Psychological Assessment © 2016 American Psychological Association

2017, Vol. 29, No. 9, 1157–1166 1040-3590/17/$12.00 http://dx.doi.org/10.1037/pas0000419

Evaluation of the Children’s Depression Inventory—Short Version (CDI–S)

Johan Ahlen Ata Ghaderi

Uppsala University Karolinska Institutet

The Children’s Depression Inventory—Short Version (CDI–S), an abbreviated version of the widely used
Children’s Depression Inventory (CDI), has been regularly used in recent research. In comparison to the
original CDI, the CDI–S has not been rigorously evaluated for its psychometrics. The present study
examined the dimensionality, convergent and discriminant validity, and gender differences of the CDI–S
in a school-based sample of 809 children 8 –12 years of age. All children completed the CDI–S. One
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subsample additionally completed another measure of depression, 1 subsample completed a measure of

This document is copyrighted by the American Psychological Association or one of its allied publishers.

anxiety, and 1 subsample completed the CDI–S at a second occasion, after 2 weeks. Information
regarding parents’ education and household income were available for 476 children. We evaluated the
dimensionality of the CDI–S in a series of exploratory factor analyses. Despite some evidence of
multidimensionality, a bifactor model revealed that the variation of scores was primarily explained by
variations of the general factor. Consequently, the CDI–S is most adequately interpreted as a univocal
measure. The CDI–S showed high correlation to another measure of depression and a moderately high
correlation to a measure of anxiety, with nonoverlapping confidence intervals. We also found that girls
reported higher levels of depressive symptoms than did boys, and we found a negative correlation
between depressive symptoms and socioeconomic factors for boys only. Future studies should preferably
include a broader age range, to acquire a more comprehensive understanding of the validity of the CDI–S.

Public Significance Statement

This study examined the reliability and validity of a widely used questionnaire assessing depressive
symptoms in children. The results showed that the questionnaire could be interpreted as a one-
dimensional measure of depression, that girls reported higher levels of depressive symptoms than did
boys, and that boys from low-income households reported higher depressive symptoms than did boys
from high-income households.

Keywords: depression, Children’s Depression Inventory, factor structure, gender differences, socioeconomic status

The Children’s Depression Inventory—Short Version (CDI–S;
Kovacs, 2003) is a measure of depressive symptoms that is widely
used for screening purposes, and it commonly serves as a second-
ary measure in clinical trials (e.g., Hanks, McGuire, Lewin, Storch,
& Murphy, 2016; Sibinga, Webb, Ghazarian, & Ellen, 2016). The
10-item CDI–S was originally developed as a one-dimensional,
rapid version of the original 27-item Children’s Depression Inven-
tory (CDI) for screening purposes (Kovacs, 2003). Despite its
common occurrence in studies, few studies have examined its
psychometric properties, and as far as we know, no study has
thoroughly examined its dimensionality. For a better understand-
ing, and to correctly interpret the results of the CDI–S, the present
study aimed to examine test’s dimensionality, reliability, and con-
vergent and discriminant validity in a large school-based sample.
Additionally, the present study also aimed to examine mean dif-
This article was published Online First December 5, 2016.
Johan Ahlen, Department of Psychology, Uppsala University; Ata Gha-
deri, Department of Clinical Neuroscience, Karolinska Institutet.
Correspondence concerning this article should be addressed to Johan
Ahlen, Department of Psychology, Uppsala University, P.O. Box 1225,
SE-751 42 Uppsala, Sweden. E-mail: johan.ahlen@psyk.uu.se
ferences by gender, parent education, and household income. It
should be noted that a new 28-item revised version of the full-
length questionnaire (CDI–2) and a new 12-item short version
(CDI–2S) derived from the revised version were developed re-
cently (Kovacs, 2011). Although the new CDI–2S holds some
possible advantages over the CDI–S, it has not yet been widely
recognized in research and thus has been used in only a few
studies.
Literature Review
Depression is the most prevalent lifetime psychiatric disorder
(Kessler et al., 2005), and even though predominantly studied in
adults and adolescents, depression has been found to be quite
common also in children (E. J. Costello, Erkanli, & Angold, 2006).
Depressive symptoms in children are quite stable over time (Cole
& Martin, 2005) and are associated with impairment in school and
peer functioning (Twenge & Nolen-Hoeksema, 2002). Further,
depressive symptoms have been shown to predict impairment and
depressive disorders in adolescence (Keenan et al., 2008), which in
turn often continue into adulthood (Lewinsohn, Rohde, Klein, &
Seeley, 1999) and involve an increased risk of suicidal behavior
and alcohol and drug abuse (Bittner et al., 2007).

