Academic journal article Journal of Nursing Measurement

Measurement Properties of the Centers for Epidemiological Studies Depression Scale (CES-D) in a Sample of African American and Non-Hispanic White Pregnant Women

Academic journal article Journal of Nursing Measurement

Measurement Properties of the Centers for Epidemiological Studies Depression Scale (CES-D) in a Sample of African American and Non-Hispanic White Pregnant Women

Article excerpt

This study investigated the appropriateness of using the CES-D scale for comparing depressive symptoms among pregnant women of different races. Black and White women were matched on education, age, Medicaid status, and marital status-living arrangements. The matching procedure yielded a study sample of 375 in each ethnic group. Using a confirmatory factor analysis, the fit of several factor models for the CES-D was evaluated. One CES-D item, "everything was an effort," showed a low item-total correlation (0.04 among blacks, 0.22 among whites) and was excluded from further analysis. After imposing the constraints of equal factor loadings and factor covariance across both groups, a two-factor model with 19 CES-D items provided a good fit. Only the loading for the "was happy" item displayed a small difference between the two groups. Furthermore, the correlations between the original 20-item and the unbiased 18-item scales were r = 0.994 for Whites and r = 0.992 for Blacks. The results suggest that the 20-item CES-D can be used to compare depressive symptoms in White and Black pregnant women without introducing significant ethnic-racial bias in the measurement of these symptoms.

Keywords: race comparison; depression; pregnancy; CES-D; ethnic mental health

Many women, particularly low-income women and adolescents, experience depressive symptoms during pregnancy (Holzman et al., 2006; Marcus, Flynn, Blow, & Barry, 2003; Orr, Sherman, & Prince, 2002). These depressive symptoms have been linked to risk factors such as drinking, smoking, and substance abuse that can lead to unfavorable pregnancy outcomes (Steyn, de-Wet, Saloojee, Nel, & Yach, 2006; Zhu & Valbo, 2002). In addition, there may be more direct associations between depressive symptoms in pregnancy and preeclampsia (Kurki, Hiilesmaa, Raitasalo, Mattila, & Ylikorkala, 2000) and low birth weight (Hoffman & Hatch, 1996). These associations may be especially prevalent among women of lower socioeconomic status (Hoffman & Hatch, 2000) who are disproportionately women of color.

Investigators interested in measuring depressive symptoms in pregnancy face the difficult decision of determining what instrument to select. Historically, studies of depressive symptoms in pregnancy have used various screening tools such as the Beck Depression Inventory (Beck, Steer, & Garbin, 1988), the Edinburgh (Cox, Holden, & Sagovsky, 1987), and the Centers for Epidemiological Studies Depression Scale (CES-D; Hoffman & Hatch, 2000). While the CES-D scale is one of the more frequently used scales, to date, no study has closely examined the measurement properties of the CES-D scale among pregnant women from diverse racial-ethnic backgrounds.

The effects of depressive symptoms on pregnancy outcome may vary between racial- ethnic groups, and depressive symptoms may partially mediate racial-ethnic differences in adverse pregnancy outcome (Gaynes et al., 2005). However, before these issues can be adequately studied, it is important to ascertain if there is a cultural bias in the tools used to measure depressive symptoms. Often researchers overlook the possibility that measurement scales may not be equivalent or may not have the same measurement properties across groups being compared. For example, if African American and White American respondents differ systematically in their responses to some, but not all, of the indicators of depressive symptoms in a standardized instrument, the total scale scores may not provide an unbiased estimate of depressive symptoms across these two groups. Therefore, the purpose of this study was to assay the psychometric properties of the CES-D in African American and White American pregnant women with special consideration of assessing for racially biased items.


The CES-D scale, a tool that has been in the public domain since 1977 (Radloff, 1977), has often been used to compare prevalence of depressive symptoms in different racial-ethnic groups (Aneshensel, Clark, & Frerichs, 1983; Cole, Kawachi, Maller, & Berkman, 2000; Nguyen, Kitner-Triolo, Evans, & Zonderman, 2004; Roberts, 1980; Vera, Alegria, Freeman, Robles, & Rios, 1991). …

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