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J Nurs Meas. 2009;17(2):91-104.

Measurement properties of the centers for epidemiological studies depression scale (CES-D) in a sample of African American and non-Hispanic White pregnant women.

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  • 1Ingham County Health Department, Lansing, Michigan 48911, USA.


This study investigated the appropriateness of using the CES-D scale for comparing depressive symptoms among pregnant women of different races. Black and White women were matched on education, age, Medicaid status, and marital status-living arrangements. The matching procedure yielded a study sample of 375 in each ethnic group. Using a confirmatory factor analysis, the fit of several factor models for the CES-D was evaluated. One CES-D item, "everything was an effort", showed a low item-total correlation (0.04 among blacks, 0.22 among whites) and was excluded from further analysis. After imposing the constraints of equal factor loadings and factor covariance across both groups, a two-factor model with 19 CES-D items provided a good fit. Only the loading for the "was happy" item displayed a small difference between the two groups. Furthermore, the correlations between the original 20-item and the unbiased 18-item scales were r = 0.994 for Whites and r = 0.992 for Blacks. The results suggest that the 20-item CES-D can be used to compare depressive symptoms in White and Black pregnant women without introducing significant ethnic-racial bias in the measurement of these symptoms.

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