1157
 1158 AHLEN AND GHADERI
According to several studies, only a few children suffering from
depression become psychiatrically assessed and hence identified.
These studies generally report that only about 20% to 30% of
children and adolescents with depression have received help for
their condition (Allgaier et al., 2012; Bienvenu & Ginsburg, 2007;
Essau, 2005; Samm et al., 2008).
To identify depression in early ages, self-reported screening
questionnaires can be used to select “at risk” children for further
assessment (Stevanovic, 2012; Timbremont, Braet, & Dreessen,
2004). Brief self-report questionnaires, for instance as a part of
regular checkups for schoolchildren, could be a practical, efficient,
and cost-effective solution (Ivarsson, Svalander, & Litlere, 2006;
Samm et al., 2008; Stevanovic, 2012).
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The original Children’s Depression Inventory (CDI; Kovacs,
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1992) is the most frequently used questionnaire measuring depres-
sive symptoms in children, and it has regularly been used in
nonclinical populations (Giannakopoulos et al., 2009; Twenge &
Nolen-Hoeksema, 2002). Several advantages of the CDI have been
emphasized in the literature, for example its simple wordings,
short completion time, and strong psychometrics properties (All-
gaier et al., 2012; Craighead, Smucker, Craighead, & Ilardi, 1998;
Myers & Winters, 2002; Samm et al., 2008; Twenge & Nolen-
Hoeksema, 2002). However, others have critiqued the CDI for its
low specificity and poor construct validity, suggesting the CDI
could be better described as a measure of distress rather than
depression (Myers & Winters, 2002).
The CDI was developed to measure several domains of depres-
sion (Twenge & Nolen-Hoeksema, 2002), and its multidimension-
ality has been extensively supported (for a review see Huang &
Dong, 2014). Using a sample of 1,266 Florida schoolchildren, the
constructor of the CDI originally found a five-factor model com-
prising the following subscales: Negative Mood, Inter-Personal
Problems, Ineffectiveness, Anhedonia, and Negative Self-Esteem
(Kovacs, 1992). However, reliability coefficients of the subscales
scores were not impressive, with alphas ranging from .58 to .69,
and subsequent studies have yielded mixed results regarding the
factor structure, ranging from one to eight factors (Huang & Dong,
2014; Kovacs, 1992).
In a meta-analysis of 24 studies examining the dimensionality of
the CDI, an overall support was found for a five-factor structure
(Huang & Dong, 2014). These factors, however, differed notice-
ably from those reported by Kovacs (1992). The items of the
original Negative Mood subscale loaded on two different factors
(Somatic Concerns and Dysphoric Mood), the items of the original
Inter-Personal Problems subscale and Ineffectiveness were in large
part merged into a single factor (Externalizing), and the items of
the original Anhedonia subscale loaded on two different factors
(Somatic Concerns and Lack of Personal and Social Interest). Only
the items of the original Negative Self-Esteem subscale loaded on
a corresponding factor (Negative Self-Concept).
Despite strong support for multidimensionality, factors have
shown to be strongly correlated, indicating possible higher order
factors (Huang & Dong, 2014; Sun & Wang, 2015). However,
possible hierarchical structure of the CDI has not been evaluated.
In recent studies regarding the dimensionality of clinical question-
naires, researchers have emphasized the insufficiency of merely
examining one or multiple dimensionalities without investigating
the partitioning of variance due to higher order and group factors
(e.g., Ebesutani et al., 2012). Despite evidence of multidimension-
ality, the interpretation of subscale scores does not necessarily
provide reliable information about the group factor (Brouwer,
Meijer, & Zevalkink, 2013; Reise, 2012).
In comparison to the original CDI, the CDI–S has not been
comprehensively evaluated. Only one study has rudimentarily
examined the dimensionality of the CDI–S (Stevanovic, 2012). In
a confirmatory factor analysis, a one-dimensional model provided
a good fit to the data, but Stevanovic (2012) did not examine any
alternative models.
Studies of the CDI (and the CDI–S for that matter) have gen-
erally presented only Cronbach’s alphas when estimating the reli-
ability of scale scores. Several researchers (Brunner, Nagy, &
Wilhelm, 2012; Cortina, 1993) have highlighted the perfunctory
use of the Cronbach’s alpha in psychometrics and the inappropri-
ateness of using the Cronbach’s alpha coefficient when dealing
with multidimensional and hierarchically structured constructs. In
the case of multidimensional scales, Brunner et al. (2012) and
Cortina (1993) proposed the use of the omega and the omega
hierarchical coefficient.
In support of the convergent validity of the original CDI, large
positive correlations to other self-ratings of depressive symptoms,
such as the depression subscale of the Revised Child Anxiety and
Depression Scale and other related constructs such as hopeless-
ness, self-esteem, and locus of control, have been reported (Chor-
pita, Yim, Moffitt, Umemoto, & Francis, 2000; Kazdin, Rodgers,
& Colbus, 1986; Myers & Winters, 2002). However, more varied
results have been reported regarding discriminant validity. First,
the scores of the CDI have shown an ability to differentiate
between depressed and nondepressed youths (Carey, Faulstich,
Gresham, Ruggiero, & Enyart, 1987; Chorpita, Moffitt, & Gray,
2005) but not between depressed and other clinical groups (Carey
et al., 1987). Further, the CDI has shown a lower correlation to
measures of anxiety (.18 –.58) compared to measures of depression
(.68 –.70) in some studies (Chorpita et al., 2000; Muris, Meesters,
& Schouten, 2002), whereas other studies have found equal or
higher correlation to measures of anxiety (.52– 63) compared to
measures of depression (.58; Doerfler, Felner, Rowlison, Raley, &
Evans, 1988).
Stevanovic (2012) examined the convergent validity of the
CDI–S and found a large positive correlation (.60) to another
self-rated questionnaire of depressive symptoms (the Short Mood
and Feelings Questionnaire) and a moderate correlation (.38) to a
measure of anxiety (Screen for Child Anxiety Related Disorders).
However, the possible overlap of these correlation coefficients was
not examined.
Regarding gender differences, slightly higher rates of major
depressive disorders have been found in adolescent girls compared
to adolescent boys (E. J. Costello et al., 2006). To explain gender
differences emerging in adolescence, theories regarding the phys-
iological changes of puberty and theories of social changes have
been proposed (Twenge & Nolen-Hoeksema, 2002). Gender dif-
ferences in the CDI scores have been evaluated in several studies.
In a meta-analysis of 310 samples responding to the CDI, girls
showed higher symptom ratings from the age of 13 (Twenge &
Nolen-Hoeksema, 2002). The meta-analysis did not find any sig-
