@article {ADAMS2020850,
	title = {Dimensionality and differential item endorsement of depressive symptoms among aging Black populations in South Africa: Findings from the HAALSI study},
	journal = {Journal of Affective Disorders},
	volume = {277},
	year = {2020},
	pages = {850 - 856},
	abstract = {Background The Center for Epidemiologic Studies-Depression (CES-D) scale is a widely used measure of depressive symptoms, but its construct validity has not been adequately assessed in sub-Saharan Africa. This study validates the CES-D among an aging Shangaan-speaking and predominantly Black African sample in rural South Africa, with a special emphasis on gender differences. Methods An 8-item CES-D scale was administered in Shangaan to 5059 respondents, aged 40+ years, residing in Agincourt, South Africa. We used Cronbach{\textquoteright}s alpha and exploratory and confirmatory factor analysis to examine and confirm dimensionality of the CES-D scale. Differential endorsement of CES-D items by gender were assessed using the Mantel-Haenszel (MH) odds ratio test. Results Reliability of the CES-D scale differed by gender with women reporting higher internal consistency on items than men. A two-factor solution was retained and confirmed representing two latent factors: (1) Negative Affect (six items) and (2) Diminished Positive Affect (two items). MH results showed that men exhibited significantly higher odds of putting an effort in everything that they did (OR: 1.33, 95\% CI: 1.15{\textendash}1.54) and lower odds of feeling depressed (OR: 0.71, 95\% CI: 0.56{\textendash}0.89) and having restless sleep (OR: 0.67, 95\% CI:0.58{\textendash}0.77) than women. Limitations Analyses were limited to a dichotomous, short form of the CES-D, a self-reported population-based measure. Conclusion Aging Black Africans differ in endorsing affective and somatic items on the CES-D scale by gender, which may lead to skewed population-level estimates of depression in key subpopulations. These findings highlight the importance of continued research disentangling cross-cultural and gendered nuances of depression measurements.},
	keywords = {CES-D, Depression, Factor Analysis, gender, Race, South Africa},
	issn = {0165-0327},
	doi = {https://doi.org/10.1016/j.jad.2020.08.073},
	url = {http://www.sciencedirect.com/science/article/pii/S0165032720326793},
	author = {Leslie B. Adams and Farrell, Meagan and Sumaya Mall and Nomsa Mahlalela and Berkman, Lisa}
}
