Cited by 837Anxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesPsychometric Methodologies and TestingMental Health Research Topics

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Meta-analysis of the factor structures of four depression questionnaires: Beck, CES-D, Hamilton, and Zung

Shafer, Alan B.·2006·Journal of Clinical Psychology

DOI 10.1002/jclp.20213

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Abstract

Four separate metaanalyses of factor analyses were conducted for the Beck Depression Inventory (BDI), the Center for Epidemiological Studies Depression Scale (CES-D), the Hamilton Rating Scale for Depression (HRSD), and the Zung Self-Rating Depression Scale (SDS). The total number of participants (N) and studies (k) included in each of the metaanalyses were the following: BDI (N = 13,643, k = 33), CES-D (N = 22,340, k = 28), HRSD (N = 2,606, k = 17), and SDS (N = 12,621, k = 13). Metaanalysis results suggest that the specific depression symptom factors within each test appear to be relatively robust and well established and match fairly closely previously hypothesized factor structures. A general Depression Severity factor and a small Somatic Symptoms factor are found in all four tests and two tests had a small Positive Affect factor. There were fewer common specific depression symptom factors across tests than expected.

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Method
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BackgroundMethod
Positive maternal mental health during pregnancy associated with specific forms of adaptive development in early childhood: Evidence from a longitudinal study
Phua, D. Y., Kee, M. Z. L., Koh, D. X. P., Rifkin‐Graboi, A., Daniels, M., Chen, H., Chong, Y. S., Broekman, B. F. P., Magiati, I., Karnani, N., et al. (2017) · Development and Psychopathology · doi:10.1017/s0954579417001249 · Cited by 68
“Factor analyses of other common psychiatric screening tools have also found a factor of positive affect that comprises the positively worded items (Hernández-Martı́nez et al., 2011; Hu et al., 2007; Iwata et al., 1998; Shafer, 2006).”
Background
Brainstem Aminergic Nuclei and Late-Life Depressive Symptoms
Wilson, R. S., Nag, S., Boyle, P. A., Hizel, L. P., Yu, L., Buchman, A. S., Shah, R. C., Schneider, J. A., Arnold, S. E., & Bennett, D. A. (2013) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2013.2224 · Cited by 60
Distributional patterns of item responses and total scores on the PHQ-9 in the general population: data from the National Health and Nutrition Examination Survey
Tomitaka, S., Kawasaki, Y., Ide, K., Akutagawa, M., Yamada, H., Ono, Y., & Furukawa, T. A. (2018) · BMC Psychiatry · doi:10.1186/s12888-018-1696-9 · Cited by 61
Symptom clusters in adolescent depression and differential response to treatment: a secondary analysis of the Treatment for Adolescents with Depression Study randomised trial
Bondar, J., Caye, A., Chekroud, A. M., & Kieling, C. (2020) · The Lancet Psychiatry · doi:10.1016/s2215-0366(20)30060-2 · Cited by 60
Emotional traits predict individual differences in amphetamine-induced positive mood in healthy volunteers
Kirkpatrick, M. G., Goldenson, N. I., Kapadia, N., Kahler, C. W., de Wit, H., Swift, R. M., McGeary, J. E., Sussman, S. Y., & Leventhal, A. M. (2015) · Psychopharmacology · doi:10.1007/s00213-015-4091-y · Cited by 59
“Symptoms of depression and other emotional disturbances, as well as emotional functioning in general, are highly heterogeneous, with features that often do not cluster together into a single category or empirically common dimension (Shafer 2006).”
Non-pharmacological prevention of major depression among community-dwelling older adults: A systematic review of the efficacy of psychotherapy interventions
Lee, S. Y., Franchetti, M. K., Imanbayev, A., Gallo, J. J., Spira, A. P., & Lee, H. B. (2012) · Archives of Gerontology and Geriatrics · doi:10.1016/j.archger.2012.03.003 · Cited by 63
“The items in the CES-D have been found to have high internal consistency and adequate test-retest reliability in a meta-analysis based on a wide range of samples across age and ethnicity (Shafer, 2006).”
