The center for epidemiologic studies depression scale: support for a bifactor model with a dominant general factor and a specific factor for positive affect

Can a global score be derived from the Integration of Stressful Life Experiences Scale-Short Form (ISLES-SF)? Empirical support for a bi-factor model

The Integration of Stressful Life Experiences Scale-Short Form (ISLES-SF) is a popular, two-factor measure of meaning-making. Although researchers have used this instrument to calculate a global index of meaning-making, there has been little evidence to support this practice. Therefore, the objective of this study was to examine the validity of this approach by analyzing data from 2,380 American adults during the beginning of the COVID-19 pandemic. A series of confirmatory factor analyses, reliability analyses, and concurrent validity analyses support a bi-factor model of meaning-making. These results affirm the practice of not only using the ISLES-SF to measure meaning-making at a global level, but also to interpret its two specific dimensions (Comprehensibility and Footing in the World) as well.

A bifactor representation of the Center for Epidemiological Studies Depression Scale for children: gender and age invariance and implications for adolescents' social and academic adjustment

BACKGROUND

The Center for Epidemiological Studies Depression Scale for Children (CES-DC) is a widely used scale for screening depressive symptoms in children and adolescents. This study aims to uncover the optimal factor structure of the DES-DC and presents an alternate conceptualization of adolescent depression by estimating bifactor models and several competing models using a sample of Chinese adolescents.

METHODS

The participants were 533 adolescents (49.7% boys, 49.7% girls, 3 participants did not report) between 12 and 18 years of age attending public secondary schools in the middle part of mainland China. Data were collected in classrooms using a questionnaire survey. A structural equation modeling approach was used to estimate and compare a series of competing models for the DES-DC.

RESULTS

A Bifactor exploratory structural equation model (Bi-ESEM) with the best model fit was retained for representing the current data. Tests of measurement invariance demonstrated strict measurement equivalence across gender and age. No gender and age differences have been found in the general depression factor. Findings provided evidence for the composite reliability and construct validity of DES-DC. Depressive symptoms positively related to the Big Five trait neuroticism, negative emotions, loneliness, social anxious behaviors, and disruptive behaviors during school and negatively related to agreeableness, conscientiousness, extraversion, physical health status, school connectedness, and academic self-efficacy.

CONCLUSIONS

This study provides support for the one general factor construct of the CES-DC and the continuum concept structure of adolescent depression. Moreover, this research offers empirical evidence for comparing depression symptoms among adolescent populations with diverse genders and age groups. Additionally, the findings replicate and expand upon the implications of depressive symptoms on adolescents' traits, well-being, social-relational adjustment, and academic adaptation.

Validation of the Center for Epidemiologic Studies Depression Scale (CES-D) in a Moroccan sample with substance use disorder

BACKGROUND

Transcultural validation studies of depression scales are rare in Morocco. The Center for Epidemiologic Studies Depression Scale (CES-D) is commonly one of the most common and frequently used screening instruments for depressive symptoms, but the scale has not, up to date, been validated in dialect of Arabic in Moroccan contexts. Given the importance of assessing and preventing depressive symptoms in our Moroccan context, this study aims to validate the CES-D, translated, and adapted to the dialect of Arabic and Moroccan culture, in a sample with substance use disorder.

METHODS

The data were analyzed in two successive phases. First, exploratory factor analysis (EFA) was used to assess the factor structure in the pilot sample (N = 140). Then, this structure was confirmed in the validation sample (N = 205) using confirmatory factor analysis (CFA).

RESULTS

Exploratory factor analysis extracted three factors different from the four factors in the original version. Confirmatory factor analysis confirmed the structure of three factors. The fit indices level showed acceptable to good performance of the measurement model. The instrument showed sufficient reliability and convergent validity, as demonstrated by acceptable values of composite reliability (CR = 0.89-0.93) and average variance extracted (AVE = 0.64-0.66), respectively. The square roots of AVE were higher than factor-factor pairs correlations, and the Heterotrait-Monotrait ratio (HTMT) of correlations values was less than 0.85, indicating acceptable discriminant validity.

