The center for epidemiologic studies depression scale: a review with a theoretical and empirical examination of item content and factor structure

PLoS One. 2013;8(3):e58067. doi: 10.1371/journal.pone.0058067. Epub 2013 Mar 1.


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.

Methods and findings: Differential item functioning estimates were used to examine sex biases in item responses, and confirmatory factor analyses were used to assess prior CES-D factor structures and new models heeding current theoretical and empirical considerations. Data used for the analyses included undergraduate (n = 948; 74% women), community (n = 254; 71% women), rehabilitation (n = 522; 53% women), clinical (n =84; 77% women), and National Health and Nutrition Examination Survey (NHANES; n = 2814; 56% women) samples. Differential item functioning identified an item as inflating CES-D scores in women. Comprehensive comparison of the several models supported a novel, psychometrically robust, and unbiased 3-factor 14-item solution, with factors (i.e., negative affect, anhedonia, and somatic symptoms) that are more in line with current diagnostic criteria for depression.

Conclusions: Researchers and practitioners may benefit from using the novel factor structure of the CES-D and from being cautious in interpreting results from the originally proposed scale. Comprehensive results, implications, and future research directions are discussed.

Publication types

  • Review

MeSH terms

  • Adolescent
  • Adult
  • Depression / diagnosis*
  • Depression / psychology
  • Depressive Disorder / diagnosis*
  • Depressive Disorder / psychology
  • Epidemiologic Studies
  • Factor Analysis, Statistical*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Nutrition Surveys
  • Psychometrics / methods
  • Psychometrics / statistics & numerical data*
  • Self Report
  • Severity of Illness Index
  • Sex Factors

Grant support

The authors have no support or funding to report.