Anhedonia and the relative reward value of drug and nondrug reinforcers in cigarette smokers.
Leventhal, A. M., Trujillo, M. A., Ameringer, K. J., Tidey, J. W., Sussman, S. Y., & Kahler, C. W. (2014) · Journal of Abnormal Psychology · doi:10.1037/a0036384 · Cited by 58
Determinants of subjective sleepiness in suspected obstructive sleep apnoea
Koutsourelakis, I., Perraki, E., Bonakis, A., Vagiakis, E., Roussos, C., & Zakynthinos, S. G. (2008) · Journal of Sleep Research · doi:10.1111/j.1365-2869.2008.00663.x · Cited by 61
“Furthermore, the use of any antidepressant medication prescribed by a psychiatrist or a Center for Epidemiologic Studies Depression scale score >16 was considered to classify a patient in the depression group (Shafer, 2006).”
Alexithymia in anorexia nervosa: the mediating role of depression.
Torres, S., Guerra, M., Lencastre, L., Miller, K. M., Vieira, F., Roma-Torres, A., Brandão, I., & Costa, P. (2015) · Psychiatry Research · doi:10.1016/j.psychres.2014.10.023 · Cited by 53
“In addition to the previously mentioned differences between these scales, the BDI-13 assesses negative affect (Shafer, 2006) and requires a severity or intensity judgment of depressive symptoms (Meites et al.”
BackgroundMethod
Depressive Symptoms in Patients With Dry Eye Disease
Hallak, J., Tibrewal, S., & Jain, S. K. (2015) · Cornea · doi:10.1097/ico.0000000000000641 · Cited by 58
“The BDI is a widely used tool for measuring the severity of depressive symptoms.(16) The tool is a 21-question multiplechoice self-report inventory that was created by Aaron T.”
Method
Acylcarnitine metabolomic profiles inform clinically-defined major depressive phenotypes
Ahmed, A. T., MahmoudianDehkordi, S., Bhattacharyya, S., Arnold, M., Liu, D., Neavin, D. R., Moseley, M. A., Thompson, J. W., Williams, L. S. J., Louie, G., et al. (2019) · Journal of Affective Disorders · doi:10.1016/j.jad.2019.11.122 · Cited by 59
Confirmatory factor analysis of the Beck Depression Inventory-II and the association with cardiac morbidity and mortality after coronary revascularization
Tully, P. J., Winefield, H. R., Baker, R. A., Turnbull, D. A., & de Jonge, P. (2011) · Journal of Health Psychology · doi:10.1177/1359105310383604 · Cited by 57
“…note the CFA fit indices of such general models are likely optimized by the 21 extra free parameters, while it is not clear what the C and S orthogonal factors measure once all common variance with depressive symptoms (or negative affectivity) is removed (Shafer, 2006; Vanheule et al., 2008).”
Background
Depressive Symptoms and Mental Stress–Induced Myocardial Ischemia in Patients With Coronary Heart Disease
Boyle, S. H., Samad, Z. Z., Becker, R. C., Williams, R. B., Kuhn, C. M., Ortel, T. L., Kuchibhatla, M. N., Prybol, K., Rogers, J. G., O’Connor, C. M., et al. (2013) · Psychosomatic Medicine · doi:10.1097/psy.0b013e3182a893ae · Cited by 57
“The CESD-SOM, CESD-NA, CESD-IP, Cook-Medley Hostility Scale, Spielberger Trait Anxiety Scale, and the Spielberger State Anxiety Scale were not associated with MSIMI or ESIMI (see Table 1).”
Background
Factor structure and longitudinal invariance of the Center for Epidemiological Studies Depression Scale (CES-D) in adult women: application in a population-based sample of mothers of children with epilepsy
Ferro, M. A., & Speechley, K. N. (2013) · Archives of Women s Mental Health · doi:10.1007/s00737-013-0331-5 · Cited by 57
“This finding is congruent with a recent meta-analysis which demonstrated that the four-factor model of the CES-D is the most commonly reported structure of the measure (Shafer 2006).”
MethodResultInfluential
Similarity in depressive symptom profile in a population-based study of migrants in the Netherlands
Schrier, A. C., de Wit, M. A. S., Rijmen, F., Tuinebreijer, W. C., Verhoeff, A. P., Kupka, R., Dekker, J., & Beekman, A. T. F. (2009) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-009-0135-0 · Cited by 58
Validation of the Chinese version of the Hamilton Rating Scale for Depression in adults with epilepsy