CONCLUSIONS

Overall reliability and both convergent and discriminant validity tests indicated that the Moroccan dialectal Arabic version of the CES-D had a good performance and may serve as a valid tool for measuring the severity of depression in people with substance use disorder.

Full-information item bifactor model for mathematical ability assessment in Chinese compulsory education quality monitoring

This study focuses on the measurement of mathematical ability in the Chinese Compulsory Education Qualification Monitoring (CCEQM) framework using bifactor theory. First, we propose a full-information item bifactor (FIBF) model for the measurement of mathematical ability. Second, the performance of the FIBF model is empirically studied using a data set from three representative provinces were selected from CCEQM 2015-2017. Finally, Monte Carlo simulations are conducted to demonstrate the accuracy of the model evaluation indices and parameter estimation methods used in the empirical study. The obtained results are as follows: (1) The results for the four used model selection indices (AIC, SABIC, HQ, BIC) consistently showed that the fit of the FIBF model is better than that of the UIRT; (2) All of the estimated general and domain-specific abilities of the FIBF model have reasonable interpretations; (3) The model evaluation indices and parameter estimation methods exhibit excellent accuracy, indicating that the application of the FIBF model is technically feasible in large-scale testing projects.

Social participation and depressive symptoms in community-dwelling older adults: Emotional social support as a mediator

Previous studies have documented the protective effects of social participation on depression in older adults. In this study, we investigated the association between social participation and depressive symptoms and the associated gender difference in older adults. In addition, we explored the mediating role of emotional social support in the association between social participation and depressive symptoms. We collected data from 4751 community-dwelling adults aged 60 and above from the Korean Retirement and Income Study (KReIS) conducted in 2017 and 2018. The relationship between social participation (participation in different types of activities, frequency of participation, and the number of activities participated) and the risk for depressive symptoms was examined. Older adults who participated in social activity, volunteer work, and donation had decreased risk of depressive symptoms. More frequent and more diverse participation in activities further reduced the risk. Overall, women benefited more from social participation than men. Importantly, emotional social support significantly mediated the relationship between social participation and depressive symptoms. Social participation was associated lower odds for depression in older adults, particularly in older women. Our findings provided one of very few pieces of evidence that documents the mediating role of emotional social support in the relationship between social participation and depression among the elderly.

Psychosocial Risk Factors for Food Insecurity in Puerto Ricans Living in the USA from Baseline to 5-Year Follow-Up

BACKGROUND

Food insecurity is prevalent among Puerto Rican adults in the USA and is associated with adverse psychosocial outcomes. However, the direction of this association has not been established in this understudied population.

OBJECTIVES

In this study, we aimed to examine the longitudinal association between a group of psychosocial risk factors and subsequent food insecurity in a cohort of Puerto Rican adults.

METHODS

Secondary analysis was conducted using data from the prospective Boston Puerto Rican Health Study. A total of 517 Puerto Rican participants aged 45-75 y in the Boston area who were food secure at baseline, and who completed food security surveys at baseline and 5 y were included. Psychosocial factors, including depressive symptoms, stress, tangible social support, and acculturation were assessed with validated instruments. Multivariable logistic regression models were used to examine the risk of food insecurity at 5 y, as a function of psychosocial factors at baseline and their changes over 5 y, adjusting for age, sex, education, baseline and change in total annual household income, and in family size.

RESULTS

The cumulative incidence of food insecurity at 5 y was 12.6%. The odds of incident food insecurity was significantly associated with baseline depressive symptom score [OR = 1.78 (1.16, 2.76) per each 10 score units], with change in depressive symptom score [OR = 1.50 (1.07, 2.09) per each 10-unit increase], and with change in perceived stress [OR = 1.59 (1.01, 2.51) per each 10-unit increase], after adjusting for potential confounders.

CONCLUSION

In this cohort of Puerto Rican adults, depressive symptoms at baseline, and increases in depressive symptoms and perceived stress over 5 y were associated with a higher risk of food insecurity. Psychosocial health and environment appear to play important roles in predicting risk of food insecurity in the Puerto Rican community.

