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

R Nicholas Carleton, Michel A Thibodeau, Michelle J N Teale, Patrick G Welch, Murray P Abrams, Thomas Robinson, Gordon J G Asmundson, R Nicholas Carleton, Michel A Thibodeau, Michelle J N Teale, Patrick G Welch, Murray P Abrams, Thomas Robinson, Gordon J G Asmundson

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.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1. Item characteristic curves.
Figure 1. Item characteristic curves.
Figure 2. Path Diagram for the CES-D…
Figure 2. Path Diagram for the CES-D new factor solution.

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