The center for epidemiologic studies depression scale: a review with a theoretical and empirical examination of item content and factor structure.
TL;DR: Comprehensive comparison of the several models supported a novel, psychometrically robust, and unbiased 3-factor 14-item solution, with factors that are more in line with current diagnostic criteria for depression.
Abstract: Background
The Center for Epidemiologic Studies Depression Scale (CES-D; Radloff, 1977) is a commonly used freely available self-report measure of depressive symptoms. Despite its popularity, several recent investigations have called into question the robustness and suitability of the commonly used 4-factor 20-item CES-D model. The goal of the current study was to address these concerns by confirming the factorial validity of the CES-D.
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TL;DR: A novel framework to understanding emotion-smoking comorbidity is presented, proposing that transdiagnostic emotional vulnerabilities-core biobehavioral traits reflecting maladaptive responses to emotional states that underpin multiple types of emotional psychopathology-link various anxiety and depressive psychopathologies to smoking.
Abstract: Research into the comorbidity between emotional psychopathology and cigarette smoking has often focused upon anxiety and depression's manifest symptoms and syndromes, with limited theoretical and clinical advancement. This article presents a novel framework to understanding emotion-smoking comorbidity. We propose that transdiagnostic emotional vulnerabilities-core biobehavioral traits reflecting maladaptive responses to emotional states that underpin multiple types of emotional psychopathology-link various anxiety and depressive psychopathologies to smoking. This framework is applied in a review and synthesis of the empirical literature on 3 transdiagnostic emotional vulnerabilities implicated in smoking: (a) anhedonia (Anh; diminished pleasure/interest in response to rewards), (b) anxiety sensitivity (AS; fear of anxiety-related sensations), and (c) distress tolerance (DT; ability to withstand distressing states). We conclude that Anh, AS, and DT collectively (a) underpin multiple emotional psychopathologies, (b) amplify smoking's anticipated and actual affect-enhancing properties and other mechanisms underlying smoking, (c) promote progression across the smoking trajectory (i.e., initiation, escalation/progression, maintenance, cessation/relapse), and (d) are promising targets for smoking intervention. After existing gaps are identified, an integrative model of transdiagnostic processes linking emotional psychopathology to smoking is proposed. The model's key premise is that Anh amplifies smoking's anticipated and actual pleasure-enhancing effects, AS amplifies smoking's anxiolytic effects, and poor DT amplifies smoking's distress terminating effects. Collectively, these processes augment the reinforcing properties of smoking for individuals with emotional psychopathology to heighten risk of smoking initiation, progression, maintenance, cessation avoidance, and relapse. We conclude by drawing clinical and scientific implications from this framework that may generalize to other comorbidities.
401 citations
Cites background from "The center for epidemiologic studie..."
...…functioning that is composed of related but distinct lower order dimensions of (a) global Anh (reduced happiness and enjoyment derived in one’s life; Carleton et al., 2013), (b) consummatory Anh (incapacity to experience pleasure in response to rewarding stimuli; Gard, Gard, Kring, & John, 2006),…...
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TL;DR: The SARS‐CoV‐2 pandemic has significantly impacted the mental health of HCWs and frontline staff demonstrate worse mental health outcomes, which should be staffed to meet service provision requirements and to mitigate the impact onmental health.
Abstract: Objectives The SARS-CoV-2 global pandemic has subjected healthcare workers (HCWs) to high risk of infection through direct workplace exposure, coupled with increased workload and psychological stress. This review aims to determine the impact of SARS-CoV-2 on mental health outcomes of hospital-based HCWs and formulate recommendations for future action. Methods A systematic review was performed between 31st December 2019 and 17th June 2020 through Ovid Medline and Embase databases (PROSPERO ID CRD42020181204). Studies were included for review if they investigated the impact of SARS-CoV-2 on mental health outcomes of hospital-based HCWs and used validated psychiatric scoring tools. Prevalence of ICD-10 classified psychiatric disorders was the primary outcome measure. Results The initial search returned 436 articles. Forty-four studies were included in final analysis, with a total of 69,499 subjects. Prevalence ranges of six mental health outcomes were identified: depression 13.5%-44.7%; anxiety 12.3%-35.6%; acute stress reaction 5.2%-32.9%; post-traumatic stress disorder 7.4%-37.4%; insomnia 33.8%-36.1%; and occupational burnout 3.1%-43.0%. Direct exposure to SARS-CoV-2 patients was the most common risk factor identified for all mental health outcomes except occupational burnout. Nurses, frontline HCWs, and HCWs with low social support and fewer years of working experience reported the worst outcomes. Conclusion The SARS-CoV-2 pandemic has significantly impacted the mental health of HCWs. Frontline staff demonstrate worse mental health outcomes. Hospitals should be staffed to meet service provision requirements and to mitigate the impact onmental health. This can be improved with access to rapid-response psychiatric teams and should be continually monitored throughout the pandemic and beyond its conclusion.
