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The center for epidemiologic studies depression scale: a review with a theoretical and empirical examination of item content and factor structure.

Carleton RN, Thibodeau MA, Teale MJ, Welch PG, Abrams MP, Robinson T, Asmundson GJ - PLoS ONE (2013)

Bottom Line: Differential item functioning identified an item as inflating CES-D scores in women.Researchers and practitioners may benefit from using the novel factor structure of the CES-D and from being cautious in interpreting results from the originally proposed scale.Comprehensive results, implications, and future research directions are discussed.

View Article: PubMed Central - PubMed

Affiliation: The Anxiety and Illness Behaviour Laboratory, Department of Psychology, University of Regina, Regina, Saskatchewan, Canada. Nick.Carleton@uregina.ca

ABSTRACT

Background: The Center for Epidemiologic Studies Depression Scale (CES-D; Radloff, 1977) is a commonly used freely available self-report measure of depressive symptoms. Despite its popularity, several recent investigations have called into question the robustness and suitability of the commonly used 4-factor 20-item CES-D model. The goal of the current study was to address these concerns by confirming the factorial validity of the CES-D.

Methods and findings: Differential item functioning estimates were used to examine sex biases in item responses, and confirmatory factor analyses were used to assess prior CES-D factor structures and new models heeding current theoretical and empirical considerations. Data used for the analyses included undergraduate (n = 948; 74% women), community (n = 254; 71% women), rehabilitation (n = 522; 53% women), clinical (n =84; 77% women), and National Health and Nutrition Examination Survey (NHANES; n = 2814; 56% women) samples. Differential item functioning identified an item as inflating CES-D scores in women. Comprehensive comparison of the several models supported a novel, psychometrically robust, and unbiased 3-factor 14-item solution, with factors (i.e., negative affect, anhedonia, and somatic symptoms) that are more in line with current diagnostic criteria for depression.

Conclusions: Researchers and practitioners may benefit from using the novel factor structure of the CES-D and from being cautious in interpreting results from the originally proposed scale. Comprehensive results, implications, and future research directions are discussed.

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Related in: MedlinePlus

Path Diagram for the CES-D new factor solution.
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pone-0058067-g002: Path Diagram for the CES-D new factor solution.

Mentions: The fit indices for each of the previously reported models – as evaluated with data from each sample – are presented in Table 3 (where the model CFI exceeded.92 in at least three out of the five samples). The results were interpreted to suggest that five models might have the factorial validity to provide utility in divergent populations, as many of the fit indices met acceptable standards across the different samples. However, all of these models included item 17 and/or failed to include items that assess positive affect, which is inconsistent with current theory and diagnostic approaches concerning depression [1]. Of all the newly derived models (i.e., with items 15, 17, and 19 removed and without 2-item factors [if relevant]), only one exhibited acceptable fit indices within each sample, included positive affect items, and did not include item 17. The model with the best fit indices was a revision of the one proposed by Radloff [47], which also excluded items 9, 10, and 13. Relevant fit indices and inter-factor correlations for this newly derived model are reported in Table 4. The original model proposed by Radloff [47] included four factors: depressed affect (items 3, 6, 14, 17, 18), anhedonia (items 4, 8, 12, 16), somatic complaints (items 1, 2, 5, 7, 11, 20), and interpersonal concerns (items 15, 19). Eliminating item 17 and the two interpersonal items results in an easily interpretable 3-factor structure (Tables 5 and 6; Figure 2– Path Diagram for the CES-D new factor solution) that includes factors of negative affect (items 3, 6, 14, 18), anhedonia (items 4, 8, 12, 16), and somatic complaints (items 1, 2, 5, 7, 11, 20), which is compatible with current DSM-IV-TR conceptualization of depression [1]. The internal consistencies (determined using Cronbach’s alpha) for the total score of the newly derived factor structure (undergraduate α = .87; community α = .92; rehabilitation α = .90; clinical α = .80; NHANES α = .83), the negative affect subscale (undergraduate α = .87; community α = .90; rehabilitation α = .89; clinical α = .82; NHANES α = .74), the anhedonia subscale (undergraduate α = .75; community α = .86; rehabilitation α = .79; clinical α = .81; NHANES α = .73), and the somatic subscale (undergraduate α = .72; community α = .80; rehabilitation α = .78; clinical α = .51; NHANES α = .81) were all acceptable with the exception of the somatic subscale in the clinical sample (i.e., α = .51). The correlation between the total score of the original CES-D and the total score of the current variant, as well as the correlations between their respective subscale scores, were all very high (Table 7).


