Factor Structure of the Center for Epidemiologic Studies Depression Scale in Low- Income Women Attending Primary Care Clinics

Given the high rates of major depressive disorder in primary care settings, routine use of screening measures to assist in identifying depressed individuals is warranted. The Center for Epidemiologic Studies Depression Scale (CES-D) ( Radloff, 1977 ) is a self-rated measure of distress commonly used to screen for depression in primary care settings. The present study was undertaken to confirm the original four-factor model in a sample of low-income women attending primary care clinics (N = 179). Although the original four-factor structure has been replicated in a variety of population groups, internal validity of the measure has not been previously examined in this population sample. A series of confirmatory factor analytic procedures failed to replicate the original four-factor structure or a second-order model. An exploratory analysis, using principal components and a VARIMAX rotation yielded three factors: Depressed Affect/Somatic Symptoms, Positive Affect, and Interpersonal Difficulties. Results of this study add support to previous research documenting an increased somatic presentation of depression in low-income samples. Implications for the use of the CES-D as a screening tool to identify depression in similar primary care samples are discussed.

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The Psychometric Properties of the Center for Epidemiologic Studies Depression Scale in Chinese Primary Care Patients: Factor Structure, Construct Validity, Reliability, Sensitivity and Responsiveness

PLoS ONE ◽

10.1371/journal.pone.0135131 ◽

2015 ◽

Vol 10 (8) ◽

pp. e0135131 ◽

Cited By ~ 50

Author(s):

Weng Yee Chin ◽

Edmond P. H. Choi ◽

Kit T. Y. Chan ◽

Carlos K. H. Wong

Keyword(s):

Primary Care ◽

Construct Validity ◽

Psychometric Properties ◽

Factor Structure ◽

Depression Scale ◽

Epidemiologic Studies ◽

Reliability Sensitivity ◽

Primary Care Patients

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Examination of the Temporal Relationship between Smoking and Major Depressive Disorder among Low-Income Women in Public Primary Care Clinics

American Journal of Health Promotion ◽

10.4278/0890-1171-16.6.323 ◽

2002 ◽

Vol 16 (6) ◽

pp. 323-330 ◽

Cited By ~ 13

Author(s):

Isabel C. Scarinci ◽

Janet Thomas ◽

Phillip J. Brantley ◽

Glenn N. Jones

Keyword(s):

Primary Care ◽

Major Depressive Disorder ◽

Depressive Disorder ◽

Low Income ◽

Temporal Relationship ◽

Smoking Initiation ◽

First Episode ◽

Major Depressive ◽

Primary Care Clinics ◽

Low Income Women

Purpose. To determine the prevalence of major depressive disorder (MDD) by smoking status, and the temporal relationship between smoking and MDD, and explore other smoking-related variables that may be associated with MDD. Design. Cross-sectional study. Setting. Public primary care clinics. Subjects. Researchers studied 338 women (76% African-Americans) who were randomly selected while attending appointments in two public primary care clinics. Measures. Data pertaining to smoking-related variables and MDD diagnosis were obtained using the Diagnostic Interview Schedule for the Diagnostic Statistical Manual of Mental Disorders IV (DSM-IV). Results. The prevalence of a lifetime history of MDD was significantly higher for current smokers (56.6%) than among former smokers (37.5%) or never-smokers (30.3%; p < .001). Most ever-smokers (81.3%) began smoking and were nicotine-dependent (63.6%) prior to their first episode of MDD. Using logistic regression, after controlling for demographic and smoking-related variables, age of smoking onset was the strongest variable associated with MDD among ever-smokers. Specifically, the odds of having an MDD decreased by 8.2% for each year delay in smoking initiation. Conclusion. These results suggest that smoking initiation precedes MDD and that smoking is associated with a high prevalence of MDD among low-income women attending primary care clinics. Further, the younger women start smoking the more likely they are to have MDD.

