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The factor structure of the CES-D in a sample of Rwandan genocide survivors

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Abstract

Background

Past research suggests that culture shapes the way psychopathology is experienced and expressed. Standard psychiatric assessment instruments may therefore not capture the same underlying constructs in different contexts. The present study investigated the factor structure of a standard depression scale in a sample of Rwandan genocide survivors.

Methods

One hundred ninety six Rwandan adults provided socio-demographic information and completed the Center for Epidemiological Studies-Depression scale (CES-D), one of the most widely used self-report instruments assessing depressive symptoms, as part of a larger study on well-being and mental health in Rwanda.

Results

A two-factor solution provided the best fit for these CES-D data. The first factor corresponded to general depressive symptoms (including depressed affect, somatic symptoms, and interpersonal concerns) and explained 37.20 % of the variance. The second factor included items assessing positive affect and explained 8.68 % of the variance.

Conclusions

The two-factor solution found in the present study deviates from the commonly reported four-factor structure, but is consistent with studies showing that depressed affect and somatic symptoms may not be experienced as distinct in certain non-Western and minority cultural groups.

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Notes

  1. We also reverse-coded this item to examine the resulting factor reliability, which was improved (Cronbach’s α = 0.71). However, this item still displayed a lower corrected item-total correlation (r = 0.19) than all four other items (all r s = 0.51−0.63). Furthermore, it remained unclear whether the content of this item was meaningfully related to the content of the four positive affect items. Given these limitations, we decided to exclude this item from the final solution.

References

  1. Rohner RP (1984) Toward a conception of culture for cross-cultural psychology. J Cross Cult Psychol 15:111–138. doi:10.1177/0022002184015002002

    Article  Google Scholar 

  2. Lopez SR, Guarnaccia PJ (2000) Cultural psychopathology: uncovering the social world of mental illness. Annu Rev Psychol 51:571–598. doi:10.1146/annurev.psych.51.1.571

    Article  CAS  PubMed  Google Scholar 

  3. Deisenhammer EA, Çoban-Başaran M, Mantar A et al (2012) Ethnic and migrational impact on the clinical manifestation of depression. Soc Psychiatry Psychiatr Epidemiol 47:1121–1129. doi:10.1007/s00127-011-0417-1

    Article  PubMed  Google Scholar 

  4. Bener A, Ghuloum S, Abou-Saleh MT (2012) Prevalence, symptom patterns and comorbidity of anxiety and depressive disorders in primary care in Qatar. Soc Psychiatry Psychiatr Epidemiol 47:439–446. doi:10.1007/s00127-011-0349-9

    Article  PubMed  Google Scholar 

  5. Kleinman A (1977) Depression, somatization and the “new cross-cultural psychiatry”. Soc Sci Med 11:3–9. doi:10.1016/0037-7856(77)90138-x

    Article  CAS  PubMed  Google Scholar 

  6. Batniji R, Van Ommeren M, Saraceno B (2006) Mental and social health in disasters: relating qualitative social science research and the sphere standard. Soc Sci Med 62:1853–1864. doi:10.1016/j.socscimed.2005.08.050

    Article  PubMed  Google Scholar 

  7. Marsella AJ (2003) Cultural aspects of depressive experience and disorders. Online Read Psychol Cult Unit 10

  8. Nichter M (1981) Idioms of distress: alternatives in the expression of psychosocial distress: a case study from South India. Cult Med Psychiatry 5:379–408

    Google Scholar 

  9. Nichter M (2010) Idioms of distress revisited. Cult Med Psychiatry 34:401–416

    Google Scholar 

  10. Bass JK, Bolton PA, Murray LK (2007) Do not forget culture when studying mental health. Lancet 370:918–919. doi:10.1016/S0140-6736(07)61426-3

    Article  PubMed  Google Scholar 

  11. Hollifield M (2002) Accurate measurement in cultural psychiatry: will we pay the costs? Transcult Psychiatry 39:419–421. doi:10.1177/136346150203900401

    Article  Google Scholar 

  12. Radloff LS (1977) The CES-D scale. Appl Psychol Meas 1:385–401. doi:10.1177/014662167700100306

    Article  Google Scholar 

  13. Snook SC, Gorsuch RL (1989) Component analysis versus common factor analysis: a Monte Carlo study. Psychol Bull 106:148–154. doi:10.1037/0033-2909.106.1.148

    Article  Google Scholar 

  14. Velicer WF, Fava JL (1998) Affects of variable and subject sampling on factor pattern recovery. Psychol Methods 3:231–251. doi:10.1037/1082-989x.3.2.231