Latent structure of the Centre for Epidemiologic Studies Depression Scale (CES-D) in older adult populations: a systematic review

Objective: The Center for Epidemiologic Studies Depression Scale (CES-D) is a 20-item, self-report metric intended to measure depression. Despite being one of the most popular depression scales, the psychometric properties, specifically the underlying factor structure of the scale, have come under scrutiny. The latent structure of a scale is a key indicator of its construct validity, i.e. the degree to which the intended variable is captured. To date, a comprehensive review of the latent structure of the CES-D in older adult populations (≥65 years old) has not been conducted. We aimed to examine the latent structure of the CES-D in samples of older adults to assess its ability to capture depressive symptoms.Methods: A systematic review across Scopus, Web of Science, and PsycINFO databases was conducted. Original studies conducting latent variable analysis of the 20-item CES-D in samples aged ≥65 years old were included.Results: Included studies (n = 6) were primarily conducted with community-dwelling older adults in the United States. Studies that conducted exploratory and confirmatory factor analysis (n = 2) revealed two latent factors, whereas those conducting confirmatory factor analysis of previously identified structures (n = 4) revealed four-factor structures in line with the original four-factor structure.Conclusions: A general alignment with the original four-factor structure of the CES-D provides tentative support for continued use amongst older adults; however, further research is required to provide conclusive evidence for these psychometric properties.

Exercise, Mood, Self-Efficacy, and Social Support as Predictors of Depressive Symptoms in Older Adults: Direct and Interaction Effects

Background

Depression is a chronic condition that affects up to 15% of older adults. The healthogenic effects of regular exercise are well established, but it is still unclear which exercise-related variables characterise the antidepressant effects of exercise. Thus, the purpose of this study was to examine the extent to which exercise-related variables (exercise behaviour, exercise-induced mood, exercise self-efficacy, and social support) can predict depressive symptoms in a cohort of community-dwelling older adults.

Methods

This study employed a cross-sectional analysis of questionnaire data from a sample of 586 community-dwelling older Australians aged 65 to 96 years old. Participants completed the Center for Epidemiologic Studies Depression Scale, modified CHAMPS Physical Activity Questionnaire for Older Adults, Four-Dimension Mood Scale, Self-Efficacy for Exercise Scale, and Social Provisions Scale – Short Form. Bivariate correlations were performed, and hierarchical multiple regression was subsequently used to test the regression model.

Results

Exercise behaviour, exercise-induced mood, exercise self-efficacy, and social support were all negatively associated with depressive symptoms (r = −0.20 to −0.56). When the variables were entered as predictors into the hierarchical multiple regression model, social support was the strongest predictor of depressive symptoms (β = −0.42), followed by exercise-induced mood (β = −0.23), and exercise self-efficacy (β = −0.07). Exercise behaviour did not explain any additional variance in depressive symptoms. A modest interaction effect was also observed between exercise-induced mood and social support.

Conclusion

These findings indicate that social support is the strongest predictor of depressive symptomology in community-dwelling older adults, particularly when combined with positive exercise-induced mood states. When addressing the needs of older adults at risk of depression, healthcare professionals should consider the implementation of exercise programmes that are likely to benefit older adults by improving mood, enhancing self-efficacy, and building social support.

Reliability and Validity of the Center for Epidemiologic Studies Depression Scale in a Population-Based Cohort of Middle-Aged U.S. Adults

BACKGROUND AND PURPOSE

Globally, depressive symptoms are a leading contributor to years lived with disability. The Center for Epidemiological Studies-Depression (CES-D) scale has been used extensively to quantify depression; yet, its psychometric properties remain contentious. This study examined the reliability and factor structure of the CES-D in the MacArthur Foundation's Midlife in the United States Study (MIDUS), a nationally representative cohort study of noninstitutionalized, English-speaking adults aged 24-74 years.

METHODS

Internal consistency (Cronbach's alpha) and confirmatory factor analysis (CFA) were used to examine the reliability and factor structure of the CES-D.

