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Cross-Cultural Confirmatory Factor Analysis of the CES-D in Spanish and Mexican Dementia Caregivers

Published online by Cambridge University Press:  10 January 2013

Andrés Losada*
Universidad Rey Juan Carlos (Spain)
Mª de los Ángeles Villareal
Universidad Autónoma de Coahuila (Mexico)
Roberto Nuevo
Hospital Universitario de Getafe (Spain)
María Márquez-González
Universidad Autónoma de Madrid (Spain)
Bertha C. Salazar
Universidad Autónoma de Nuevo León (Mexico)
Rosa Romero-Moreno
Universidad Rey Juan Carlos (Spain)
Ana L. Carrillo
Universidad Autónoma de Coahuila (Mexico)
Virginia Fernández-Fernández
Universidad Rey Juan Carlos (Spain)
Correspondence concerning this article should be addressed to Andrés Losada-Baltar. Facultad de Ciencias de la Salud. Departamento de Psicología. Edificio Departamental II. Avda. de Atenas, s/n. 28922 Alcorcón-Madrid (Spain). Phone: + 34-914888941. E-mail:


The Center for Epidemiologic Studies-Depression Scale (CES-D) is the most frequently used scale for measuring depressive symptomatology in caregiving research. The aim of this study is to test its construct structure and measurement equivalence between caregivers from two Spanish-speaking countries. Face-to-face interviews were carried out with 595 female dementia caregivers from Madrid, Spain, and from Coahuila, Mexico. The structure of the CES-D was analyzed using exploratory and confirmatory factor analysis (EFA and CFA, respectively). Measurement invariance across samples was analyzed comparing a baseline model with a more restrictive model. Significant differences between means were found for 7 items. The results of the EFA clearly supported a four-factor solution. The CFA for the whole sample with the four factors revealed high and statistically significant loading coefficients for all items (except item number 4). When equality constraints were imposed to test for the invariance between countries, the change in chi-square was significant, indicating that complete invariance could not be assumed. Significant between-countries differences were found for three of the four latent factor mean scores. Although the results provide general support for the original four-factor structure, caution should be exercised on reporting comparisons of depression scores between Spanish-speaking countries.

La Escala del Centro para Estudios Epidemiológicos (CES-D) es la más utilizada para medir sintomatología depresiva en la investigación sobre cuidadores. El objetivo de este estudio es analizar su estructura dimensional y su equivalencia de medida entre cuidadores de dos países de habla hispana. Se entrevistó a 595 mujeres cuidadoras de familiares con demencia de Madrid, España, y Coahuila, México. La estructura del CES-D se analizó mediante análisis factoriales exploratorios (AFE) y confirmatorios (AFC). Se encontraron diferencias estadísticamente significativas entre las medias de 7 ítems. Los resultados del AFE con la muestra total respaldan claramente una solución de 4 factores. El AFC de la estructura de 4 factores revela cargas elevadas y significativas para todos los ítems (excepto el 4). Al imponer restricciones de igualdad para valorar la equivalencia entre países, el cambio en chi-cuadrado fue significativo, indicando que no se puede asumir una equivalencia completa. Se encontraron diferencias significativas entre países para tres de las cuatro puntuaciones medias en los factores latentes. Aunque los resultados proporcionan un apoyo general a la estructura original de cuatro factores, se debería tener una cierta cautela a la hora de informar sobre comparaciones en puntuaciones en depresión entre países de habla hispana.

Research Article
Copyright © Cambridge University Press 2012

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