    Article  Google Scholar 

  15. Shafer AB (2006) Meta-analysis of the factor structures of four depression questionnaires: beck, CES-D, Hamilton, and Zung. J Clin Psychol 62:123–146. doi:10.1002/jclp.20213

    Article  PubMed  Google Scholar 

  16. Edwards MC, Cheavens JS, Heiy JE et al (2010) A reexamination of the factor structure of the Center for Epidemiologic Studies Depression scale: is a one-factor model plausible? Psychol Assess 22:711–715. doi:10.1037/a0019917

    Article  PubMed Central  PubMed  Google Scholar 

  17. Schroevers M, Sanderman R, van-Sonderen E et al (2000) The evaluation of the Center for Epidemiologic Studies Depression (CES-D) scale: depressed and positive affect in cancer patients and healthy reference subjects. Qual Life Res 9:1015–1029. doi:10.1023/a:1016673003237

    Article  CAS  PubMed  Google Scholar 

  18. Crockett L, Randall BA, Shen Y et al (2005) Measurement equivalence of the Center for Epidemiological Studies Depression scale for latino and anglo adolescents: a national study. J Consult Clin Psychol 73:47–58. doi:10.1037/0022-006x.73.1.47

    Article  PubMed  Google Scholar 

  19. Golding JM, Aneshensel CS (1989) Factor structure of the Center for Epidemiologic Studies Depression scale among mexican Americans and non-hispanic whites. Psychol Assess 1:163–168. doi:10.1037/1040-3590.1.3.163

    Article  Google Scholar 

  20. Posner SF, Stewart AL, Marín G et al (2001) Factor variability of the Center for Epidemiological Studies Depression scale (CES-D) among urban Latinos. Ethn Health 6:137–144. doi:10.1080/13557850120068469

    Article  CAS  PubMed  Google Scholar 

  21. Roberts RE (1980) Reliability of the CES-D scale in different ethnic contexts. Psychiatry Res 2:125–134. doi:10.1016/0165-1781(80)90069-4

    Article  CAS  PubMed  Google Scholar 

  22. Noh S, Kaspar V, Xinyin C (1998) Measuring depression in Korean immigrants: assessing validity of the translated korean version of CES-D scale. Cross Cult Res 32:358–377. doi:10.1177/106939719803200403

    Article  Google Scholar 

  23. Campo-Arias A, Díaz-Martinez LA, Rueda-Jaimes GE et al (2007) Psychometric properties of the CES-D scale among Colombian adults from the general population. Rev Colomb Psiquiat 36:664–674

    Google Scholar 

  24. Long Foley K, Reed PS, Mutran EJ et al (2002) Measurement adequacy of the CES-D among a sample of older African Americans. Psychiatry Res 109:61–69. doi:10.1016/s0165-1781(01)00360-2

    Article  PubMed  Google Scholar 

  25. Kuo WH (1984) Prevalence of depression among Asian-Americans. J Nerv Ment Dis 172:449–457. doi:10.1097/00005053-198408000-00002

    Article  CAS  PubMed  Google Scholar 

  26. DaSilveira DX, Jorge MR (2002) Reliability and factor structure of the Brazilian version of the Center for Epidemiologic Studies-Depression. Psychol Rep 91:865–874. doi:10.2466/pr0.2002.91.3.865

    Article  Google Scholar 

  27. Guarnaccia PJ, Angel R, Worobey JL (1989) The factor structure of the CES-D in the Hispanic health and nutrition examination survey: the influences of ethnicity, gender and language. Soc Sci Med 29:85–94. doi:10.1016/0277-9536(89)90131-7

    Article  CAS  PubMed  Google Scholar 

  28. Stroup–Benham CA, Lawrence RH, Trevifio FM (1992) CES-D factor structure among Mexican American and Puerto Rican women from single- and couple-headed households. Hisp J Behav Sci 14:310–326. doi:10.1177/07399863920143002

    Article  Google Scholar 

  29. Gupta R, Yick A (2001) Validation of CES-D scale for older Chinese immigrants. J Ment Health Aging 7:257–272

    Google Scholar 

  30. Ying Y (1988) Depressive symptomatology among Chinese-Americans as measured by the CES-D. J Clin Psychol 44:739–746. doi:10.1002/1097-4679(198809)44:5<739:aid-jclp2270440512>3.0.co;2-0

    Article  CAS  PubMed  Google Scholar 

  31. Leykin Y, Torres LD, Aguilera A et al (2011) Factor structure of the CES-D in a sample of Spanish- and English-speaking smokers on the Internet. Psychiatry Res 185:269–274. doi:10.1016/j.psychres.2010.04.056