nificant gender differences in children below the age of 13. How-
ever, studies that more thoroughly examined gender differences in
children regarding different factors of the CDI, have found higher
scores for girls regarding symptoms of anhedonia and negative
 CHILDREN’S DEPRESSION INVENTORY—SHORT VERSION
self-esteem and for boys regarding symptoms of ineffectiveness
(Aluja & Blanch, 2002; Samm et al., 2008). Moreover, a study by
Craighead and colleagues (1998) found higher scores for girls on
Dysphoria and Negative Self-Esteem, and higher scores for boys
on Ineffectiveness, Externalizing, and Social Problems. Only one
study has examined gender differences for the CDI–S, and it found
higher scores for girls (Houghton, Cowley, Houghton, & Kelleher,
2003).
The association between socioeconomic status (SES) and de-
pression has shown ambiguous results in different studies. How-
ever, a meta-analysis by Lorant et al. (2003) analyzing 51 studies
found that in adults, low SES implied greater odds of depression
onset and depression persistence. In this sample, both education
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and income showed a negative dose response relation to depres-
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sion.
Regarding CDI scores, no association to SES was found in the
meta-analysis by Twenge and Nolen-Hoeksema (2002). However,
a recent study from Greece showed that children from well-off
families reported lower CDI scores (Giannakopoulos et al., 2009).
To our knowledge no study has examined the association between
depressive symptoms according to the CDI–S and SES factors.
The prevalence of major depressive disorders has been found to
vary broadly across countries, whereas other aspects of depression
such as age of onset, gender differences, and persistence have been
found to be quite consistent across countries (Kessler & Bromet,
2013). Regarding the CDI, mean scores have been found to vary
between studies performed in different countries, with European
samples typically reporting lower mean scores than do American
samples (Craighead et al., 1998; Doerfler et al., 1988; Giannako-
poulos et al., 2009; Ivarsson et al., 2006; Larsson & Melin, 1992).
The CDI–S has not been examined in populations as large as those
tested with the original CDI; however, available results have
indicated that CDI–S symptoms are rather consistent across Euro-
pean and Caucasian American samples (Allgaier et al., 2012;
Mata, Thompson, & Gotlib, 2010; Stevanovic, 2012; Thompson et
al., 2010) but higher in Australian samples and African American
and Mexican American samples (Bauman, 2008; Bennett, Sulli-
van, & Lewis, 2010; Vines & Nixon, 2009).
The current study contributes to the research literature in several
ways. First, in comparison to the psychometric and normative data
presented by the constructor of the CDI–S (and the CDI–2S), the
results in the current study are based on administration of the
CDI–S in its proper short form rather than the full-length ques-
tionnaire. As expressed by Smith, McCarthy, and Anderson
(2000), “The key empirical evidence should not be based on a
sample in which the full, long form was administered. One should
show that the short form, as it will be used, performs as hypoth-
esized” (p. 107). Further, the current study is the first to thoroughly
examine the factor structure of the CDI–S, by using adequate
analyses for a multifaceted construct such as depression. Last, the
present study is the first to examine associations between scores on
the CDI–S and SES factors.
The first aim of the present study was to examine the dimen-
sionality of the CDI–S and the reliability of scale scores, by
comparing one-dimensional, multidimensional, and bifactor mod-
els. The second aim of the present study was to examine the
convergent and discriminant validity of the CDI–S. The third aim
was to examine gender differences and associations with SES
factors.
1159
Method
Participants
Participants were recruited from 17 schools in Stockholm, Swe-
den. Written consent, signed by parents, was required for partici-
pation in the study. A total of 1,262 children were asked to
participate. The parents of 809 children (64%) consented, whereas
113 parents (9%) refused to consent and 340 parents (27%) did not
respond to the invitation. Among the children included, 405
(50.1%) were girls and the age range was 8 –12 years (M ⫽ 9.8).
The parents of 454 children (56.1%) and 476 children (58.9%)
provided information regarding household income and education,
respectively.
Procedure
A total of 804 children (99%) completed the CDI–S at their
school. The remaining five children who were sick or absent at all
occasions offered to complete the questionnaire. Most of the
children (n ⫽ 688) were recruited within an intervention study
(Ahlen, Hursti, Tanner, Tokay, & Ghaderi, 2016) and additionally
completed the Spence Children’s Anxiety Scale (SCAS; Spence,
1997) on the same occasion as the completion of the CDI–S. The
remaining 116 children were recruited from the same schools but
from six school classes that did not participate in the intervention
study. These classes were randomly divided into two subgroups,
either completing the Revised Child Anxiety and Depression Scale
(n ⫽ 56) on the same occasion as the CDI–S or completing the
CDI–S on two occasions with 2 weeks in between (n ⫽ 60). Four
of the children in the latter subgroup completed only the CDI–S on
the first occasion and were therefore not included in the test–retest
analysis. We chose the procedure of using different subgroups for
different analyses (divergent validity, convergent validity, and
test–retest reliability) due to the schools’ request to reduce the
number of questionnaires completed by the children. To increase
understanding, a clinical psychologist, or a master’s-level psychol-
ogy student was present and read items out loud and answered any
questions regarding the comprehension of items. Parents were
asked to respond to a web survey containing questions about their
education and income. All questionnaires (paper and web surveys)
were coded to ensure confidentiality, and no IP addresses were
collected from the web surveys.
Measures
Children’s Depression Inventory—Short Version (Kovacs,
2003). The CDI–S is a 10-item short form of the original 27-item
CDI. It was originally developed as a one-dimensional question-
naire by excluding items with low interitem correlation (Kovacs,
2003). According to the constructor, the CDI–S provides an ac-
ceptable approximation of the total scale content, given a strong
correlation (r ⫽ .89) between the CDI and the CDI–S. The 10
items in the CDI–S cover sadness, pessimism, self-deprecation,
self-hate, crying, distress, negative body image, loneliness, lack of
friends, and feeling unloved. Although the new 28-item version
CDI–2 is similar to the original 27-item CDI (sharing 25 items),
the new 12-item short version CDI–2S differs markedly from the
CDI–S (sharing only six items). The CDI–2S was refined by