Lin, J., Wang, X., Dong, F., Du, Y., Shen, J., Ding, S., Wang, L., Ye, M., Wang, Y., Xia, N., et al. (2018) · Epilepsy & Behavior · doi:10.1016/j.yebeh.2018.10.009 · Cited by 56
Depressive Symptoms Are Not Associated with Leukocyte Telomere Length: Findings from the Nova Scotia Health Survey (NSHS95), a Population-Based Study
Shaffer, J. A., Epel, E. S., Kang, M. S., Ye, S., Schwartz, J. E., Davidson, K. W., Kirkland, S., Honig, L. S., & Shimbo, D. (2012) · PLoS ONE · doi:10.1371/journal.pone.0048318 · Cited by 56
“To do so, we computed four subscales of the CES-D based upon previously reported factor analytic studies showing that this measure has a four-factor structure [37].”
Method
Temporal course of depressive symptoms during the development of Alzheimer disease
Wilson, R. S., Hoganson, G. M., Rajan, K. B., Barnes, L. L., de Leon, C. F. M., & Evans, D. A. (2010) · Neurology · doi:10.1212/wnl.0b013e3181e620c5 · Cited by 57
General and specific components of depression and anxiety in an adolescent population
Brodbeck, J., Abbott, R., Goodyer, I. M., & Croudace, T. J. (2011) · BMC Psychiatry · doi:10.1186/1471-244x-11-191 · Cited by 57
To each his own well-being boosting intervention: using preference to guide selection
Schueller, S. M. (2011) · The Journal of Positive Psychology · doi:10.1080/17439760.2011.577092 · Cited by 53
“For the measure of depressive symptoms, this study used the CES-D, which includes items that assess stable depressive symptoms, such as interpersonal relationships (Shafer, 2006).”
Method
A systematic review of mental health measurement scales for evaluating the effects of mental health prevention interventions
Breedvelt, J., Zamperoni, V., South, E., Uphoff, E., Gilbody, S. M., Bockting, C., Churchill, R. C., & Kousoulis, A. A. (2019) · European Journal of Public Health · doi:10.1093/eurpub/ckz233 · Cited by 54
Differences on Psychosocial Outcomes Between Male and Female Caregivers of Children With Life-Limiting Illnesses
Schneider, M., Steele, R., Cadell, S., & Hemsworth, D. (2010) · Journal of Pediatric Nursing · doi:10.1016/j.pedn.2010.01.007 · Cited by 58
Differential change in specific depressive symptoms during antidepressant medication or cognitive therapy
Fournier, J. C. J., DeRubeis, R. J., Hollon, S. D., Gallop, R., Shelton, R. C., & Amsterdam, J. D. (2013) · Behaviour Research and Therapy · doi:10.1016/j.brat.2013.03.010 · Cited by 56
A double-blind, placebo-controlled treatment trial of citalopram for major depressive disorder in older patients with heart failure: The relevance of the placebo effect and psychological symptoms
Fráguas, R., Telles, R. M. S., Alves, T. C. T. F., Andrei, A. M., Rays, J., Iosifescu, D. V., & Wajngarten, M. (2009) · Contemporary Clinical Trials · doi:10.1016/j.cct.2009.01.007 · Cited by 53
“[22], using the BDI, a self-report scale weighted on cognitive symptoms of depression [42], reported a significant superiority of paroxetine over placebo in patients with depression and heart failure, with a large effect size [22].”
Method
West Nile Virus Retinopathy and Associations with Long Term Neurological and Neurocognitive Sequelae
Hasbun, R., Garcia, M. N., Kellaway, J., Baker, L., Salazar, L., Woods, S. P., & Murray, K. O. (2016) · PLoS ONE · doi:10.1371/journal.pone.0148898 · Cited by 53
“Beck Depression Inventory was used to assess recent mood,[13] and the Modified Fatigue Impact Scale (MFIS) measured the impact of fatigue on physical, cognitive and psychosocial functioning.”
Method
Differential symptom cluster responses to repetitive transcranial magnetic stimulation treatment in depression
Kaster, T. S., Downar, J. H., Vila‐Rodriguez, F., Baribeau, D. A., Thorpe, K. E., Daskalakis, Z. J., & Blumberger, D. M. (2022) · EClinicalMedicine · doi:10.1016/j.eclinm.2022.101765 · Cited by 52
Evaluating Depressive Symptoms in Schizophrenia: A Psychometric Comparison of the Calgary Depression Scale for Schizophrenia and the Hamilton Depression Rating Scale
Schennach, R., Obermeier, M., Seemüller, F., Jäger, M., Schmauß, M., Laux, G., Pfeiffer, H., Naber, D., Schmidt, L., Gäebel, W., et al. (2012) · Psychopathology · doi:10.1159/000336729 · Cited by 53
