Evidence map›Paper›PMID 41555287›Full record

ArticleBMC psychiatry2026

A psychometric assessment of the factor structure and reliability of the Center for Epidemiological Studies Depression (CES-D) questionnaire in four African nations.

Tyler Hamby, Seth Frndak, Glenna Schluck, Hannah Kibuuka, John Owuoth, Valentine Sing'oei, Jonah Maswai, Emmanuel Bahemana, Zahra Parker, Robert Paul and 4 more

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In one paragraph

Article in BMC psychiatry, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

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0cells of the map it votes in
1citing papers in PubMed
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1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

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3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

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5 · Who and what money

Authors and funding

14 authors.

Tyler HambyU.S. Military HIV Research Program, CIDR, Walter Reed Army Institute of Research, Silver Spring, MD, USA. thamby@global-id.org.
Seth FrndakU.S. Military HIV Research Program, CIDR, Walter Reed Army Institute of Research, Silver Spring, MD, USA.
Glenna SchluckU.S. Military HIV Research Program, CIDR, Walter Reed Army Institute of Research, Silver Spring, MD, USA.
Hannah KibuukaMakerere University Walter Reed Project, Kampala, Uganda.
John OwuothU.S. Military HIV Research Program, Walter Reed Army Institute of Research-Africa, Kisumu, Kenya.
Valentine Sing'oeiU.S. Military HIV Research Program, Walter Reed Army Institute of Research-Africa, Kisumu, Kenya.
Jonah MaswaiU.S. Military HIV Research Program, Walter Reed Army Institute of Research-Africa, Kericho, Kenya.
Emmanuel BahemanaU.S. Military HIV Research Program, Walter Reed Army Institute of Research-Africa, Mbeya, Tanzania.
Zahra ParkerHenry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA.
Robert PaulMissouri Institute of Mental Health, University of Missouri - St. Louis, St. Louis, MO, USA.
Neha ShahU.S. Military HIV Research Program, CIDR, Walter Reed Army Institute of Research, Silver Spring, MD, USA.
Julie A AkeU.S. Military HIV Research Program, CIDR, Walter Reed Army Institute of Research, Silver Spring, MD, USA.
Trevor A CrowellU.S. Military HIV Research Program, CIDR, Walter Reed Army Institute of Research, Silver Spring, MD, USA.
AFRICOS Study Group

Funding

Understanding Pandemic Evolution through Networked Data (UPEND)RF1MH133442 · NIMH · HENRY M. JACKSON FDN FOR THE ADV MIL/MED · PI CROWELL, TREVOR ADAM · 2023 to 2023
$3.8M
NIMH NIH HHS RF1 MH133442U.S. Department of Defense W81XWH-18-2-0040
6 · The paper itself

Abstract

backgroundThe Center for Epidemiological Studies Depression (CES-D) is commonly used to identify people at risk for clinical depression in HIV care and research settings in Africa, though it has not been validated in these settings. We examined the psychometric properties of the CES-D in people living with (PLWH) and without HIV (PLWoH) in four African countries.

methodsThe African Cohort Study (AFRICOS) administers the CES-D biannually to participants aged 15 years or older in Kenya, Nigeria, Tanzania, and Uganda. The CES-D is completed in English, Kiswahili, or Luganda. Exploratory (EFA) and confirmatory factor analysis (CFA) were each performed in separate subsamples. Longitudinal measurement invariance and invariance by nation, language, sex, and HIV status were examined. CES-D score distributions, internal consistency, and test-retest reliability were reported.

resultsThere were 3320 participants: 1663 (50%) exploratory sample, 1397 (42%) males, and 2732 (82%) PLWH. EFA supported a 1- or 2-factor solution. CFA confirmed 1-factor solution with a method factor for reverse-scored items. Configural, metric, and either scalar or partial scalar invariance were established for all variables examined. Collapsing across samples, the median CES-D score was 3; internal consistency was α = 0.89; and 6- and 12-month test-retest reliabilities were ρ = 0.37 and 0.33, respectively.

conclusionsThese results have positive implications for using the CES-D in African nations and PLWH. That the four reverse-scored items are not a second factor, but covary due to methodological issues, has implications that transcend specific samples. Further research is needed to establish validity in African nations and PLWH. CLINICAL TRIAL NUMBER: Not applicable.

Indexed as

DepressionHIV InfectionsPsychiatric Status Rating ScalesAdolescentAdultCohort StudiesFactor Analysis, StatisticalFemaleHumansKenyaMaleMiddle AgedNigeriaPsychometricsReproducibility of ResultsSurveys and QuestionnairesAfricaCES-DFactor analysisHIVInvariance testingReliability

Identifiers

PMID41555287
PMCPMC12896242

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LicenceCC BY-NC-ND
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.