 1160 AHLEN AND GHADERI
another method, specifically by examining the items’ ability to
discriminate between depressed and nondepressed children (Ko-
vacs, 2011). In an evaluation of the CDI–S in a pediatric sample in
Germany, Allgaier et al. (2012) found that the CDI–S showed a
predictive validity (diagnostic accuracy) as good as that of the
original CDI. Kovacs (2003) found high internal consistency of
scores in the CDI–S (␣ ⫽ .80), and a meta-analysis of Cronbach’s
alpha estimates from 22 studies using the CDI–S found similar
results (␣ ⫽ .77; Sun & Wang, 2015).
The CDI–S has not previously been subjected to an evaluation
in Sweden; however, the scores of the original CDI (Ivarsson et al.,
2006) have shown good internal consistency (␣ ⫽ .86), similar to
an overall alpha coefficient of .84, estimated in a meta-analysis of
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331 studies from 44 countries (Sun & Wang, 2015). Internal
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consistency of CDI–S scores in the current sample was .80. Total
score mean and standard deviation in the current sample (M ⫽
1.78, SD ⫽ 2.55) were comparable to means and standard devia-
tions of the same age group reported in studies in Serbia (Ste-
vanovic, 2012) and in Germany (Allgaier et al., 2012) and in the
United States, when including predominantly Caucasian Ameri-
cans (Thompson et al., 2010). Children in the current sample,
however, scored lower on the CDI–S compared to the same age
group in an Australian sample (Vines & Nixon, 2009) and samples
of African Americans (Bennet et al., 2010) and Mexican Ameri-
cans (Bauman, 2008).
Spence Children’s Anxiety Scale (SCAS; Spence, 1997).
The SCAS is a questionnaire assessing anxiety symptoms. It
contains 44 items, of which 38 are divided into the following
subscales; separation anxiety disorder, social phobia, obsessive–
compulsive disorder, panic attack and agoraphobia, physical injury
fears, and generalized anxiety disorder. The remaining six items
are “filter items” that serve to reduce negative response bias. An
evaluation in a Swedish sample found excellent internal consis-
tency of the total score (␣ ⫽ .93) and acceptable internal consis-
tency of the subscale scores (␣ ⫽ .71–.76; Essau, Sasagawa,
Anastassiou-Hadjicharalambous, Guzmán, & Ollendick, 2011). In-
ternal consistency of scores in the current sample was .93. Total
score mean and standard deviation in the current sample (M ⫽
26.4, SD ⫽ 15.1) were comparable but somewhat higher than
German norms and were comparable but somewhat lower than
Australian norms (Essau, Sakano, Ishikawa, & Sasagawa, 2004;
Spence, 1998 respectively).
Revised Child Anxiety and Depression Scale (RCADS;
Chorpita et al., 2000). The RCADS is an adaption of the SCAS
that was developed to better correspond to the dimensions of
anxiety disorders and major depression, according to the Diagnos-
tic and Statistical Manual of Mental Disorders (4th ed.; DSM–IV;
American Psychiatric Association, 2000). In the present trial, only
the depression subscale of the RCADS (RCADS-MDD) was com-
pleted by children. The RCADS-MDD consists of 10 items cor-
responding to the criteria of major depressive disorders in the
DSM–IV. The scores of the RCADS-MDD have showed accept-
able to good internal consistency (␣ ⫽ .76 –.87) and good test–
retest reliability (intraclass correlation coefficient [ICC] ⫽ .86).
Moreover, it has shown an acceptable ability to discriminate be-
tween those with and those without any affective disorder (Ebe-
sutani et al., 2012). The RCADS has not been psychometrically
evaluated in Sweden; however, in the current sample, mean and
standard deviation of the RCADS-MDD subscale (M ⫽ 5.9, SD ⫽
4.3) and internal consistency of scores (␣ ⫽ .84) very much
resembled the results of evaluations in the same age group in
Denmark and the Netherlands (Esbjørn, Sømhovd, Turnstedt, &
Reinholdt-Dunne, 2012; Muris et al., 2002 respectively). Children
in the current sample, however, scored lower on the RCADS-
MDD subscale compared to samples in Hawaii (Chorpita et al.,
2000; Ebesutani et al., 2012).
Socioeconomic status. Parents reported total monthly house-
hold income, and parents’ educational level was dichotomized into
“no postsecondary education” (32%, 95% confidence interval [CI:
27%, 36%], N ⫽ 476) or “postsecondary education” (68%, 95% CI
[64%, 73%]) and then labeled low education and high education.
According to the Swedish National Agency for Education (2015),
62% of parents in Stockholm county had a postsecondary educa-
tion, which means that the subsample providing household income
and parents’ educational level had only slightly higher education
than did the population the sample was drawn from.
Data Analysis
Earlier studies examining the dimensionality of the CDI have
generally used principal components analysis as the reduction
method (for a review, see Huang & Dong, 2014). However, several
researchers have argued for the inadequacy of a principal compo-
nents analysis in assessing the factor structure of questionnaires
and have suggested factor analysis (e.g., Baglin, 2014). Conse-
quently, to examine possible latent factors, we chose explanatory
factor analysis (EFA), using the principal axis as the extraction
method as recommended for nonnormally distributed data (A. B.
Costello & Osborne, 2005).
Item-level data for the CDI–S are ordinal and have been shown
not to fulfill the requirements of multivariate normality in non-
clinical populations (Houghton et al., 2003). Factor analyses based
on Pearson correlations do not provide sound results if these
requirements are not met (Basto & Pereira, 2012). Correlations are
affected by the similarity of the distribution of data, and using
EFAs based on Pearson correlations for nonnormally distributed
ordinal data could produce factors that are based solely on item
distribution similarity (Basto & Pereira, 2012). To overcome this
problem, we conducted EFAs based on polychoric correlations.
To examine how many factors to retain, we chose two different
methods. First, the Kaiser criterion, which includes keeping all
factors with an eigenvalue larger than 1. The Kaiser criterion has
been extensively used in research. Because recent studies have
suggested that the Kaiser criterion might under- or overestimate
the number of factors to retain (e.g., Zwick & Velicer, 1986), we
also used another method: parallel analysis. Parallel analysis re-
tains factors that explain more variance than do factors generated
from random data (O’Connor, 2000).
Different dimensions of depressive symptoms have been repeat-
edly shown to be strongly correlated. Therefore, an oblimin rota-
tion was used to uniquely delineate factors. To examine one- or
multidimensionality, we performed the Schmid–Leiman bifactor
orthogonalization (Schmid & Leiman, 1957). Compared to the
second-order, or correlated, factor models, the Schmid–Leiman
bifactor model estimates an item’s factor loadings on an uncorre-
lated general factor (second-order factor) and group factors (Reise,
