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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


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          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.


          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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          Most cited references 32

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          Screening for depression in well older adults: evaluation of a short form of the CES-D (Center for Epidemiologic Studies Depression Scale).

          We derived and tested a short form of the Center for Epidemiologic Studies Depression Scale (CES-D) for reliability and validity among a sample of well older adults in a large Health Maintenance Organization. The 10-item screening questionnaire, the CESD-10, showed good predictive accuracy when compared to the full-length 20-item version of the CES-D (kappa = .97, P or = 16 for the full-length questionnaire and > or = 10 for the 10-item version. We discuss other potential cutoff values. The CESD-10 showed an expected positive correlation with poorer health status scores (r = .37) and a strong negative correlation with positive affect (r = -.63). Retest correlations for the CESD-10 were comparable to those in other studies (r = .71). We administered the CESD-10 again after 12 months, and scores were stable with strong correlation of r = .59.
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            Positive and negative affectivity and their relation to anxiety and depressive disorders.

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              Two shorter forms of the CES-D (Center for Epidemiological Studies Depression) depression symptoms index.

              Brief measurement devices can alleviate respondent burden and lower refusal rates in surveys. This article reports on a field test of two shorter forms of the Center for Epidemiological Studies Depression (CES-D) symptoms index in a multisite survey of persons 65 and older. Factor analyses demonstrate that the briefer forms tap the same symptoms dimensions as does the original CES-D, and reliability statistics indicate that they sacrifice little precision. Simple transformations are presented to how scores from the briefer forms can be compared to those of the original.

                Author and article information

                Role: Editor
                PLoS One
                PLoS ONE
                PLoS ONE
                Public Library of Science (San Francisco, USA )
                1 March 2013
                : 8
                : 3
                [1 ]The Anxiety and Illness Behaviour Laboratory, Department of Psychology, University of Regina, Regina, Saskatchewan, Canada
                [2 ]Regina Qu’Appelle Health Region, Functional Rehabilitation Program, Regina, Saskatchewan, Canada
                Tehran University of Medical Sciences, Iran (Republic of Islamic)
                Author notes

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

                Conceived and designed the experiments: RNC. Performed the experiments: RNC PGW MPA TR GJGA. Analyzed the data: RNC MAT PGW. Contributed reagents/materials/analysis tools: RNC MAT TR GJGA. Wrote the paper: RNC MAT MJNT MPA TR GJGA.


                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                Page count
                Pages: 11
                The authors have no support or funding to report.
                Research Article
                Mental Health
                Mood Disorders
                Clinical Psychology
                Non-Clinical Medicine
                Health Care Policy
                Screening Guidelines
                Social and Behavioral Sciences
                Adjustment (Psychology)
                Applied Psychology
                Clinical Psychology



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