RESULTS

There were 1,233 participants who were included in the analysis (mean age = 57.3 years [SD = 11.5], 56.7% female). Cronbach's alpha of .90 was observed. The 4-factor model had the best model fit.

CONCLUSIONS

High internal consistency was demonstrated alongside a replication of the original 4-factor structure. Continued use of the CES-D in noninstitutionalized populations is warranted.

Psychometric Properties and Structures of the IAT, GPIUS and GAS Scales: A Bifactor Approach

This study applied a bifactor approach to investigate the structures and simultaneously compare the psychometric properties of three popular self-report internet addiction (IA) instruments. A bifactor confirmatory factor analysis was used to address the structures of the three scales, while the bifactor multidimensional item response model was employed to compare the psychometric properties of the three scales. Results of bifactor confirmatory factor analysis (CFA) showed that the bifactor structures were suitable for the three scales. These corresponding bifactor structures were used in the subsequent bifactor multidimensional item response theory (MIRT) analysis. Results of the bifactor MIRT showed that: three instruments of IA performed well as a whole; the Generalised Problematic Internet Use Scale (GPIUS) and Internet Addiction Test (IAT) provided more test information and had less standard error of measurement, which ranged from −3 to −1 standard deviations of theta or IA severity; the Game Addiction Scale (GAS) performed better than the other two scales in that it can provide more test information in the large area of IA severity (from −1 to +3 SDs). These suggest that the GPIUS and IAT may be the best choice for epidemiological IA studies and for measuring those with lower IA severity. Meanwhile, the GAS may be a good choice when we recruit those with various levels of IA severity.

Use of CES-D among 56–66 year old people of Dutch, Moroccan and Turkish origin: Measurement invariance and mean differences between the groups

When assessing depressive symptoms across ethnic populations it is important to ensure that items from a questionnaire are valued and interpreted similarly across groups. We aimed to examine measurement (in)variance of the Center for Epidemiological Studies Depression Scale (CES-D) among people of Dutch, Moroccan and Turkish origin in the Netherlands and to compare the level of depressive symptoms across these three groups. Data were used from the Longitudinal Aging Study Amsterdam, including 269 people from Turkish, 209 from Moroccan and 618 from Dutch origin (aged 55–65 years). A multi-group confirmatory factor analysis (MGCFA) was performed to test measurement invariance of the four-factor CES-D across the three cohorts. To compare scores across ethnic groups, we performed ANCOVA. The four subscales of the CES-D (depressed affect, positive affect, somatic symptoms, and interpersonal problems) appeared measurement invariant in people of Dutch, Moroccan and Turkish origin. Turkish and Moroccan participants reported more depressive symptoms on all four domains. The four subscales of the CES-D measure the same constructs in people of Dutch, Moroccan and Turkish origin. Higher levels of depressive symptoms in the migrants groups are therefore not due to measurement invariance, but point to increased mental health problems in these groups.

Assessing the dimensionality of the CES-D using multi-dimensional multi-level Rasch models

Objectives

The CES-D is a widely used depression screening instrument. While numerous studies have analysed its psychometric properties using exploratory and various kinds of confirmatory factor analyses, only few studies used Rasch models and none a multidimensional one.

Methods

The present study applies a multidimensional Rasch model using a sample of 518 respondents representative for the Austrian general population aged 18 to 65. A one-dimensional model, a four-dimensional model reflecting the subscale structure suggested by [1], and a four-dimensional model with the background variables gender and age were applied.

Results

While the one-dimensional model showed relatively good fit, the four-dimensional model fitted much better. EAP reliability indices were generally satisfying and the latent correlations varied between 0.31 and 0.88. In the analysis involving background variables, we found a limited effect of the participants’ gender. DIF effects were found unveiling some peculiarities. The two-items subscale Interpersonal Difficulties showed severe weaknesses and the Positive Affect subscale with the reversed item wordings also showed unexpected results.

Conclusions

While a one-dimensional over-all score might still contain helpful information, the differentiation according to the latent dimension is strongly preferable. Altogether, the CES-D can be recommended as a screening instrument, however, some modifications seem indicated.