Moore, & Haviland, 2010). The Schmid–Leiman estimation
method therefore more adequately enables an analysis of how the
 CHILDREN’S DEPRESSION INVENTORY—SHORT VERSION
variance is apportioned to the general versus the group factors and
clarifies the viability of group factors.
To assess the dimensionality, we first calculated common vari-
ance attributable to the general and group factors (explained com-
mon variance). To assess reliability, we calculated the coefficient
omega for the general and any possible group factors. Coefficient
omega estimates the degree of measurement precision when all
sources of common variance (general and group factors) are
thought to underlie the score. In the bifactor model, we also
calculated the coefficient omega hierarchical, where only the com-
mon variance of the factor of interest (general or group factor) is
thought to underlie the score, thus treating other sources of com-
mon variances as error variance (Brunner et al., 2012; Reise, 2012;
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Reise et al., 2010). Last, we calculated two fit indices for an
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evaluation of the goodness of fit applicable to ordinal data: good-
ness of fit index (GFI) and root-mean-square residual (RMSR;
Jöreskog & Sörbom, 1981). GFI values over .95 are interpreted as
a good fit; RMSR values below .05 are interpreted as a good fit,
and values below .10 are considered to imply an acceptable fit as
recommended by Schermelleh-Engel, Moosbrugger, and Müller
(2003).
To explore the convergent and discriminant validity of the
CDI–S, we examined correlations to other self-report measures.
We also compared magnitudes of correlations by examining the
presence or absence of overlapping confidence intervals based on
bootstrap standard errors.
To explore any possible gender differences, and to examine any
differences between high and low education for parents, we ex-
amined mean differences by calculating 95% confidence intervals
based on bootstrap standard errors. To examine the association
between scores of the CDI–S and the RCADS-MDD, the SCAS,
and household income, we calculated Pearson correlation coeffi-
cients with 95% confidence intervals based on bootstrap standard
errors. Last, to compare the subgroups completing different ques-
tionnaires, we compared continuous outcomes in bootstrap analy-
ses of variance (ANOVAs) and count data using the Fisher’s exact
test. We considered mean differences and correlations as signifi-
cant if the 95% confidence intervals did not include 0 and ANO-
VAs and Fisher’s exact tests when p values were less than .05. All
bootstrap analyses included 1,000 bootstrap samples, resampled by
replacement from the original sample. All statistical analyses were
performed in the R software program (R Core Team, 2015) using
the “psych” package (Revelle, 2015), the “boot” package (Davi-
son, & Hinkley, 1997), and the “car” package (Fox, Friendly, &
Weisberg, 2013).
Results
Preliminary Analyses
A Fisher’s exact test showed no significant difference on gender
distribution between the subgroup completing the SCAS, the sub-
group completing the RCADS-MDD, and the subgroup complet-
ing the CDI–S on two occasions (p ⫽ .08). Further, a bootstrap
ANOVA showed no significant difference on CDI–S scores be-
tween the three subgroups, F(2, 801) ⫽ .53, p ⫽ .69. However, a
bootstrap ANOVA showed a significant difference in age between
the three subgroups, F(2, 798) ⫽ 216.43, p ⬍ .001. The subgroup
completing the CDI–S on two occasions was older than the sub-
1161
group completing the RCADS-MDD (MD ⫽ .89, 95% CI [.59,
1.21], n ⫽ 116) and the subgroup completing the SCAS (MD ⫽
1.62, 95% CI [1.45, 1.78], n ⫽ 748). Additionally, the subgroup
completing the RCADS-MDD was also older than the subgroup
completing the SCAS (MD ⫽ 0.73, 95% CI [.46, .98], n ⫽ 744).
A bootstrap mean difference test showed no significant differ-
ence in CDI–S scores between children whose parents completed
the web survey and children whose parents did not (MD ⫽ .31,
95% CI [⫺.05, .66], N ⫽ 809). The test–retest correlation coeffi-
cient between the two occasions of the subsample was .74 (95% CI
[.63, .84], N ⫽ 56), indicating an adequate test–retest reliability of
total scores.
Explanatory Factor Analysis
Table 1 presents factor loadings, proportions of total variance,
proportions of variance explained, reliability indices, and goodness
of fit statistics for the one-factor model, the two correlated factors
model, and the bifactor model for the CDI–S.
In the first EFA, two factors had an eigenvalue greater than 1
and should, according to the Kaiser criterion, be retained in anal-
yses. However, according to parallel analyses, the recommenda-
tion is to retain only one factor. We therefore decided to perform
EFAs of a one-factor model, a two-factor model, and a bifactor
model with one general factor and two group factors. No other
models were examined.
The one-factor model. The one-factor model showed a good
fit to the data according to the GFI and a fairly acceptable fit
according to the RMSR index. All items showed high loadings
(⬎.30) on the factor (mean of loadings ⫽ .69, range ⫽ .62–.84).
The omega coefficient was .90, indicating a good reliability of
total scale scores.
The two correlated factors model. The two correlated fac-
tors model also showed a good fit to the data according to the GFI
and a more acceptable fit according to the RMSR index compared
to the one-factor model. All items loaded high on a factor. One
item cross-loaded, meaning it loaded high on both factors. The first
factor included seven items (mean of loadings ⫽ .67, range ⫽
.51–.86) and was labeled Negative Self-Concept and Loneliness
(NS & L). This factor explained about 62% of the common
variance. The second factor included three items (mean of load-
ings ⫽ .78, range ⫽ .64 –.86) and was labeled Sadness and
Distress (S & D). This factor explained about 38% of the common
variance. The omega coefficients of the factors were .86 and .83,
respectively, indicating a good reliability of scale scores.
The bifactor model. The bifactor factors model showed a
good fit to the data according to the GFI and an acceptable fit
according to the RMSR index in similarity to the two correlated
factors model. First, all items loaded high on the Depression factor
(mean of loadings ⫽ .61, range ⫽ .53–.72), which however, was
somewhat lower than in the one-factor model, indicating that at
least some variance in item responses was influenced by group
factors. The general factor explained about 67% of the common
variance. Second, all items also showed high loadings on one of
the group factors. There were no cross-loadings. The first factor
included the same seven items as in the two correlated factors
model (mean of loadings ⫽ .40, range ⫽ .30 –.51). This factor
explained about 20% of the common variance after controlling for
the general factor. The second factor included the same three items
 1162 AHLEN AND GHADERI

