Academic journal article The Spanish Journal of Psychology

Cross-Cultural Confirmatory Factor Analysis of the CES-D in Spanish and Mexican Dementia Caregivers

Academic journal article The Spanish Journal of Psychology

Cross-Cultural Confirmatory Factor Analysis of the CES-D in Spanish and Mexican Dementia Caregivers

Article excerpt

The Center for Epidemiologic Studies-Depression Scale (CES-D) is the most frequently used scale for measuring depressive symptomatology in caregiving research. The aim of this study is to test its construct structure and measurement equivalence between caregivers from two Spanish-speaking countries. Face-to-face interviews were carried out with 595 female dementia caregivers from Madrid, Spain, and from Coahuila, Mexico. The structure of the CES-D was analyzed using exploratory and confirmatory factor analysis (EFA and CFA, respectively). Measurement invariance across samples was analyzed comparing a baseline model with a more restrictive model. Significant differences between means were found for 7 items. The results of the EFA clearly supported a four-factor solution. The CFA for the whole sample with the four factors revealed high and statistically significant loading coefficients for all items (except item number 4). When equality constraints were imposed to test for the invariance between countries, the change in chi-square was significant, indicating that complete invariance could not be assumed. Significant between-countries differences were found for three of the four latent factor mean scores. Although the results provide general support for the original four-factor structure, caution should be exercised on reporting comparisons of depression scores between Spanish-speaking countries.

Keywords: Alzheimer, caregiving, dementia, depression, Spanish-speaking, Latino.

La Escala del Centro para Estudios Epidemiológicos (CES-D) es la más utilizada para medir sintomatología depresiva en la investigación sobre cuidadores. El objetivo de este estudio es analizar su estructura dimensional y su equivalencia de medida entre cuidadores de dos países de habla hispana. Se entrevistó a 595 mujeres cuidadoras de familiares con demencia de Madrid, España, y Coahuila, México. La estructura del CES-D se analizó mediante análisis factoriales exploratorios (AFE) y confirmatorios (AFC). Se encontraron diferencias estadísticamente significativas entre las medias de 7 ítems. Los resultados del AFE con la muestra total respaldan claramente una solución de 4 factores. El AFC de la estructura de 4 factores revela cargas elevadas y significativas para todos los ítems (excepto el 4). Al imponer restricciones de igualdad para valorar la equivalencia entre países, el cambio en chi-cuadrado fue significativo, indicando que no se puede asumir una equivalencia completa. Se encontraron diferencias significativas entre países para tres de las cuatro puntuaciones medias en los factores latentes. Aunque los resultados proporcionan un apoyo general a la estructura original de cuatro factores, se debería tener una cierta cautela a la hora de informar sobre comparaciones en puntuaciones en depresión entre países de habla hispana.

Palabras clave: Alzheimer, cuidadores, demencia, depresión, hispano hablantes, latinos.

Dementia is a public health priority worldwide. The number of people suffering from dementia is estimated at 35.6 million (Alzheimer's Disease International, 2009). Prevalence rates of dementia for over-65s in Spain range from 7.4% to 17.2% (Berr, Wancata, & Ritchie 2005), while the figure for Mexico is around 8.6% (Llibre et al., 2008). Caring for an elderly relative is associated with high levels of reported distress by caregivers, especially if they are caring for a relative with a diagnosis of dementia (Pinquart & Sörensen, 2003). Depression is one of the principal emotional disorders suffered by caregivers (Schulz, ÓBrien, Bookwala, & Fleissner, 1995). A frequently reported finding is that female caregivers have higher depression scores than male caregivers (Pinquart & Sörensen, 2003).

The Center for Epidemiologic Studies-Depression Scale (CES-D) is one of the most frequently used scales in caregiving studies (Pinquart & Sörensen, 2003; Schulz et al., 1995). Although it has been recommended as a measure for psychological outcomes in caregiving research (Brodaty, 2007), further validation of this scale has been required in settings outside North America (Moniz-Cook et al. …

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