Assessment of depressive symptoms and validation of the CES-D scale in Albanian undergraduate health students
Abstract
Depression is a major public health concern among university students, particularly in health-related fields characterized by high academic and emotional demands. Limited evidence exists on the psychometric properties of the Center for Epidemiologic Studies Depression Scale (CES-D) in Albanian populations. This study aimed to estimate the prevalence and explore correlates of depressive symptoms among Albanian undergraduate health students, and to examine the psychometric properties of the CES-D. A cross-sectional observational study was conducted during January-June 2025 among 195 undergraduate students enrolled in Nursing, Physiotherapy, Medical Imaging, and Medical Laboratory Technology programs at the Faculty of Technical Medical Sciences, “Aleksandër Xhuvani” University and “Ismail Qemali” University, Albania. Data were collected using a structured questionnaire that included socio-demographic variables and the 20-item CES-D. Descriptive statistics, non-parametric tests (Mann-Whitney U, Kruskal-Wallis), and exploratory factor analysis were performed using SPSS. The mean CES-D score was 22.1 (SD = 10.0), and 18.5% of students exceeded the commonly used cutoff score (>15), indicating mild-to-moderate depressive symptoms. Female students scored significantly higher than males (M = 22.8 vs. 18.1, p < .05). Higher depression scores were found among Midwifery and Physiotherapy students, those financially dependent on family, and those perceiving higher academic stress. Social withdrawal and family history of depression were additional predictors, while prior psychological counseling was protective. Factor analysis confirmed a two-factor model, Negative Affect and Positive Affect, with high internal consistency (Cronbach’s α = .90) and construct validity (KMO = 0.884; Bartlett’s χ² = 1285.988, p < .001). Depressive symptoms were moderately prevalent among Albanian Technical Medical Sciences students, reflecting similar international patterns. The CES-D demonstrated good psychometric performance, supporting its use in Albanian academic settings. Early screening, counseling services, and targeted resilience-based interventions are essential to support student well-being and academic performance.