Table 1
Factor Loadings, Reliability Indices, and Fit Statistics for One-, Two-, and Bifactor Exploratory
Factor Analyses Models for the CDI–S

Two correlated
factors model Bifactor model
One-factor
Variable model (D) NS & L S&D D NS & L S&D

Item
Sadness .68 ⫺.02 .86 .67 ⫺.01 .51
Pessimism .66 .56 .14 .56 .33 .08
Self-deprecation .70 .81 ⫺.08 .59 .48 ⫺.05
Self-hate .84 .86 .03 .72 .51 .02
Crying .67 ⫺.01 .84 .66 ⫺.01 .50
Distress .66 .14 .64 .62 .08 .38
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Negative body image .63 .70 ⫺.04 .53 .42 ⫺.03

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Loneliness .81 .55 .33 .70 .33 .20

Lack of friends .63 .72 ⫺.06 .53 .43 ⫺.04
Feeling unloved .62 .51 .16 .53 .30 .09
Total variance (%) 47.6 33.0 20.2 37.8 11.7 7.1
Common variance (%) 62.0 38.0 66.8 20.6 12.6
␻ .90 .86 .83 .92 .88 .84
␻h .73 .28 .28
GFI .98 .99 .99
RMSR .09 .06 .06
Note. Italic font indicates the factor on which the item loaded most heavily according to the model examined.
CDI–S ⫽ Children’s Depression Inventory—Short Version; D ⫽ Depression factor; NS & L ⫽ Negative
Self-Concept and Loneliness factor; S & D ⫽ Sadness and Distress factor; ␻h ⫽ omega hierarchical coefficient;
GFI ⫽ goodness of fit index; RMSR ⫽ root-mean-square residual.

as in the two correlated factors model (mean of loadings ⫽ .46,
range ⫽ .38 –.51). This factor explained about 13% of the common
variance after controlling for the general factor. The omega coef-
ficient of the general factor was .92, and the omega coefficients of
the group factors were .88 and .84, respectively, indicating a good
reliability of scale scores. However, the omega hierarchical coef-
ficient was .73 for the general factor and .28 for both group factors,
Thus, despite high omega coefficients (.82–.88) of group factors
most of the variance of the scores was due to the general factor,
and only 28% of the variance of scores was explained by the
content specific to the group factor, beyond the content of the
general factor. In the following analyses, we examined the total
scale scores, the NS & L factor scores, and the S & D factor scores.
Convergent and Divergent Validity
There was a positive and significant correlation between the
CDI–S and the RCADS-MDD, r(54) ⫽ .72, 95% CI [.62, .88].
Further, there was also a positive and significant correlation be-
tween the CDI–S and the SCAS, r(686) ⫽ .53, 95% CI [.47, .59].
The correlation between the two depressive questionnaires was
considered significantly larger than the correlation between the
CDI–S and the anxiety questionnaire, because estimated confi-
dence intervals based on bootstrap standard errors did not overlap.
Gender Differences
See Table 2 for means, standard deviations, and test statistics
regarding gender differences on scale scores. Three bootstrap
mean difference tests showed significant differences between gen-
ders, with girls reporting higher scores on the total scale (d ⫽ .21,
95% CI [.08, .35]), the NS & L factor (d ⫽ .15, 95% CI [.02, .29]),
and the S & D factor (d ⫽ .27, 95% CI [.13, .47]). All differences
were small or trivial, when interpreted according to guidelines by
Cohen (1987).

