baseline data from cohorts 1 and 2. The models then were subjected to a longitudinal analysis of factorial invariance using baseline and follow-up data from cohort 1. RESULTS: The CFAs supported the fit of unidimensional models to the four questionnaires, and the models were cross-validated, as indicated by evidence of multigroup factorial invariance. The models also possessed evidence of longitudinal factorial invariance. CONCLUSIONS: Evidence was provided for the factorial validity and the invariance of the questionnaires designed to be unidimensional measures of attitudes, subjective norms, perceived behavioral control, and self-efficacy about physical activity among adolescent girls.     

Confirmatory Factor Analysis and Sample Invariance of the Chinese Patient Satisfaction Questionnaire (ChPSQ-9) among Patients with Breast and Lung Cancer

Objectives:  Previous exploratory factor analysis of the 9-item Chinese Patient Satisfaction Questionnaire (ChPSQ-9) identified two dominant factors: doctor and nurse. The present study employed confirmatory factor analysis (CFA) to examine the factorial invariance of the ChPSQ-9 between and within samples of Chinese patients with breast or lung cancer.
Methods:  Longitudinal data were analyzed from Chinese breast and lung cancer patients who had completed the ChPSQ-9 during their first outpatient visit, at 3 months, and at 6 months after baseline. CFAs tested the fit of a one-factor model, a hierarchical model that comprised a general latent factor and two first-order factors, and a correlated model that comprised two correlated first-order factors to the data. The factorial invariance of the ChPSQ-9 between six independent samples across time was investigated using multigroup CFAs.
Results:  The CFA's results demonstrated a better fit of the correlated model over the one-factor model and the hierarchical model in the breast and lung cancer samples. The correlated model showed evidence of cross-sample and longitudinal factorial invariance. Patients were generally satisfied with services provided by doctors and nurses. Internal consistency of the scale was also good for both cancer samples across time.
Conclusions:  The ChPSQ-9 is a valid and reliable instrument to be employed among breast and lung cancer patients, in clinical settings or intervention research, to evaluate group differences in patient satisfaction and its association with intervention effectiveness.     

Measurement equivalence of the CES-D 8 in the general population in Belgium: a gender perspective

International research consistently finds gender differences in depression, but do women genuinely experience more complaints or are the findings contaminated by group-specific elements unrelated to depression but affecting its measurement? The study of gender differences in depression depends on the measurement quality of the instrument used to evaluate depression. In the present study we test the measurement equivalence of a shorter version of a commonly used instrument in mental health research, the Center for Epidemiologic Studies - Depression Scale (CES-D), using data from the Belgian sample of the third round of the European Social Survey (N = 1794). Evidence for measurement invariance can be established within the multigroup confirmatory factor analysis framework. This method allows us to evaluate a nested hierarchy of hypotheses to test different levels of cross-group measurement invariance: configural, metric, scalar and residual invariance, and clarifies under what conditions meaningful comparisons between the male and female respondents can be made. The best fitting factor model is then used to estimate the ''true'' prevalence of depressive symptoms for both groups. In our study measurement equivalence is established at all levels, indicating that the current depression scale allows defensible quantitative gender comparisons. Our data also confirm the epidemiological finding that women report more complaints of depression than men.