Harvard Center for Population and Development Studies, Harvard University, Cambridge, MA, USA; Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Harvard Center for Population and Development Studies, Harvard University, Cambridge, MA, USA.
J Affect Disord. 2020 Dec 1;277:850-856. doi: 10.1016/j.jad.2020.08.073. Epub 2020 Sep 2.
The Center for Epidemiologic Studies-Depression (CES-D) scale is a widely used measure of depressive symptoms, but its construct validity has not been adequately assessed in sub-Saharan Africa. This study validates the CES-D among an aging Shangaan-speaking and predominantly Black African sample in rural South Africa, with a special emphasis on gender differences.
An 8-item CES-D scale was administered in Shangaan to 5059 respondents, aged 40+ years, residing in Agincourt, South Africa. We used Cronbach's alpha and exploratory and confirmatory factor analysis to examine and confirm dimensionality of the CES-D scale. Differential endorsement of CES-D items by gender were assessed using the Mantel-Haenszel (MH) odds ratio test.
Reliability of the CES-D scale differed by gender with women reporting higher internal consistency on items than men. A two-factor solution was retained and confirmed representing two latent factors: (1) Negative Affect (six items) and (2) Diminished Positive Affect (two items). MH results showed that men exhibited significantly higher odds of putting an effort in everything that they did (OR: 1.33, 95% CI: 1.15-1.54) and lower odds of feeling depressed (OR: 0.71, 95% CI: 0.56-0.89) and having restless sleep (OR: 0.67, 95% CI:0.58-0.77) than women.
Analyses were limited to a dichotomous, short form of the CES-D, a self-reported population-based measure.
Aging Black Africans differ in endorsing affective and somatic items on the CES-D scale by gender, which may lead to skewed population-level estimates of depression in key subpopulations. These findings highlight the importance of continued research disentangling cross-cultural and gendered nuances of depression measurements.
抑郁自评量表（CES-D）是一种广泛使用的衡量抑郁症状的工具，但它在撒哈拉以南非洲的结构效度尚未得到充分评估。本研究在南非农村的 Shangaan 讲者和主要是黑人群体中验证了 CES-D，特别强调了性别差异。
在 Shangaan 语中对 5059 名年龄在 40 岁以上的受访者进行了 8 项 CES-D 量表的测试，他们居住在南非的 Agincourt。我们使用 Cronbach's alpha 和探索性和验证性因素分析来检查和确认 CES-D 量表的维度。使用 Mantel-Haenszel（MH）比值比检验评估 CES-D 项目在性别上的不同认可。
CES-D 量表的可靠性因性别而异，女性在项目上的内部一致性高于男性。保留并确认了一个两因素解决方案，代表两个潜在因素：（1）负性情绪（六项）和（2）积极情绪减弱（两项）。MH 结果表明，男性在做任何事情时都表现出更高的努力意愿（OR：1.33，95%CI：1.15-1.54），而感到沮丧（OR：0.71，95%CI：0.56-0.89）和睡眠不安（OR：0.67，95%CI：0.58-0.77）的可能性低于女性。
分析仅限于 CES-D 的二分简短形式，即基于自我报告的人群测量。
老化的黑人群体在性别上对 CES-D 量表的情感和躯体项目的认可存在差异，这可能导致关键亚人群中对抑郁症的人群水平估计出现偏差。这些发现强调了继续研究解开跨文化和性别化的抑郁症测量细微差别的重要性。
