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

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