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Measurement invariance of the center for epidemiological studies depression scale (CES-D) among chinese and dutch elderly

Baoshan Zhang1, Marjolein Fokkema2, Pim Cuijpers2, Juan Li1*, Niels Smits2 and Aartjan Beekman3

Author Affiliations

1 Center on Aging Psychology, Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China

2 Department of Clinical Psychology, Faculty of Psychology and Education, Vrije Universiteit Amsterdam, The Netherlands

3 Institute for Research in Extramural Medicine and Department of Psychiatry, Vrije Universiteit, Amsterdam, The Netherlands

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BMC Medical Research Methodology 2011, 11:74  doi:10.1186/1471-2288-11-74

Published: 20 May 2011



Although previous studies using non- elderly groups have assessed the factorial invariance of the Center for Epidemiological Studies Depression Scale (CES-D) across different groups with the same social-cultural backgrounds, few studies have tested the factorial invariance of the CES-D across two elderly groups from countries with different social cultures. The purposes of this study were to examine the factorial structure of the CES-D, and test its measurement invariance across two different national elderly populations.


A total of 6806 elderly adults from China (n = 4903) and the Netherlands (n = 1903) were included in the final sample. The CES-D was assessed in both samples. Three strategies were used in the data analysis procedure. First, a confirmatory factor analysis (CFA) was carried out to determine the factor structures of the CES-D that best fitted the two samples. Second, the best fitting model was incorporated into a multi-group CFA model to test measurement invariance of the CES-D across the two population groups. Third, latent mean differences between the two groups were tested.


The results of confirmatory factor analysis (CFA) showed: 1) in both samples, Radloff's four-factor model resulted in a significantly better fit and the four dimensions (somatic complaints, depressed affect, positive affect, and interpersonal problems) of the CES-D seem to be the most informative in assessing depressive symptoms compared to the single-, three-, and the second-order factor models; and 2) the factorial structure was invariant across the populations under study. However, only partial scalar and uniqueness invariance of the CES-D items was supported. Latent means in the partial invariant model were lower for the Dutch sample, compared to the Chinese sample.


Our findings provide evidence of a valid factorial structure of the CES-D that could be applied to elderly populations from both China and the Netherlands, producing a meaningful comparison of total scores between the two elderly groups. However, for some specific factors and items, caution is required when comparing the depressive symptoms between Chinese and Dutch elderly groups.