147 citations
TL;DR: The WHO construct of intrinsic capacity appears to provide valuable predictive information on an individual’s subsequent functioning, even after accounting for the number of multimorbidities.
Abstract: Objectives To assess the validity of the WHO concept of intrinsic capacity in a longitudinal study of ageing; to identify whether this overall measure disaggregated into biologically plausible and clinically useful subdomains; and to assess whether total capacity predicted subsequent care dependence. Design Structural equation modelling of biomarkers and self-reported measures in the English Longitudinal Study of Ageing including exploratory factor analysis, exploratory bi-factor analysis and confirmatory factor analysis. Longitudinal mediation and moderation analysis of incident care dependence. Settings Community, United Kingdom. Participants 2560 eligible participants aged over 60 years. Main outcome measures Activities of daily living (ADL) and instrumental activities of daily living (IADL). Results One general factor (intrinsic capacity) and five subfactors emerged: locomotor, cognitive; psychological; sensory; and ‘vitality’. This structure is consistent with biological theory and the model had a good fit for the data (χ2=71.2 (df=39)). The summary score of intrinsic capacity and specific subfactors showed good construct validity. In a causal path model examining incident loss of ADL and IADL, intrinsic capacity had a direct relationship with the outcome—root mean square error of approximation (RMSEA)=0.02 (90% CI 0.001 to 0.05) and RMSEA=0.008 (90% CI0.001 to 0.03) respectively—and was a strong mediator for the effect of age, sex, wealth and education. Multimorbidity had an independent direct relationship with incident loss of ADLs but not IADLs, and also operated through intrinsic capacity. More of the indirect effect of personal characteristics on incident loss of ADLs and IADLs was mediated by intrinsic capacity than multimorbidity. Conclusions The WHO construct of intrinsic capacity appears to provide valuable predictive information on an individual’s subsequent functioning, even after accounting for the number of multimorbidities. The proposed general factor and subdomain structure may contribute to a transformative paradigm for future research and clinical practice.
138 citations
TL;DR: The CES-D has good reliability and validity for assessing subthreshold depression in Chinese university students and suggests that the newly derived model with 14 items was the best fit for data.
Abstract: Aims: Depression is prevalent among university students worldwide, and the prevalence appears to be increasing. As an intermediate stage between being healthy and having depression, students with subthreshold depression could develop worsening depression or recover with intervention to prevent depression. The Center for Epidemiologic Studies Depression Scale (CES-D) is a useful tool to assess subthreshold depression. The primary purpose of the current study was to evaluate the psychometric characteristics of CES-D in Chinese university students. Secondly, we aimed to describe the prevalence of subthreshold depression among the student sample and examine its demographic correlates. Methods: A total of 2,068 university students participated in the study, and they were asked to respond to the Chinese CES-D, Beck Depression Inventory-II (BDI-II), and Positive and Negative Affect Schedule (PANAS). The factor structure was evaluated by conducting exploratory (EFA) and confirmatory factor analysis (CFA) using a structural equation modeling approach. The reliability was assessed by calculating Cronbach's alpha, inter-item correlation, and item-total correlation coefficients. The prevalence of subthreshold depression was calculated and demographic correlates of gender, grade, and major were examined by multiple regression. Results: The final sample included 1,920 participants. The EFA results suggested extraction of three factors (somatic symptoms, negative affect, and anhedonia) that account for 52.68% of total variance. The CFA results suggested that the newly derived model with 14 items was the best fit for our data. Six items were removed from the original scale (item 9, 10, 13, 15, 17, and 19). The Cronbach's alpha of the 14-item CES-D was 0.87. The prevalence of subthreshold depression among university students reached 32.7% for the 20-item CES-D and 31% for the 14-item CES-D, although there was no significant difference of prevalence in gender, grade, and major. Conclusions: The CES-D has good reliability and validity for assessing subthreshold depression in Chinese university students.