The center for epidemiologic studies depression scale: a review with a theoretical and empirical examination of item content and factor structure.

Carleton RN, Thibodeau MA, Teale MJ, Welch PG, Abrams MP, Robinson T, Asmundson GJ - PLoS ONE (2013)

Path Diagram for the CES-D new factor solution.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3585724&req=5

pone-0058067-g002: Path Diagram for the CES-D new factor solution.
Mentions: The fit indices for each of the previously reported models – as evaluated with data from each sample – are presented in Table 3 (where the model CFI exceeded.92 in at least three out of the five samples). The results were interpreted to suggest that five models might have the factorial validity to provide utility in divergent populations, as many of the fit indices met acceptable standards across the different samples. However, all of these models included item 17 and/or failed to include items that assess positive affect, which is inconsistent with current theory and diagnostic approaches concerning depression [1]. Of all the newly derived models (i.e., with items 15, 17, and 19 removed and without 2-item factors [if relevant]), only one exhibited acceptable fit indices within each sample, included positive affect items, and did not include item 17. The model with the best fit indices was a revision of the one proposed by Radloff [47], which also excluded items 9, 10, and 13. Relevant fit indices and inter-factor correlations for this newly derived model are reported in Table 4. The original model proposed by Radloff [47] included four factors: depressed affect (items 3, 6, 14, 17, 18), anhedonia (items 4, 8, 12, 16), somatic complaints (items 1, 2, 5, 7, 11, 20), and interpersonal concerns (items 15, 19). Eliminating item 17 and the two interpersonal items results in an easily interpretable 3-factor structure (Tables 5 and 6; Figure 2– Path Diagram for the CES-D new factor solution) that includes factors of negative affect (items 3, 6, 14, 18), anhedonia (items 4, 8, 12, 16), and somatic complaints (items 1, 2, 5, 7, 11, 20), which is compatible with current DSM-IV-TR conceptualization of depression [1]. The internal consistencies (determined using Cronbach’s alpha) for the total score of the newly derived factor structure (undergraduate α = .87; community α = .92; rehabilitation α = .90; clinical α = .80; NHANES α = .83), the negative affect subscale (undergraduate α = .87; community α = .90; rehabilitation α = .89; clinical α = .82; NHANES α = .74), the anhedonia subscale (undergraduate α = .75; community α = .86; rehabilitation α = .79; clinical α = .81; NHANES α = .73), and the somatic subscale (undergraduate α = .72; community α = .80; rehabilitation α = .78; clinical α = .51; NHANES α = .81) were all acceptable with the exception of the somatic subscale in the clinical sample (i.e., α = .51). The correlation between the total score of the original CES-D and the total score of the current variant, as well as the correlations between their respective subscale scores, were all very high (Table 7).

Bottom Line: Differential item functioning identified an item as inflating CES-D scores in women.Researchers and practitioners may benefit from using the novel factor structure of the CES-D and from being cautious in interpreting results from the originally proposed scale.Comprehensive results, implications, and future research directions are discussed.

View Article: PubMed Central - PubMed

Affiliation: The Anxiety and Illness Behaviour Laboratory, Department of Psychology, University of Regina, Regina, Saskatchewan, Canada. Nick.Carleton@uregina.ca

ABSTRACT

Background: The Center for Epidemiologic Studies Depression Scale (CES-D; Radloff, 1977) is a commonly used freely available self-report measure of depressive symptoms. Despite its popularity, several recent investigations have called into question the robustness and suitability of the commonly used 4-factor 20-item CES-D model. The goal of the current study was to address these concerns by confirming the factorial validity of the CES-D.

Methods and findings: Differential item functioning estimates were used to examine sex biases in item responses, and confirmatory factor analyses were used to assess prior CES-D factor structures and new models heeding current theoretical and empirical considerations. Data used for the analyses included undergraduate (n = 948; 74% women), community (n = 254; 71% women), rehabilitation (n = 522; 53% women), clinical (n =84; 77% women), and National Health and Nutrition Examination Survey (NHANES; n = 2814; 56% women) samples. Differential item functioning identified an item as inflating CES-D scores in women. Comprehensive comparison of the several models supported a novel, psychometrically robust, and unbiased 3-factor 14-item solution, with factors (i.e., negative affect, anhedonia, and somatic symptoms) that are more in line with current diagnostic criteria for depression.

Conclusions: Researchers and practitioners may benefit from using the novel factor structure of the CES-D and from being cautious in interpreting results from the originally proposed scale. Comprehensive results, implications, and future research directions are discussed.

Show MeSH
Related in: MedlinePlus