Depression, a major contributor to the global burden of disease, is an outcome of interest in clinical trials. Researchers and clinicians note that depression often presents differently across cultures, posing challenges in the accurate measurement of depressive symptoms across populations. A commonly used self-administered screening tool to measure depressive symptoms, the Center for Epidemiologic Studies Scale-Depression (CES-D), has been translated into dozens of languages and used in thousands of studies, yet gaps remain in our understanding of its factor structure and invariance across studies and over time in the context of interventions. In this secondary analysis, we sampled six recent trials from lower- and middle-income countries to (a) establish the factor structure of the CES-D, (b) assess measurement invariance of the CES-D across treatment versus control arms and over time, (c) examine cross-study invariance, and (d) identify items that may be driving potential noninvariance. We performed exploratory/confirmatory factor analysis to establish the factor structure of the CES-D within each trial and used multiple group confirmatory analysis to assess within-study cross-arm/cross-time and cross-study invariance. After removal of positive affect items, a unidimensional model performed equivalently over time and across arms within trials, but exhibited noninvariance across trials, supporting prior literature describing differences in factor structure of the scale across populations. While our findings suggest that the CES-D without positive affect items is a valid measure of depressive symptoms within trials in our sample, caution is warranted in interpreting the findings of meta-analyses and multisite/multicountry studies using the CES-D as an outcome measure. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

中文翻译：

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流行病学研究中心抑郁量表在六项不同干预试验中和之间的测量不变性。

抑郁症是全球疾病负担的一个主要因素，也是临床试验中令人感兴趣的结果。研究人员和临床医生指出，抑郁症在不同文化中的表现往往不同，这给准确测量不同人群的抑郁症状带来了挑战。流行病学研究中心抑郁量表 (CES-D) 是一种常用的自我管理筛查工具，用于测量抑郁症状，已被翻译成数十种语言并在数千项研究中使用，但我们对其影响因素的理解仍然存在差距跨研究和干预背景下随时间推移的结构和不变性。在这项二次分析中，我们对来自低收入和中等收入国家的六项近期试验进行了抽样，以（a）建立 CES-D 的因子结构，（b）评估 CES-D 在治疗组与对照组之间的测量不变性。时间，(c) 检查交叉研究不变性，(d) 识别可能驱动潜在非不变性的项目。我们进行了探索性/验证性因素分析，以确定每个试验中 CES-D 的因素结构，并使用多组验证性分析来评估研究内的跨臂/跨时间和跨研究不变性。去除积极情感项目后，一维模型在试验中随时间和跨臂的表现相当，但在试验中表现出非不变性，支持了描述不同人群量表因子结构差异的先前文献。虽然我们的研究结果表明，没有积极情感项目的 CES-D 是我们样本试验中抑郁症状的有效衡量标准，但在解释使用 CES-D 作为结果的荟萃分析和多地点/多国家研究的结果时需要谨慎措施。（PsycInfo 数据库记录 (c) 2023 APA，保留所有权利）。