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The Utility of the Ces-D as a Depression Screening Measure among Low-Income Women Attending Primary Care Clinics

The International Journal of Psychiatry in Medicine ◽

10.2190/fufr-pk9f-6u10-jxrk ◽

2001 ◽

Vol 31 (1) ◽

pp. 25-40 ◽

Cited By ~ 121

Author(s):

Janet L. Thomas ◽

Glenn N. Jones ◽

Isabel C. Scarinci ◽

Daniel J. Mehan ◽

Phillip J. Brantley

Keyword(s):

Primary Care ◽

Positive Predictive Value ◽

Low Income ◽

Predictive Value ◽

Depression Screening ◽

Care Practice ◽

Primary Care Clinics ◽

Medical Disorders ◽

Cut Score ◽

Low Income Women

Objective: Depressive disorders are among the most common medical disorders seen in primary care practice. The Center for Epidemiologic Studies-Depression (CES-D) scale is one of the measures commonly suggested for detecting depression in these clinics. However, to our knowledge, there have been no previous studies examining the validity of the CES-D among low-income women attending primary care clinics. Method: Low-income women attending public primary care clinics ( n = 179, ages 20–77) completed the CES-D and the Diagnostic Interview Schedule for the DSM-IV (DIS-IV). Results: The results supported the validity of the CES-D. The standard cut-score of 16 and above yielded a sensitivity of .95 and specificity of .70 in predicting Major Depressive Disorder (MDD). However, over two-thirds of those who screened positive did not meet criteria for MDD (positive predictive value = .28). The standard cut-score appears valid, but inefficient for depression screening in this population. An elevated cut-score of 34 yielded a higher specificity (.95) and over 50 percent of the patients who screened positive had a MDD (positive predictive value = .53), but at great cost to sensitivity (.45). Conclusion: Results indicated that the CES-D appears to be as valid for low-income, minority women as for any other demographic group examined in the literature. Despite similar validity, the CES-D appears to be inadequate for routine screening in this population. The positive predictive value remains very low no matter which cut-scores are used. The costs of the false positive rates could be prohibitive, especially in similar public primary care settings.

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A reexamination of the factor structure of the Center for Epidemiologic Studies Depression Scale: Is a one-factor model plausible?

Psychological Assessment ◽

10.1037/a0019917 ◽

2010 ◽

Vol 22 (3) ◽

pp. 711-715 ◽

Cited By ~ 42

Author(s):

Michael C. Edwards ◽

Jennifer S. Cheavens ◽

Jane E. Heiy ◽

Kelly C. Cukrowicz

Keyword(s):

Factor Structure ◽

Factor Model ◽

Depression Scale ◽

Epidemiologic Studies

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Factor structure and measurement invariance of the Chinese version of the Center for Epidemiological Studies Depression (CES-D) scale among undergraduates and clinical patients

BMC Psychiatry ◽

10.1186/s12888-021-03474-x ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Lishui Niu ◽

Jiayue He ◽

Chang Cheng ◽

Jinyao Yi ◽

Xiang Wang ◽

...

Keyword(s):

Measurement Invariance ◽

Factor Structure ◽

Internal Consistency ◽

Factor Model ◽

Five Factor Model ◽

Depression Scale ◽

Internal Consistency Reliability ◽

Epidemiological Studies ◽

Epidemiologic Studies ◽

Hunan Province

Abstract Background The Center for Epidemiologic Studies Depression scale (CESD) was widely used for screening of depressive symptoms. The purpose of the current study was to investigate the factor structure and measurement invariance of the CESD across genders and groups in a sample of Chinese undergraduates and clinical patients. Methods Participants included 3093 undergraduates from the Hunan province and 336 patients from psychological clinics. The structure of the CESD scale was analyzed by confirmatory factor analysis (CFA). Multiple sets of CFAs were used to test measurement invariance across genders among undergraduates and clinical patients. Internal consistency reliability was also evaluated. Results The five-factor model achieved satisfactory fit (in the undergraduate sample: WLSMVχ2 = 1662.385, df = 160, CFI = 0.973, TLI = 0.968, RMSEA = 0.055; in the clinical patients: WLSMVχ2 = 502.089, df = 160, CFI = 0.962, TLI = 0.955, RMSEA = 0.072). The measurement invariance of the five-factor model across genders was supported fully assuming different degrees of invariance. The CESD also showed acceptable internal consistency. Conclusion Due to its sound structure and measurement invariance, the five-factor model of the CESD is best suited for testing in Chinese mainland college students and clinical patients.