Factor Structure and Further Validation of the 20-Item Short Form of the Obsessive Beliefs Questionnaire

A 44-item version of the Obsessive Beliefs Questionnaire (OBQ-44) put forward by the Obsessive Compulsive Cognitions Working Group remains the most widely used version of the OBQ, despite research casting doubt on its factorial validity and the existence of a short form (i.e., OBQ-20). In a large sample of undergraduate students ( n = 1,210), a bifactor model of the OBQ-20, consisting of a general factor and four specific factors (threat, responsibility, importance/control of thoughts, perfectionism/certainty), was supported as the best-fitting model. None of the examined OBQ-44 models provided adequate fit. The bifactor model of the OBQ-20 was retained in two independent samples ( n = 1,342 community adults, n = 319 undergraduate students). The incremental validity of the specific factors of the OBQ-20 beyond the general factor was evidenced across multiple criterion indices, including obsessive–compulsive symptom measures and reactions to a thought-induction task. Results further support use of the OBQ-20.

Well-Being and Institutional Care in Older Adults: Cross-Sectional and Time Effects of Provided and Received Support

BACKGROUND

The aim of the study was to examine the cross-sectional and longitudinal effects of provided and received support on older adults' subjective well-being (positive affect and depression) and to examine whether being a recipient of institutional care moderates these effects.

METHODS

Social support (provided and received), positive affect, and depressive symptoms were assessed twice (at baseline and 1 month later) for 277 older adults (age 77.39 ± 9.20 years, 67.50% women, 65% residents of an institutional care facility).

FINDINGS

Two structural equation models were analyzed: cross-sectional (at baseline) and longitudinal (after 1 month). The first model revealed a significant positive relationship between providing and receiving support and positive affect, and a negative relationship between receiving support and depression. However, being a recipient of institutional care appeared to be a significant moderator in the longitudinal model. Specifically, the findings indicated effects of both providing and receiving support on positive affect but only for noninstitutionalized older adults.

DISCUSSION

Although both types of support may be beneficial for older adults, their effects depend on the nature of social exchange and the dimensions of well-being. This suggests that such factors should be systematically investigated in future research.

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

Background

The Center for Epidemiologic Studies Depression Scale (CES-D) is a commonly used instrument to measure depressive symptomatology. Despite this, the evidence for its psychometric properties remains poorly established in Chinese populations. The aim of this study was to validate the use of the CES-D in Chinese primary care patients by examining factor structure, construct validity, reliability, sensitivity and responsiveness.

Methods and Results

The psychometric properties were assessed amongst a sample of 3686 Chinese adult primary care patients in Hong Kong. Three competing factor structure models were examined using confirmatory factor analysis. The original CES-D four-structure model had adequate fit, however the data was better fit into a bi-factor model. For the internal construct validity, corrected item-total correlations were 0.4 for most items. The convergent validity was assessed by examining the correlations between the CES-D, the Patient Health Questionnaire 9 (PHQ-9) and the Short Form-12 Health Survey (version 2) Mental Component Summary (SF-12 v2 MCS). The CES-D had a strong correlation with the PHQ-9 (coefficient: 0.78) and SF-12 v2 MCS (coefficient: -0.75). Internal consistency was assessed by McDonald’s omega hierarchical (ωH). The ωH value for the general depression factor was 0.855. The ωH values for “somatic”, “depressed affect”, “positive affect” and “interpersonal problems” were 0.434, 0.038, 0.738 and 0.730, respectively. For the two-week test-retest reliability, the intraclass correlation coefficient was 0.91. The CES-D was sensitive in detecting differences between known groups, with the AUC >0.7. Internal responsiveness of the CES-D to detect positive and negative changes was satisfactory (with p value <0.01 and all effect size statistics >0.2). The CES-D was externally responsive, with the AUC>0.7.

Conclusions

The CES-D appears to be a valid, reliable, sensitive and responsive instrument for screening and monitoring depressive symptoms in adult Chinese primary care patients. In its original four-factor and bi-factor structure, the CES-D is supported for cross-cultural comparisons of depression in multi-center studies.