103 citations
TL;DR: Examination of the reliability and factor structure of the CES-D in the MacArthur Foundation's Midlife in the United States Study (MIDUS), a nationally representative cohort study of noninstitutionalized, English-speaking adults aged 24–74 years found high internal consistency was demonstrated alongside a replication of the original 4-factor structure.
Abstract: Background and purpose Globally, depressive symptoms are a leading contributor to years lived with disability. The Center for Epidemiological Studies-Depression (CES-D) scale has been used extensively to quantify depression; yet, its psychometric properties remain contentious. This study examined the reliability and factor structure of the CES-D in the MacArthur Foundation's Midlife in the United States Study (MIDUS), a nationally representative cohort study of noninstitutionalized, English-speaking adults aged 24-74 years. Methods Internal consistency (Cronbach's alpha) and confirmatory factor analysis (CFA) were used to examine the reliability and factor structure of the CES-D. Results There were 1,233 participants who were included in the analysis (mean age = 57.3 years [SD = 11.5], 56.7% female). Cronbach's alpha of .90 was observed. The 4-factor model had the best model fit. Conclusions High internal consistency was demonstrated alongside a replication of the original 4-factor structure. Continued use of the CES-D in noninstitutionalized populations is warranted.
90 citations
Cites background or methods from "The center for epidemiologic studie..."
...These items were not, however, developed a priori to reflect contemporary diagnostic criteria (Carleton et al., 2013)....
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...Previous examinations of the latent structure of the CES-D have posited one-, two-, and three-factor alternative structures (Carleton et al., 2013); therefore, the four-factor structure of the CES-D must be replicated in other samples to conclude that symptoms of depression are being captured in…...
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...Previous studies have demonstrated low IP alphas (Thombs et al., 2008) with concerns raised the validity of a 2-item scale (Carleton et al., 2013), concerns echoed in this study....
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...Previous psychometric validations of the CES-D have posited various factor structures, ranging from one to four factors (Carleton et al., 2013)....
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References
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11 Jun 2013
113,134 citations
TL;DR: An issue concerning the criteria for tic disorders is highlighted, and how this might affect classification of dyskinesias in psychotic spectrum disorders.
Abstract: Given the recent attention to movement abnormalities in psychosis spectrum disorders (e.g., prodromal/high-risk syndromes, schizophrenia) (Mittal et al., 2008; Pappa and Dazzan, 2009), and an ongoing discussion pertaining to revisions of the Diagnostic and Statistical Manuel of Mental Disorders (DSM) for the upcoming 5th edition, we would like to take this opportunity to highlight an issue concerning the criteria for tic disorders, and how this might affect classification of dyskinesias in psychotic spectrum disorders.
Rapid, non-rhythmic, abnormal movements can appear in psychosis spectrum disorders, as well as in a host of commonly co-occurring conditions, including Tourette’s Syndrome and Transient Tic Disorder (Kerbeshian et al., 2009). Confusion can arise when it becomes necessary to determine whether an observed movement (e.g., a sudden head jerk) represents a spontaneous dyskinesia (i.e., spontaneous transient chorea, athetosis, dystonia, ballismus involving muscle groups of the arms, legs, trunk, face, and/or neck) or a tic (i.e., stereotypic or patterned movements defined by the relationship to voluntary movement, acute and chronic time course, and sensory urges). Indeed, dyskinetic movements such as dystonia (i.e., sustained muscle contractions, usually producing twisting and repetitive movements or abnormal postures or positions) closely resemble tics in a patterned appearance, and may only be visually discernable by attending to timing differences (Gilbert, 2006).
