Depressive symptoms following natural disaster in Korea: psychometric properties of the Center for Epidemiologic Studies Depression Scale

Cho and Cho Health and Quality of Life Outcomes Depressive symptoms following natural disaster in Korea: psychometric properties of the Center for Epidemiologic Studies Depression Scale Sungkun Cho 1 Yongrae Cho 0 0 Department of Psychology, Hallym University , 1 Hallymdaehak-gil, Chuncheon, Gangwon-do 24252 , Republic of Korea 1 Department of Psychology, Chungnam National University , 99 Daehak-ro, Yuseong-gu, Daejeon 34134 , Republic of Korea Background: Depressive symptoms have been recognized as one of the most frequent complaints among natural disaster survivors. One of the most frequently used self-report measures of depressive symptoms is the Center for Epidemiologic Studies Depression Scale (CES-D). To our knowledge, no study has yet examined the factor structure, reliability, and validity of the CES-D in a sample of natural disaster survivors. Thus, the present study investigated the factor structure, reliability, and validity of a Korean language version of the CES-D (KCES-D) for natural disaster survivors. Methods: We utilized two archived datasets collected independently for two different periods in 2008 in the same region of Korea (n = 192 for sample 1; n = 148 for sample 2). Participants were survivors of torrential rains in the mid-eastern region of the Korean peninsula. For analysis, Samples 1 and 2 were merged (N = 340). Confirmatory factor analysis was performed to evaluate the one-factor model, the four-factor model, and the bi-factor models, as well as the second-order factor model. Composite reliability was computed to examine the internal consistency of the KCES-D total and subscale scores. Finally, Pearson's r was computed to examine the relationship between the KCES-D and the trauma-related measures. Results: The four-factor model provided the best fit to the data among the alternatives. The KCES-D showed adequate internal consistency, except for the 'interpersonal difficulties' subscale. Also regarding concurrent validity, weak to moderate positive correlations were observed between the KCES-D and the trauma-related measures. Conclusions: The results support the four-factor model and indicate that the KCES-D has adequate psychometric properties for natural disaster survivors. If these findings are further confirmed, the KCES-D can be used as a useful, rapid, and inexpensive screening tool for assessing depressive symptoms in natural disaster survivors. Natural disaster; Depressive symptoms; Center for Epidemiologic Studies Depression Scale; Psychometric properties; Korean Background Depressive symptoms have been recognized as one of the most frequent complaints among natural disaster survivors [ 1, 2 ]. It has been reported that depressive symptoms and depressive disorders of trauma survivors are associated with their poor health-related quality of life [ 3–5 ]. The development, validation, and utilization of instruments to measure depressive symptoms in trauma survivors are essential for planning and applying interventions designed to reduce depressive symptoms and improve quality of life. A number of self-report measures have been developed to evaluate the degree of depressive symptoms. One of the most frequently used self-report measures of depressive symptoms is the Center for Epidemiologic Studies Depression Scale (CES-D). The CES-D contains 20 items rated on a 4-point Likert scale, ranging from 0 to 3 (total range 0-60) [ 6 ]. There is an extensive body of research demonstrating its sound psychometric properties, including high internal consistency, fair stability, good concurrent, convergent, and discriminant validity in a variety of samples (e.g., [ 7–10 ]). Numerous investigations have been conducted to investigate the factor structure of the CES-D. The original study found a fourfactor structure in the general population; ‘depressive affect,’ ‘positive affect,’ ‘somatic and retarded activity,’ and ‘interpersonal difficulties’ [6]. The four original factors have been extensively replicated (e.g., [ 10–13 ]) and confirmed with meta-analytic methods [14]. However, many other studies have suggested that the factor structure of the CES-D may vary with the study populations and culture. For example, several studies have suggested the presence of one-, two-, three-, four-, five-, and seven-factor structures in different populations and subpopulations (e.g., [ 11, 15 ]). To our knowledge, no study has yet examined the factor structure, reliability, and validity of the CES-D in a sample of natural disaster survivors. Although the CES-D has shown adequate psychometric properties in Korean clinical and nonclinical samples [ 8, 16 ], it has not been validated in a sample of Korean natural disaster survivors. Thus, the objectives of the present study were twofold. First, we aimed to identify the best-fitting factor model for a Korean language version of the CES-D (KCES-D) in a sample of natural disaster survivors. To this end, confirmatory factor analyses (CFAs) we (...truncated)