Validation of the Arabic Center for Epidemiological Studies Depression (CES-D) Scale in a Lebanese Community Sample

The factor structure of the 20-items Arabic Center for Epidemiological Studies Depression scale (Arabic CES-D) and its relationship to theoretically grounded psychosocial and sociodemographic risk factors were examined in a community sample of Lebanese adults (n = 435). Two factors, Depressed Affect and Lack of Positive Affect, were empirically derived, correlating r = .35 with each other and r = .96 and r = .59, respectively, with Arabic CES-D global scores. Depressed Affect scores but not Lack of Positive Affect scores were associated with level of education and marital status but not with gender. Also, Depressed Affect scores in the collectivist Lebanese context were more strongly correlated with avoidant attachment scores than anxious attachment scores (r = .47 and r = .24, respectively; z = 3.68, p <.0001), whereas Lack of Positive Affect scores were not significantly higher in their correlation with avoidant and anxious attachment scores (r = .29 and r = .18, respectively; z = 1.62, ns). In addition, Depressed Affect scores correlated more strongly than Lack of Positive Affect scores with avoidant attachment scores but not with anxious attachment scores. These findings suggest that the Arabic CES-D scale likely taps two distinct aspects of mental health, namely, depression and well-being, such that their correlates need to be identified separately, and that the Lebanese depressed mind is undifferentiated with respect to psychological, somatic, and interpersonal expressions of depression. Finally, we discuss the implications of the findings for the use of the Arabic CES-D in the Arab world and for the universality of the Arab depressed mind.