Validation of the Arabic Center for Epidemiological Studies Depression (CES-D) Scale in a Lebanese Community Sample
Abstract
The factor structure of the 20-items Arabic Center for Epidemiological Studies Depression scale (Arabic CES-D) and its relationship to theoretically grounded psychosocial and sociodemographic risk factors were examined in a community sample of Lebanese adults (n = 435). Two factors, Depressed Affect and Lack of Positive Affect, were empirically derived, correlating r = .35 with each other and r = .96 and r = .59, respectively, with Arabic CES-D global scores. Depressed Affect scores but not Lack of Positive Affect scores were associated with level of education and marital status but not with gender. Also, Depressed Affect scores in the collectivist Lebanese context were more strongly correlated with avoidant attachment scores than anxious attachment scores (r = .47 and r = .24, respectively; z = 3.68, p < .0001), whereas Lack of Positive Affect scores were not significantly higher in their correlation with avoidant and anxious attachment scores (r = .29 and r = .18, respectively; z = 1.62, ns). In addition, Depressed Affect scores correlated more strongly than Lack of Positive Affect scores with avoidant attachment scores but not with anxious attachment scores. These findings suggest that the Arabic CES-D scale likely taps two distinct aspects of mental health, namely, depression and well-being, such that their correlates need to be identified separately, and that the Lebanese depressed mind is undifferentiated with respect to psychological, somatic, and interpersonal expressions of depression. Finally, we discuss the implications of the findings for the use of the Arabic CES-D in the Arab world and for the universality of the Arab depressed mind.
References
1967). Depression: Clinical, experimental and theoretical aspects. New York: Harper & Row.
(1998). Psychological assessment of people in diverse cultures. In , Cultural clinical psychology: Theory, research and practice (pp. 61–105). New York: Oxford University Press.
(1966). The scree test for number of factors. Multivariate Behavioral Research, 1, 245–176.
(2005). Women’s status and depressive symptoms: A multilevel analysis. Social Science and Medicine, 60, 49–60.
(2004). Development and validation of a Rasch-Derived CES-D short form. Psychological Assessment, 16, 360–372.
(1998). Attachment styles, emotion regulation, and adjustment in adolescence. Journal of Personality and Social psychology, 74, 1380–1397.
(2007). Comparison of depressive indices: Reliability, validity, relationship to anxiety and depression and the role of age and life events. Journal of Affective Disorders, 97, 187–195.
(2000). An item response theory analysis of self-report measures of adult attachment. Journal of Personality and Social Psychology, 78, 350–365.
(1999). Development vs. social personality models of adult attachment and mental ill health. British Journal of Medical Psychology, 72, 285–303.
(2000). The performance of the Center for Epidemiological Studies-Depression Scale in an Arab female community. International Journal of Social Psychiatry, 46, 241–249.
(2004). The Portuguese version of the Center for Epidemiological Studies Depression Scale (CES-D). European Journal of Psychological Assessment, 20, 339–348.
(2004). Adult attachment styles and emotional stress following romantic relationship dissolution. Unpublished Masters of Arts Thesis, Department of Social and Behavioral Sciences, The American University of Beirut, Beirut, Lebanon.
(1965). A rationale and test for the number of factors in factor analysis. Psychometrika, 30, 179–185.
(1974). An index of factorial simplicity. Psychometrika, 39, 31–36.
(2007). Ethnic variation in depressive symptoms in a community sample in Hawaii. Cultural Diversity and Ethnic Minority Psychology, 13, 35–44.
(2006). Prevalence and treatment of mental disorders in Lebanon: A national epidemiological survey. Lancet, 367, 1000–1006.
(2005). Family functioning, cultural orientation, and psychological well-being among university students in Lebanon. The Journal of Social Psychology, 145, 141–152.
(2007). The prevalence of comorbid depression among adults with diabetes in Southern Iraq. Pakistani Journal of Medical Science, 23, 185–187.
(1998). Prediction of major depression and dysthymia from CES-D scores among ethnic minority adolescents. Journal of the American Academy of Child and Adolescent Psychiatry, 37, 495–503.
(1977). The CES-D Scale: A self-report depression scale for research in the general population. Applied Psychological Measurement, 1, 385–401.
(1993). Adult romantic attachment: Theory and evidence. In , Advances in personal relationships (Vol. 4, pp. 29–70). London: Jessica Kingsley.
(2004). Depression in first labor migrants in Western Europe: The utility of the the Center for Epidemiological Studies Depression Scale (CES-D). International Journal of Geriatric Psychology, 19, 538–544.
(2004). Factor structure of the Center for Epidemiological Studies Depression Scale in low income women attending primary care clinics. European Journal of Psychological Assessment, 20, 106–115.
(1977). Assessing depressive symptoms in five psychiatric populations: A validation study. American Journal of Epidemiology, 106, 203–214.
(