Table 2
Descriptive Statistics on the Total Scale and Subscales for the Total Sample and Divided by
Gender, and a Bootstrap Mean Difference Test by Gender

Total Girls Boys

(N ⫽ 804) (n ⫽ 402) (n ⫽ 402) Girls/boys
Scale M SD M SD M SD MD 95% CI df
ⴱ
Total scale 1.78 2.55 2.05 2.75 1.51 2.31 .54 [.19, .92] 803
NS & L 1.36 1.95 1.51 2.04 1.21 1.85 .30ⴱ [.02, .58] 802
S&D .42 .96 .55 1.13 .30 .74 .25ⴱ [.11, .39] 801
Note. CI ⫽ confidence interval; NS & L ⫽ Negative Self-Concept and Loneliness factor; S & D ⫽ Sadness
and Distress factor.
ⴱ
p ⬍ .05.
 CHILDREN’S DEPRESSION INVENTORY—SHORT VERSION 1163

Education Table 4
Pearson Correlation Coefficients Between the CDI–S and
See Table 3 for means, standard deviations, and test statistics Household Income, With 95% Confidence Intervals Based on
regarding differences in CDI–S between high and low education in Bootstrap Standard Errors
parents. A series of bootstrap mean difference tests showed no
significant differences in CDI–S total scale or subscale scores CDI–S Total sample
between high and low education in parents. When divided by scale (N ⫽ 454) Girls (n ⫽ 215) Boys (n ⫽ 239)
gender, we found no significant differences in the CDI–S total Total scale ⫺.11ⴱ [⫺.20, ⫺.02] ⫺.06 [⫺.12, .14] ⫺.17ⴱ [⫺.35, ⫺.10]
scale or subscale scores between girls with parents with high or NS & L ⫺.11ⴱ [⫺.21, ⫺.02] ⫺.06 [⫺.13, .13] ⫺.17ⴱ [⫺.35, ⫺.09]
low education. However, we found a significant difference on the S&D ⫺.07 [⫺.15, .02] ⫺.03 [⫺.11, .13] ⫺.11ⴱ [⫺.27, ⫺.03]
CDI–S total scores between boys with parents with low versus Note. CDI–S ⫽ Children’s Depression Inventory—Short Version; NS &
high education (d ⫽ .32, 95% CI [.05, .59]) and on the NS & L L ⫽ Negative Self-Concept and Loneliness factor; S & D ⫽ Sadness and
factor scores between boys with parents with low versus high Distress factor.
ⴱ
education (d ⫽ .34, 95% CI [.07, .62], but no differences regarding p ⬍ .05.
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the S & D factor scores.

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Household Income
See Table 4 for correlation coefficients, as well as confidence
intervals between the CDI–S and household income. In the total
sample, we found a significant small negative correlation between
total scale and household income, and a small negative correlation
between the NS & L factor and household income. We found no
significant correlation between the S & D factor and household
income. Rerunning the analyses divided by genders, we found no
significant correlations between the CDI–S and household income
for girls for neither the total scale nor the subscales. However, for
boys we found a significant small negative correlation between
total scale and household income, a small negative correlation
between the NS & L factor and income, and a small negative
correlation between the S & D factor and income.
Discussion
The aim of the present study was to examine the dimensionality
and the convergent and discriminant validity of the CDI–S, a
commonly used measure of depressive symptoms in children, and
to examine possible gender differences and associations with SES
factors.
Although the concept of depression is multifaceted and the
items of the CDI–S reflect several dimensions of depression, the
CDI–S should above all, and as intended by its author, be inter-
preted as a univocal measure. Although the two correlated factors
model (presented in this article) seemingly demonstrates a sound
model with a good fit to data, the variation of scores in these group
factors are better interpreted as variations in the general factor than
variations stemming from the specific content of the group factors.
The three items forming the S & D group factor in the current
study have been found to cluster in the same factor in earlier
studies (Huang & Dong, 2014), labeled Dysphoric Mood or Neg-
ative Affect. The seven items forming the NS & L group factor in
the current study have generally loaded on different factors in
earlier studies. However, the majority of these items (pessimism,
self-hate, negative body image, feeling unloved) have generally
clustered in the same factor in other studies, labeled Negative
Self-Concept or Negative Self-Esteem (Huang & Dong, 2014). A
practical conclusion of these results is that the scores of the total
scale are adequately interpreted as a measure of depression,

Table 3
Descriptive Statistics for the Total Scale and Subscales, Divided by Gender and Educational
Level, and a Bootstrap Mean Difference Test by Education