Dimensions of depressive symptoms and cingulate volumes in older adults
McLaren, M. E., Szymkowicz, S. M., O’Shea, A. M., Woods, A. J., Anton, S. D., & Dotson, V. M. (2016) · Translational Psychiatry · doi:10.1038/tp.2016.49 · Cited by 52
Factor structure of the Brief Psychiatric Rating Scale – Expanded (BPRS-E) in a large hospitalized sample
Shafer, A., Dazzi, F., & Ventura, J. (2017) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2017.05.011 · Cited by 52
“Burning Tongue” and “Burning Tip”: The Diagnostic Challenge of the Burning Mouth Syndrome
Penza, P., Majorana, A., Lombardi, R., Camozzi, F., Bonadeo, S., Sapelli, P., & Lauria, G. (2010) · Clinical Journal of Pain · doi:10.1097/ajp.0b013e3181e15b83 · Cited by 52
Depression Dimensions: Integrating Clinical Signs and Symptoms from the Perspectives of Clinicians and Patients
Vares, E. A., Salum, G. A., Spanemberg, L., Caldieraro, M. A., & Fleck, M. P. D. A. (2015) · PLoS ONE · doi:10.1371/journal.pone.0136037 · Cited by 51
“The six latent factors uncovered in the study, besides presenting adequate goodness-of-fit indices (statistically speaking), are also clinically sound and intuitive, matching fairly closely factor structures hypothesized in previous studies [6].”
Result
Dimensional and hierarchical models of depression using the Beck Depression Inventory-II in an Arab college student sample
Al-Turkait, F. A., & OHAERI, J. U. (2010) · BMC Psychiatry · doi:10.1186/1471-244x-10-60 · Cited by 51
“The relationship between the items of any questionnaire where there are diverse indicators of a complex construct can be described as existing in dimensional and hierarchical models [1,14,37].”
BackgroundMethodResultInfluential
Where Is the Pleasure in That? Low Hedonic Capacity Predicts Smoking Onset and Escalation
Audrain-McGovern, J. E., Rodriguez, D., Leventhal, A. M., Cuevas, J., Rodgers, K., & Sass, J. (2012) · Nicotine & Tobacco Research · doi:10.1093/ntr/nts017 · Cited by 54
A Meta-Analysis of the Factor Structure of the Classroom Assessment Scoring System (CLASS)
Li, H., Liu, J., & Hunter, C. V. (2019) · The Journal of Experimental Education · doi:10.1080/00220973.2018.1551184 · Cited by 57
Strategies and methods to study female-specific cardiovascular health and disease: a guide for clinical scientists
Ouyang, P., WENGER, N. K., Taylor, D. A., Rich-Edwards, J. W., Steiner, M. S., Shaw, L. J., Berga, S. L., Miller, V. M., & Merz, C. N. B. (2016) · Biology of Sex Differences · doi:10.1186/s13293-016-0073-y · Cited by 54
Caregiving, residence, race, and depressive symptoms
Siegler, I. C., Brummett, B. H., Williams, R. B., Haney, T. L., & Dilworth‐Anderson, P. (2010) · Aging & Mental Health · doi:10.1080/13607861003713257 · Cited by 50
Positive emotions and favorable cardiovascular health: A 20-year longitudinal study
Boehm, J. K., Chen, Y., Qureshi, F., Soo, J., Umukoro, P. E., Hernández, R., Lloyd‐Jones, D. M., & Kubzansky, L. D. (2020) · Preventive Medicine · doi:10.1016/j.ypmed.2020.106103 · Cited by 51
Depressive Symptom Clusters and 5-Year Incidence of Coronary Artery Calcification
Stewart, J. C., Zielke, D. J., Hawkins, M. A. W., Williams, D. R., Carnethon, M. R., Knox, S. S., & Matthews, K. A. (2012) · Circulation · doi:10.1161/circulationaha.112.094946 · Cited by 49
Depression, anxiety and cardiovascular disease: Which symptoms are associated with increased risk in community dwelling older adults?
Gallagher, D., O’Regan, C., Savva, G. M., Cronin, H., LAWLOR, B. A., & Kenny, R. A. (2012) · Journal of Affective Disorders · doi:10.1016/j.jad.2012.04.012 · Cited by 49
“Factors 2 and 3 replicated the Positive Affect and Interpersonal Problems factors which have previously been described (Shafer, 2006).”
Background
Depression disorder in patients with cerebellar damage: Awareness of the mood state.
Clausi, S., Lupo, M., Olivito, G., Siciliano, L., Contento, M. P., Aloise, F., Pizzamiglio, L., Molinari, M., & Leggio, M. G. (2018) · Journal of Affective Disorders · doi:10.1016/j.jad.2018.11.029 · Cited by 53