When turning to the current DSM-IV TR for clarification, the description reads: “Tic Disorders must be distinguished from other types of abnormal movements that may accompany general medical conditions (e.g., Huntington’s disease, stroke, Lesch-Nyhan syndrome, Wilson’s disease, Sydenham’s chorea, multiple sclerosis, postviral encephalitis, head injury) and from abnormal movements that are due to the direct effects of a substance (e.g., a neuroleptic medication)”. However, as it is written, it is unclear if psychosis falls under one such exclusionary medical disorder. The “direct effects of a substance” criteria, referencing neuroleptic medications, further contributes to the uncertainty around this issue. As a result, ruling-out or differentiating tics in psychosis spectrum disorders is at best, a murky endeavor.
Historically, the advent of antipsychotic medication in the 1950s has contributed to the confusion about movement signs in psychiatric populations. Because neuroleptic medications produce characteristic movement disorder in some patients (i.e. extrapyramidal side effects), drug-induced movement disturbances have been the focus of research attention in psychotic disorders. However, accumulating data have documented that spontaneous dyskinesias, including choreoathetodic movements, can occur in medication naive adults with schizophrenia spectrum disorders (Pappa and Dazzan, 2009), as well as healthy first-degree relatives of chronically ill schizophrenia patients (McCreadie et al., 2003). Taken together, this suggests that movement abnormalities may reflect pathogenic processes underlying some psychotic disorders (Mittal et al., 2008; Pappa and Dazzan, 2009).
More specifically, because spontaneous hyperkinetic movements are believed to reflect abnormal striatal dopamine activity (DeLong and Wichmann, 2007), and dysfunction in this same circuit is also proposed to contribute to psychosis, it is possible that spontaneous dyskinesias serve as an outward manifestation of circuit dysfunction underlying some schizophrenia-spectrum symptoms (Walker, 1994). Further, because these movements precede the clinical onset of psychotic symptoms, sometimes occurring in early childhood (Walker, 1994), and may steadily increase during adolescence among populations at high-risk for schizophrenia (Mittal et al., 2008), observable dyskinesias could reflect a susceptibility that later interacts with environmental and neurodevelopmental factors, in the genesis of psychosis.
In adolescents who meet criteria for a prodromal syndrome (i.e., the period preceding formal onset of psychotic disorders characterized by subtle attenuated positive symptoms coupled with a decline in functioning), there is sometimes a history of childhood conditions which are also characterized by suppressible tics or tic like movements (Niendam et al., 2009). On the other hand, differentiating between tics and dyskinesias has also complicated research on childhood disorders such as Tourette syndrome (Kompoliti and Goetz, 1998; Gilbert, 2006).
We propose consideration of more explicit and operationalized criteria for differentiating tics and dyskinesias, based on empirically derived understanding of neural mechanisms. Further, revisions of the DSM should allow for the possibility that movement abnormalities might reflect neuropathologic processes underlying the etiology of psychosis for a subgroup of patients. Psychotic disorders might also be included among the medical disorders that are considered a rule-out for tics.
Related to this, the reliability of movement assessment needs to be improved, and this may require more training for mental health professionals in movement symptoms. Although standardized assessment of movement and neurological abnormalities is common in research settings, it has been proposed that an examination of neuromotor signs should figure in the assessment of any patient, and be as much a part of the patient assessment as the mental state examination (Picchioni and Dazzan, 2009).
To this end it is important for researchers and clinicians to be aware of differentiating characteristics for these two classes of abnormal movement. For example, tics tend to be more complex than myoclonic twitches, and less flowing than choreoathetodic movements (Kompoliti and Goetz, 1998). Patients with tics often describe a sensory premonition or urge to perform a tic, and the ability to postpone tics at the cost of rising inner tension (Gilbert, 2006). For example, one study showed that patients with tic disorders could accurately distinguish tics from other movement abnormalities based on the subjective experience of some voluntary control of tics (Lang, 1991). Another differentiating factor derives from the relationship of the movement in question to other voluntary movements. Tics in one body area rarely occur during purposeful and voluntary movements in that same body area whereas dyskinesia are often exacerbated by voluntary movement (Gilbert, 2006). Finally, it is noteworthy that tics wax and wane in frequency and intensity and migrate in location over time, often becoming more complex and peaking between the ages of 9 and 14 years (Gilbert, 2006). In the case of dyskinesias among youth at-risk for psychosis, there is evidence that the movements tend to increase in severity and frequency as the individual approaches the mean age of conversion to schizophrenia spectrum disorders (Mittal et al., 2008).