High education Low education High education/low education

Sample
and scale M SD n M SD n MD 95% CI df

Total
D 1.55 2.18 325 1.89 2.72 151 .35 [⫺.17, .86] 474
NS & L 1.18 1.57 325 1.50 2.26 151 .32 [⫺.10, .68] 474
S&D .37 .90 325 .40 .83 151 .03 [⫺.14, .20] 474
Girls
D 1.97 2.60 154 2.03 2.91 73 .05 [⫺.92, .43] 225
NS & L 1.47 1.80 154 1.56 2.50 73 .09 [⫺.68, .42] 225
S&D .51 1.13 154 .47 .87 73 .04 [⫺.10, .36] 225
Boys
D 1.16 1.62 171 1.77 2.55 78 .61ⴱ [ .11, 1.60] 247
NS & L .92 1.27 171 1.44 2.03 78 .51ⴱ [ .11, 1.26] 247
S&D .24 .60 171 .33 .78 78 .09 [⫺.07, .41] 247
Note. CI ⫽ confidence interval; D ⫽ Depression factor; NS & L ⫽ Negative Self-Concept and Loneliness
factor; S & D ⫽ Sadness and Distress factor.
ⴱ
p ⬍ .05.
 1164 AHLEN AND GHADERI
whereas the scores of the S & D and the NS & L factors could be
only cautiously interpreted.
The results of this study are in line with those of a recent study
of a depressive measure for adults, in which the total score of the
general factor was the only one that could be reliably interpreted
(Brouwer et al., 2013). Earlier studies of the CDI have not exam-
ined the hierarchical structure when considering correlated factors,
which is why it is hard to say anything about how our results are
related to the factor structure of the original CDI.
The current study sample was recruited in Sweden, and its
scores were comparable to those of European and Caucasian
American samples. However, higher scores on the self-report
measures used in the current study have been found in Australian
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and non-Caucasian samples in the United States. These differences
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generate some uncertainty regarding the overall generalizability of
the results and motivate further evaluations of the CDI–S in
samples with a broader ethnicity.
We found support for the convergent and discriminant validity
of the CDI–S, in that the scores of the CDI–S showed a high
correlation (r ⫽ .72) with a measure of depression and a moder-
ately high but lower correlation (r ⫽ .53) to a measure of anxiety.
Worth noting is that the correlation coefficients between CDI–S
and RCADS-MDD, and between the CDI–S and SCAS presented
in our study, highly resemble coefficients presented in evaluations
of the original CDI and the same measures (r ⫽ .70 and r ⫽ .48,
respectively; Chorpita et al., 2000; Spence, 1998).
The present study further showed that girls reported higher
symptoms of depression. This result is interesting because it is
seemingly not in line with previous research, where gender differ-
ences on total scale have been shown only above the age of 13.
One possible explanation is the fact that most items in the CDI–S
reflect the constructs of sadness and negative self-esteem, where
girls have shown higher scores than boys have also in younger
ages. The CDI–S does not contain the same number of items
reflecting constructs of externalization or ineffectiveness where
boys generally score higher.
We also found a negative association between scores of the
CDI–S and SES (parents’ education and household income) for
boys, indicating higher symptoms of depression among boys
whose parents have low education and low income. The associa-
tion was most apparent between depressive symptoms and house-
hold income, and this seems to be primarily linked to the items of
the NS & L factor. The associations are significant but small. For
example, income explains only about 3% of the variation in
depressive symptoms in boys. Researchers such as Nolen-
Hoeksema (2001), Piccinelli and Wilkinson (2000), and Keenan
and Hipwell (2005) have examined possible precursors of depres-
sion in girls and have suggested factors such as increased stress
reactivity and more empathy and compliance, as well as the idea
that girls may have less power and therefore, to a larger extent,
experience adverse events, harassment, lack of respect, and con-
strained choices. The present study suggests that low SES is
associated with depressive symptoms for only boys, in the 8 –12
age level. Further, the primary link between SES and the NS & L
factor, and the partial absence of association between SES and the
S & D factor, could also imply that the real relationship exists
between SES and the specific content of the group factor, as
opposed to a relationship between SES and the general factor.
Worth noting is that the procedure that founded the new short
version CDI–2S might reasonably mean that it has a stronger
predictive validity than does the CDI–S, and future studies should
preferably evaluate the CDI–2S in an independent sample, and in
its actual form, to provide further evidence of its validity and
reliability of scale scores.
There are a number of limitations regarding the present study
that must be taken into consideration when interpreting the results.
First, the study sample included only children between 8 and 12
years, who overall reported few depression symptoms. Therefore,
similar studies with a broader age span, including adolescents
(among whom depressive symptoms are more prevalent and the
difference in depressive symptoms between genders increases)
would be of much interest to more comprehensively examine the
dimensionality, gender differences, and associations with SES.
Second, although efforts were made to recruit a representable
population, the sample was recruited in an urban environment and
therefore has a limited external validity. Third, we used different
subsamples for different indices of psychometric criteria, which is
problematic, especially because the age of the subsamples differed.
Further, the correlations between the CDI–S and the RCADS-
MDD, and between the CDI–S and the SCAS, may be inflated due
to shared method variance. Therefore, further validity studies of
the CDI–S should include additional methods to self-report, pref-
erably structured diagnostic interviews. Fourth, there was also a
rather sizable group of parents who did not report their SES, which
limited the internal validity of the associations between scores of
the CDI–S and SES. With these limitations in mind, we conclude
that only the total scale score of the CDI–S could be reliably
interpreted and that gender differences regarding symptom ratings
and associations with SES are found at young ages.
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Received March 4, 2016
Revision received October 12, 2016
Accepted October 17, 2016 䡲