    Article  PubMed  Google Scholar 

  32. Ghubash R, Daradkeh TK, Al Naseri KS et al (2000) The performance of the Center for Epidemiologic Study Depression scale (CES-D) in an Arab female community. Int J Soc Psychiatry 46:241–249. doi:10.1177/002076400004600402

    Article  CAS  PubMed  Google Scholar 

  33. Fountoulakis K, Iacovides A, Kleanthous S et al (2001) Reliability, validity and psychometric properties of the Greek translation of the Center for Epidemiological Studies-Depression (CES-D) scale. BMC Psychiatry 1:1–10. doi:10.1186/1471-244x-1-3

    Article  Google Scholar 

  34. Manson SM, Ackerson LM, Dick RW et al (1990) Depressive symptoms among American Indian adolescents: psychometric characteristics of the Center for Epidemiologic Studies Depression scale (CES-D). Psychol Assess 2:231–237. doi:10.1037/1040-3590.2.3.231

    Article  Google Scholar 

  35. Somervell PD, Beals J, Kinzie JD et al (1992) Use of the CES-D in an American Indian village. Cult Med Psychiatry 16:503–517. doi:10.1007/bf00053590

    PubMed  Google Scholar 

  36. Yen S, Robins CJ, Lin N (2000) A cross-cultural comparison of depressive symptom manifestation: China and the United States. J Consult Clin Psychol 68:993–999. doi:10.1037/0022-006x.68.6.993

    Article  CAS  PubMed  Google Scholar 

  37. Edman JL, Danko GP, Andrade N et al (1999) Factor structure of the CES-D (Center for Epidemiologic Studies Depression scale) among Filipino-American adolescents. Soc Psychiatry Psychiatr Epidemiol 34:211–215. doi:10.1007/s001270050135

    Article  CAS  PubMed  Google Scholar 

  38. Kazarian SS (2009) Validation of the Armenian Center for Epidemiological Studies Depression scale (CES-D) among ethnic Armenians in Lebanon. Int J Soc Psychiatry 55:442–448. doi:10.1177/0020764008100548

    Article  PubMed  Google Scholar 

  39. Lee SW, Stewart SM, Byrne BM et al (2008) Factor structure of the Center for Epidemiological Studies Depression scale in Hong Kong adolescents. J Pers Assess 90:175–184. doi:10.1080/00223890701845385

    Article  PubMed  Google Scholar 

  40. DesForges A (1999) Leave none to tell the story: genocide in Rwanda. New York

  41. Bolton P, Neugebauer R, Ndogoni L (2002) Prevalence of depression in rural Rwanda based on symptom and functional criteria. J Nerv Ment Dis 190:631–637. doi:10.1097/00005053-200209000-00009

    Article  PubMed  Google Scholar 

  42. MacCallum RC, Widaman KF, Zhang S, Hong S (1999) Sample size in factor analysis. Psychol Methods 4:84–99. doi:10.1037/1082-989X.4.1.84

    Article  Google Scholar 

  43. Bryant FB, Yarnold PR (1995) Principal-components analysis and exploratory and confirmatory factor analysis. In: Grimm LG, Yarnold PR (eds) Reading and understanding multivariate statistics. American Psychological Association, Washington DC, pp 99–136

    Google Scholar 

  44. Everitt BS (1975) Multivariate analysis: the need for data, and other problems. Br J Psychiatry 126:237–240. doi:10.1192/bjp.126.3.237

    Article  CAS  PubMed  Google Scholar 

  45. Kunce JT, Cook DW, Miller DE (1975) Random variables and correlational overkill. Educ Psychol Meas 35:529–534. doi:10.1177/001316447503500301

    Article  Google Scholar 

  46. Nunnally J (1978) Psychometric theory. McGraw-Hill, New York

    Google Scholar 

  47. Eaton W, Muntaner C, Smith C et al (2004) Center for Epidemiologic Studies Depression scale: review and revision (CESD and CESDR). The use of psychological testing for treatment planning and outcomes assessment. Erlbaum, Mahwah, NJ

  48. Hutcheson, GD, Sofroniou, N (1999) The multivariate social scientist: introductory statistics using generalized linear models. SAGE Publications Limited

  49. Kaiser HF (1974) An index of factorial simplicity. Psychometrika 39:31–36. doi:10.1007/BF02291575

    Article  Google Scholar 

  50. Waller NG (2000) MicroFACT 2.0: a microcomputer factor analysis program for ordered polytomous data and mainframe size problems. Assessment Systems Corporation, St Paul, MN