As revisions to the DSM are currently underway in preparation for the new edition (DSM V), we encourage greater attention to the important, though often subtle, distinctions among subtypes of movement abnormalities and their association with psychiatric syndromes.
67,017 citations
Book•
01 Jan 1983
TL;DR: In this Section: 1. Multivariate Statistics: Why? and 2. A Guide to Statistical Techniques: Using the Book Research Questions and Associated Techniques.
Abstract: In this Section: 1. Brief Table of Contents 2. Full Table of Contents 1. BRIEF TABLE OF CONTENTS Chapter 1 Introduction Chapter 2 A Guide to Statistical Techniques: Using the Book Chapter 3 Review of Univariate and Bivariate Statistics Chapter 4 Cleaning Up Your Act: Screening Data Prior to Analysis Chapter 5 Multiple Regression Chapter 6 Analysis of Covariance Chapter 7 Multivariate Analysis of Variance and Covariance Chapter 8 Profile Analysis: The Multivariate Approach to Repeated Measures Chapter 9 Discriminant Analysis Chapter 10 Logistic Regression Chapter 11 Survival/Failure Analysis Chapter 12 Canonical Correlation Chapter 13 Principal Components and Factor Analysis Chapter 14 Structural Equation Modeling Chapter 15 Multilevel Linear Modeling Chapter 16 Multiway Frequency Analysis 2. FULL TABLE OF CONTENTS Chapter 1: Introduction Multivariate Statistics: Why? Some Useful Definitions Linear Combinations of Variables Number and Nature of Variables to Include Statistical Power Data Appropriate for Multivariate Statistics Organization of the Book Chapter 2: A Guide to Statistical Techniques: Using the Book Research Questions and Associated Techniques Some Further Comparisons A Decision Tree Technique Chapters Preliminary Check of the Data Chapter 3: Review of Univariate and Bivariate Statistics Hypothesis Testing Analysis of Variance Parameter Estimation Effect Size Bivariate Statistics: Correlation and Regression. Chi-Square Analysis Chapter 4: Cleaning Up Your Act: Screening Data Prior to Analysis Important Issues in Data Screening Complete Examples of Data Screening Chapter 5: Multiple Regression General Purpose and Description Kinds of Research Questions Limitations to Regression Analyses Fundamental Equations for Multiple Regression Major Types of Multiple Regression Some Important Issues. Complete Examples of Regression Analysis Comparison of Programs Chapter 6: Analysis of Covariance General Purpose and Description Kinds of Research Questions Limitations to Analysis of Covariance Fundamental Equations for Analysis of Covariance Some Important Issues Complete Example of Analysis of Covariance Comparison of Programs Chapter 7: Multivariate Analysis of Variance and Covariance General Purpose and Description Kinds of Research Questions Limitations to Multivariate Analysis of Variance and Covariance Fundamental Equations for Multivariate Analysis of Variance and Covariance Some Important Issues Complete Examples of Multivariate Analysis of Variance and Covariance Comparison of Programs Chapter 8: Profile Analysis: The Multivariate Approach to Repeated Measures General Purpose and Description Kinds of Research Questions Limitations to Profile Analysis Fundamental Equations for Profile Analysis Some Important Issues Complete Examples of Profile Analysis Comparison of Programs Chapter 9: Discriminant Analysis General Purpose and Description Kinds of Research Questions Limitations to Discriminant Analysis Fundamental Equations for Discriminant Analysis Types of Discriminant Analysis Some Important Issues Comparison of Programs Chapter 10: Logistic Regression General Purpose and Description Kinds of Research Questions Limitations to Logistic Regression Analysis Fundamental Equations for Logistic Regression Types of Logistic Regression Some Important Issues Complete Examples of Logistic Regression Comparison of Programs Chapter 11: Survival/Failure Analysis General Purpose and Description Kinds of Research Questions Limitations to Survival Analysis Fundamental Equations for Survival Analysis Types of Survival Analysis Some Important Issues Complete Example of Survival Analysis Comparison of Programs Chapter 12: Canonical Correlation General Purpose and Description Kinds of Research Questions Limitations Fundamental Equations for Canonical Correlation Some Important Issues Complete Example of Canonical Correlation Comparison of Programs Chapter 13: Principal Components and Factor Analysis General Purpose and Description Kinds of Research Questions Limitations Fundamental Equations for Factor Analysis Major Types of Factor Analysis Some Important Issues Complete Example of FA Comparison