title: The center for epidemiologic studies depression scale: a review with a theoretical and empirical examination of item content and factor structure.
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.
  
  
  RESULTS
  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.
authors.affiliation: The Anxiety and Illness Behaviour Laboratory, Department of Psychology, University of Regina, Regina, Saskatchewan, Canada. Nick.Carleton@uregina.ca
authors.forename: R Nicholas
authors.initials: RN
authors.lastname: Carleton
authors.forename: Michel A
authors.initials: MA
authors.lastname: Thibodeau
authors.forename: Michelle J N
authors.initials: MJ
authors.lastname: Teale
authors.forename: Patrick G
authors.initials: PG
authors.lastname: Welch
authors.forename: Murray P
authors.initials: MP
authors.lastname: Abrams
authors.forename: Thomas
authors.initials: T
authors.lastname: Robinson
authors.forename: Gordon J G
authors.initials: GJ
authors.lastname: Asmundson
mesh_terms: D000293:Adolescent; D000328:Adult; D003863:Depression / Q000175:diagnosis* / Q000523:psychology; D003866:Depressive Disorder / Q000175:diagnosis* / Q000523:psychology; D016021:Epidemiologic Studies; D005163:Factor Analysis, Statistical; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009749:Nutrition Surveys; D011594:Psychometrics / Q000379:methods / Q000706:statistics & numerical data*; D057566:Self Report; D012720:Severity of Illness Index; D012737:Sex Factors