  51. Tataryn DJ, Wood JM, Gorsuch RL (1999) Setting the value of k in promax: a Monte Carlo study. Educ Psychol Meas 59:384–391. doi:10.1177/00131649921969938

    Article  Google Scholar 

  52. Parker G, Cheah YC, Roy K (2001) Do the Chinese somatize depression? a cross-cultural study. Soc Psychiatry Psychiatr Epidemiol 36:287–293. doi:10.1007/s001270170046

    Article  CAS  PubMed  Google Scholar 

  53. Jayawickreme N, Jayawickreme E, Atanasov PD et al (2012) Are culturally specific measures of trauma-related anxiety and depression needed? The case of Sri Lanka. Psychol Assess 24:781–800. doi:10.1037/a0027564

    Article  Google Scholar 

  54. Zandi T, Havenaar JM, Limburg–Okken AG et al (2008) The need for culture sensitive diagnostic procedures. Soc Psychiatry Psychiatr Epidemiol 43:244–250. doi:10.1007/s00127-007-0290-0

    Article  PubMed  Google Scholar 

  55. Bolton P, Bass J, Betancourt T et al (2007) Interventions for depression symptoms among adolescent survivors of war and displacement in northern Uganda: a randomized controlled trial. JAMA 298:519–527. doi:10.1001/jama.298.5.519

    Article  CAS  PubMed  Google Scholar 

  56. Bolton P, Bass J, Neugebauer R et al (2003) Group interpersonal psychotherapy for depression in rural Uganda: a randomized controlled trial. JAMA 289:3117–3124. doi:10.1001/jama.289.23.3117

    Article  PubMed  Google Scholar 

  57. Bolton P (2001) Local perceptions of the mental health effects of the Rwandan genocide. J Nerv Ment Dis 189:243–248

    Article  CAS  PubMed  Google Scholar 

  58. Association AP (2000) Diagnostic and Statistical Manual of Mental Disorders Fourth, Revised edn. American Psychiatric Association, Washington DC

  59. Bolton P, Tang AM (2002) An alternative approach to cross-cultural function assessment. Soc Psychiatry Psychiatr Epidemiol 37:537–543. doi:10.1007/s00127-002-0580-5

    Article  PubMed  Google Scholar 

  60. Kleinman A (2004) Culture and depression. N Engl J Med 351:951–953. doi:10.1056/NEJMp048078

    Article  CAS  PubMed  Google Scholar 

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Acknowledgments

We are grateful to the Positive Psychology Center and the Department of Psychology at the University of Pennsylvania for providing the funding for this project. Additional funding was generously provided by Eva Kedar, Ph. D. We thank Virgile Uzabumugabo and his research team (Beza Gisele, Igena Clarisse, Kankindi Antoinette, Mugisha Norbert, Mushimiyimana Delphine, Mwiseneza Sophie, Nsengiyumva Joselyne, Runyurangabo Philbert, Twajamahoro Contstantin, Ufitemariya Janviere, Usabimana Hawa, and Uwanyiligira Honorine) for collecting the data for this project. We also thank Paul Di Stefano and Richard Bisa for assisting with the translation process and Eli Tsukayama for advice on data analysis.

Conflict of interest

The authors declare that they have no conflict of interest.

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Author notes

  1. Justin J. Lacasse

    Present address: Department of Psychiatry of Tufts Medical Center, Tufts University School of Medicine, Boston, USA

Authors and Affiliations

  1. School of Osteopathic Medicine, University of Medicine and Dentistry of New Jersey, Stratford, USA

    Justin J. Lacasse

  2. Department of Psychology, University of Pennsylvania, Philadelphia, USA

    Marie J. C. Forgeard

  3. Department of Psychology, Manhattan College, New York City, USA

    Nuwan Jayawickreme

  4. Department of Psychology, Wake Forest University, P.O. Box 7778, Winston-Salem, NC, 27109, USA

    Eranda Jayawickreme

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  1. Justin J. Lacasse
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  2. Marie J. C. Forgeard
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Corresponding author

Correspondence to Eranda Jayawickreme.

Additional information

J. J. Lacasse and M. J. C. Forgeard contributed equally to this paper.

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Lacasse, J.J., Forgeard, M.J.C., Jayawickreme, N. et al. The factor structure of the CES-D in a sample of Rwandan genocide survivors. Soc Psychiatry Psychiatr Epidemiol 49, 459–465 (2014). https://doi.org/10.1007/s00127-013-0766-z

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