Psychometric Properties and Factor Structure of the Center for Epidemiologic Studies Depression Scale in a National Sample of Arab Adolescents.

ABSTRACT

Having valid, reliable, and culturally adapted tools to screen for adolescent depression is a crucial concern for mental health care professionals who promote preventive care. To this aim, this study tested the psychometric properties and factor structure of the Center for Epidemiologic Studies Depression (CES-D) Scale among Arab adolescents. A nationally representative sample of 3,292 Jordanian adolescents aged 13-17 completed the CES-D 20-item scale. A principal axis factoring with a varimax rotation was used to identify the factor structure of the scale on a half of the sample (n1 = 1,655), followed by a confirmatory factor analysis to assess the fitness of the factor structure to the other half of the sample (n2 = 1,637) on a variety of model-fit indices. Findings did not support the original four-factor structure. The results indicated that two factors provide a reasonably better fit Factor 1 combined items on depressed affect, somatic complaints and interpersonal problems, and Factor 2 consisted of the remaining four positive affect items. The modified model showed high internal reliability and excellent construct validity. The results revealed that depression construct among Arab adolescents, as measured by the CES-D, differs from that in other ethnic groups. Nurses and other health professionals need to closely examine the different presentation of depressive symptoms across racial and ethnic groups to avoid diagnostic errors, inappropriate management, and poor compliance.