Authors: Shafer, A. B.
Corresponding author: Shafer, Alan B.
Venue: Journal of Clinical Psychology
Publisher: Wiley
Published: 2005
Volume: 62
Issue: 1
Pages: 123-146
ISSN: 0021-9762 (ISSN-L)
1097-4679
DOI: 10.1002/jclp.20213
OpenAlex: W2170701421
Cited by: 837
References: 111
Citations by year: 2026: 31 · 2025: 23 · 2024: 34 · 2023: 35 · 2022: 25 · 2021: 28 · 2020: 49 · 2019: 51 · 2018: 76 · 2017: 58 · 2016: 49 · 2015: 51 · 2014: 61 · 2013: 69 · 2012: 45
FWCI: 2.17
Type: journal article
Language: en
Open access: closed
Licence: doi.wiley.com/10.1002/tdm_license_1 (tdm, 3895 d)
Locations: Journal of Clinical Psychology (publishedVersion)
PubMed (publishedVersion)
Topics: Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
Social Sciences › Decision Sciences › Management Science and Operations Research › Psychometric Methodologies and Testing
Social Sciences › Psychology › Experimental and Cognitive Psychology › Mental Health Research Topics
Keywords: factor structure, Beck Depression Inventory, CES-D, Hamilton Depression Rating Scale, Zung Self-Rating Depression Scale, depression severity, somatic symptoms, positive affect
MeSH terms: Depressive Disorder, Factor Analysis, Statistical, Humans, Psychological Tests, Surveys and Questionnaires

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Meta-analysis of the factor structures of four depression questionnaires: Beck, CES-D, Hamilton, and Zung

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