Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Apr 19;21(1):197.
doi: 10.1186/s12888-021-03206-1.

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

Joanna M Blodgett  1 , Chantelle C Lachance  2 , Brendon Stubbs  3   4 , Melissa Co  3 , Yu-Tzu Wu  3 , Matthew Prina  3 , Vivian W L Tsang  5 , Theodore D Cosco  6   7
Affiliations

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

Joanna M Blodgett et al. BMC Psychiatry. .

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.

Keywords: Adolescents; Center for Epidemiologic Studies-Depression Scale; Depression; Factor structure; Psychometric.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Article inclusion flowchart
See this image and copyright information in PMC

References

    1. GBD 2015 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990-2015: a systematic analysis for the global burden of disease study 2015. Lancet 2016, 388(10053):1545–1602. - PMC - PubMed
    1. Mathers CD, Loncar D. Projections of global mortality and burden of disease from 2002 to 2030. PLoS Med. 2006;3(11):e442. 10.1371/journal.pmed.0030442. PMID: 17132052; PMCID: PMC1664601. - PMC - PubMed
    1. Lepine JP, Briley M. The increasing burden of depression. Neuropsychiatr Dis Treat. 2011;7(Suppl 1):3–7. doi: 10.2147/NDT.S19617. - DOI - PMC - PubMed
    1. Thapar A, Collishaw S, Pine DS, Thapar AK. Depression in adolescence. Lancet. 2012;379(9820):1056–1067. doi: 10.1016/S0140-6736(11)60871-4. - DOI - PMC - PubMed
    1. Windfuhr K, While D, Hunt I, Turnbull P, Lowe R, Burns J, Swinson N, Shaw J, Appleby L, Kapur N, the National Confidential Inquiry into Suicide and Homicide by People with Mental Illness Suicide in juveniles and adolescents in the United Kingdom. J Child Psychol Psychiatry. 2008;49(11):1155–1165. doi: 10.1111/j.1469-7610.2008.01938.x. - DOI - PubMed

Publication types