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Measurement invariance of the Center for Epidemiologic Studies Depression Scale in parents of individuals with disabilities

Social Behavior and Personality An International Journal ◽

10.2224/sbp.8257 ◽

2019 ◽

Vol 47 (10) ◽

pp. 1-9

Author(s):

Eun-Young Park ◽

Joungmin Kim

Keyword(s):

South Korea ◽

Measurement Invariance ◽

Factor Model ◽

Panel Study ◽

Depression Scale ◽

Epidemiologic Studies ◽

Fit Indices ◽

Chi Square ◽

Using Data ◽

Invariance Model

We aimed to verify the factor model and measurement invariance of the abbreviated Center for Epidemiologic Studies Depression Scale by conducting a confirmatory factor analysis using data from 761 parents of individuals with intellectual disabilities who completed the scale as part of the 2011 Survey on the Actual Conditions of Individuals with Developmental Disabilities, South Korea, and 7,301 participants from the general population who completed the scale as part of the 2011 Welfare Panel Study and Survey by the Ministry of Health and Welfare, South Korea. We used fit indices to assess data reliability and Amos 22.0 for data analysis. According to the results, the 4-factor model had an appropriate fit to the data and the regression coefficients were significant. However, the chi-square difference test result was nonsignificant; therefore, the metric invariance model was the most appropriate measurement invariance model for the data. Implications of the findings are discussed.

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A systematic review of the latent structure of the Center for Epidemiologic Studies Depression Scale (CES-D) amongst adolescents

BMC Psychiatry ◽

10.1186/s12888-021-03206-1 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Joanna M. Blodgett ◽

Chantelle C. Lachance ◽

Brendon Stubbs ◽

Melissa Co ◽

Yu-Tzu Wu ◽

...

Keyword(s):

Factor Analysis ◽

Cultural Differences ◽

Factor Structure ◽

English Language ◽

Depression Scale ◽

Epidemiologic Studies ◽

Latent Structure ◽

Future Research ◽

Primary Analysis ◽

The Usa

Abstract Background The Centre for Epidemiologic Studies Depression Scale (CES-D) is a commonly used psychometric scale of depression. A four-factor structure (depressed affect, positive affect, somatic symptoms, and interpersonal difficulties) was initially identified in an American sample aged 18 to 65. Despite emerging evidence, a latent structure has not been established in adolescents. This review aimed to investigate the factor structure of the CES-D in adolescents. Methods We searched Web of Science, PsychINFO and Scopus and included peer-reviewed, original studies assessing the factor structure of the 20-item CES-D in adolescents aged ≤18. Two independent researchers screened results and extracted data. Results Thirteen studies met the inclusion criteria and were primarily from school-based samples in the USA or Asia. Studies that conducted confirmatory factor analysis (CFA; n = 9) reported a four-factor structure consistent with the original factor structure; these studies were primarily USA-based. Conversely, studies that conducted exploratory factor analysis (EFA) reported distinct two or three factor structures (n = 4) and were primarily based in Asia. Limitations Studies in a non-English language and those that included individuals aged > 18 years were excluded. Ethnic or cultural differences as well as different analytical methods impacted generalisability of results. The use of CFA as the primary analysis may have biased towards a four-factor structure. Conclusions A four-factor CES-D structure was an appropriate fit for adolescents in Western countries; further research is required to determine the fit in in Asian countries. This has important implications for clinical use of the scale. Future research should consider how cultural differences shape the experience of depression in adolescents.

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