of Programs Chapter 14: Structural Equation Modeling General Purpose and Description Kinds of Research Questions Limitations to Structural Equation Modeling Fundamental Equations for Structural Equations Modeling Some Important Issues Complete Examples of Structural Equation Modeling Analysis. Comparison of Programs Chapter 15: Multilevel Linear Modeling General Purpose and Description Kinds of Research Questions Limitations to Multilevel Linear Modeling Fundamental Equations Types of MLM Some Important Issues Complete Example of MLM Comparison of Programs Chapter 16: Multiway Frequency Analysis General Purpose and Description Kinds of Research Questions Limitations to Multiway Frequency Analysis Fundamental Equations for Multiway Frequency Analysis Some Important Issues Complete Example of Multiway Frequency Analysis Comparison of Programs
53,113 citations
TL;DR: The CES-D scale as discussed by the authors is a short self-report scale designed to measure depressive symptomatology in the general population, which has been used in household interview surveys and in psychiatric settings.
Abstract: The CES-D scale is a short self-report scale designed to measure depressive symptomatology in the general population. The items of the scale are symptoms associated with depression which have been used in previously validated longer scales. The new scale was tested in household interview surveys and in psychiatric settings. It was found to have very high internal consistency and adequate test- retest repeatability. Validity was established by pat terns of correlations with other self-report measures, by correlations with clinical ratings of depression, and by relationships with other variables which support its construct validity. Reliability, validity, and factor structure were similar across a wide variety of demographic characteristics in the general population samples tested. The scale should be a useful tool for epidemiologic studies of de pression.
48,339 citations
"The center for epidemiologic studie..." refers background or methods in this paper
...The CES-D was originally posited as having a 4-factor structure representing depressed affect, absence of positive affect or anhedonia, somatic activity or inactivity, and interpersonal challenges [2]....
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...to break tendencies toward response set as well as to assess positive affect (or its absence)’’ [2]; however, these two purposes are at odds and may lead to misrepresentation of response patterns or biased estimations of positive affect [4], [30]....
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...Radloff, 1977 Model C [2]; Shafer, 2006 [4]; Williams, 2007 [14] 4 (20) 1 1 2 4 1 2 1 4 2 2 1 4 1 2 3 4 2 2 3 1...
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...Radloff, 1977 Model A [2] 4 (16) 1 1 2 4 2 1 4 1 4 2 3 4 2 2 3 1...
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...Radloff, 1977 Model B [2] 4 (20) Undergraduate 741....
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TL;DR: The difficulties inherent in obtaining consistent and adequate diagnoses for the purposes of research and therapy have been pointed out and a wide variety of psychiatric rating scales have been developed.
Abstract: The difficulties inherent in obtaining consistent and adequate diagnoses for the purposes of research and therapy have been pointed out by a number of authors. Pasamanick12in a recent article viewed the low interclinician agreement on diagnosis as an indictment of the present state of psychiatry and called for "the development of objective, measurable and verifiable criteria of classification based not on personal or parochial considerations, but on behavioral and other objectively measurable manifestations." Attempts by other investigators to subject clinical observations and judgments to objective measurement have resulted in a wide variety of psychiatric rating scales.4,15These have been well summarized in a review article by Lorr11on "Rating Scales and Check Lists for the Evaluation of Psychopathology." In the area of psychological testing, a variety of paper-and-pencil tests have been devised for the purpose of measuring specific
35,176 citations
"The center for epidemiologic studie..." refers methods in this paper
...The Center for Epidemiologic Studies Depression Scale (CES-D) [2] is among the most popular measures of depressive symptoms, likely owing its popularity to being free and generally comparable [3–5] with the wellestablished Beck Depression Inventories [6], [7]....
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