Center for Epidemiological Studies Depression Scale (CES-D and CES-D-10)

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Tool Description

  • screening measure (NOT a diagnostic tool)
  • developed to identify current depressive symptomatology related to major or clinical depression in adults and adolescents.
  • Items include depressed mood, feelings of guilt, worthlessness and helplessness, psychomotor retardation, loss of appetite and sleep difficulties.

ICF Domain:

Body Function – Subcategory: Mental Functions.

Number of Items:

There are 10 and 20 item versions of the scale. The most commonly used version of the CES-D is the 20 item version; thus when articles refer to ‘CES-D’, they are usually talking about the 20 item version.

Brief Instructions for Administration & Scoring

Administration:

  • Self report using pen/paper or interview.
  • Responses are based on the frequency of occurrence during the past week.
  • Uses a 4-point ordinal scale: Rarely or none of the time (less than 1 day); Some or a little of the time (1-2 days); Occasionally or a moderate amount of the time (3-4 days); Most or all of the time (5-7 days).
  • The measure is easy to complete (grade 4 reading level) and takes 5 –10 minutes.

Equipment:None.

Scoring:

  • a summary score is calculated.
  • range of scores on the CES-D-20 is 0-60 (0-30 for the CES-D-10)

Interpretability

MCID: not established
SEM: not established for the SCI population, but for a Hepatitis C population, CES-D(20) SEM=0.907 (pre-treatment), 0.977 (4 weeks post-treatment), 1.053 (24 weeks post-treatment). [Clark et al. 2002, “Screening for depression in a hepatitis C population: the reliability and validity of the Center for Epidemiologic Studies Depression Scale (CES-D)”, n=116]
MDC: not established

  • a CES-D(20) cutoff score of 16 is indicative of “significant” or “mild” depressive symptomatology, and a cut score of 11 for the shorter version is recommended according to the original validation study on a general population by Radloff 1997. It is equivalent to experiencing six symptoms for most of the previous week or a majority of symptoms on one or two days.
  • Higher scores indicate greater symptoms.
  • no cut-points or normative data have been established for the SCI population
  • published data for the SCI population is available for comparison for both the CES-D and CES-D-10 (see the Interpretability section of the Study Details sheet).

Languages:

Translations are available.

Training Required:

None but knowledge about depression and mental health is helpful.

Availability:

See the 'How to use' page.

Clinical Considerations

  • The CES-D- 20 was created for the general population but has been used extensively in SCI (cited in approximately 50 SCI research articles). Shorter versions such as the 10, 8 and 4 item are available but only the CES-D 10 has been assessed in the SCI population.
  • The test is simple and quick to administer.

Measurement Property Summary

For the CES-D-20:

# of studies reporting psychometric properties: 4

Reliability:

  • Internal consistency is High for the CES-D-20 (Cronbach’sα=0.88-0.91), and the CES-D-10 (Cronbach’sα=0.86).
  • Test-retest reliability is High for both the CES-D-20 (ICC=0.87) and CES-D-10 (ICC=0.85).
  • Test-retest reliability for the individual items is Low to High (ICC=0.11-0.73).

[La Chapelle 2005, Miller et al. 2008]

Validity:

  • Correlation of the CES-D-20 is Low to High for SF-36 subscales (ranging from Pain (Pearson’s r=0.27) to Mental Health (Pearson’s r=0.75)) and Moderate with the Fatigue Severity Scale (Pearson’s r=0.58).
  • The sensitivity was found to be 80.0% and specificity 69.8%.

[Kuptniratsaikul et al. 2002, Miller et al. 2008, Anton et al. 2008]

Responsiveness:

No values were reported for the responsiveness of the CES-D for the SCI population.

Floor/ceiling effect:

No values were reported for the presence of floor/ceiling effects in the CES-D for the SCI population.

For the CES-D-10:

# of studies reporting psychometric properties: 1

Reliability:

  • Internal consistency is High for the CES-D-10 (Cronbach’sα=0.86).
  • Test-retest reliability is High for (ICC=0.85).
  • Test-retest reliability for the individual items is Low to Moderate (ICC=0.32-0.68).

[Miller et al. 2008]

Validity:

  • Correlation of the CES-D-10 is Low to High for SF-36 subscales [ranging from Physical Function (Pearson’s r =0.37) to Mental Health (Pearson’s r=0.71)].

[Miller et al. 2008]

Responsiveness:

No values were reported for the responsiveness of the CES-D-10 for the SCI population.

Floor/ceiling effect:

No values were reported for the presence of floor/ceiling effects in the CES-D-10 for the SCI population.

Reviewer

Dr. Janice Eng, Christie Chan

Date Last Updated:

Feb 1, 2013

Download the measure

Download Worksheet:

Worksheet Document

Video

n/a

Scoring

A summary score is calculated by summing the reported value for each item.

Equipment Needed

CES-D:

Andresen EM, Malmgren JA, Carter WB, Patrick DL. Screening for depression in well older adults: evaluation of a short form of the CES-D (Center for Epidemiologic Studies Depression Scale). Am J Prev Med. 1994;10(2):77-84.
http://www.ncbi.nlm.nih.gov/pubmed/8037935

Anton HA, Miller WC, Townson AF. Measuring fatigue in persons with spinal cord injury. Arch Phys Med Rehabil 2008; 89: 538-542.
http://www.ncbi.nlm.nih.gov/pubmed/18295634

Kuptniratsaikul V, Chulakadabba S, Ratanavijitrasil S. An instrument for Assessment of Depression among Spinal Cord Injury Patients: Comparison between the CES-D and the TDI. J Med Assoc Thai 2002; 85:978-982
http://www.ncbi.nlm.nih.gov/pubmed/12450075

Lachapelle DL, Alfano DP. Revised neurobehavioral scales of the MMPI: sensitivity and specificity in traumatic brain injury. Appl Neuropsychol. 2005;12(3):143-50.
http://www.ncbi.nlm.nih.gov/pubmed/16131341

Miller WC, Anton HA, Townson AF. Measurement properties of the CESD scale among individuals with spinal cord injury. Spinal Cord 2008; 46: 287-292.
http://www.ncbi.nlm.nih.gov/pubmed/17909558

Radloff LS. CES-D scale: A self report depression scale for research in the general populations. Applied Psychological Measurement 1977;1:385-401.
http://apm.sagepub.com/content/1/3/385.short

Radloff LS. The Use of the Center for Epidemiological Studies of Depression Scale in Adolescents and Young Adults. J Youth Adoles 1991;20:149-166.
http://link.springer.com/article/10.1007%2FBF01537606?LI=true

Rintala DH. Predictive validity of social support relative to psychological well-being in men with spinal cord injury. Rehabil Psychol. 2013;58(4):422-8.
http://www.ncbi.nlm.nih.gov/pubmed/24128267

Wada K, Tanaka K, Theriault G, et al. Validity of the Center for Epidemiologic Studies Depression Scale as a screening instrument of major depressive disorder among Japanese workers. Am J Ind Med. 2007;50(1):8-12.
http://www.ncbi.nlm.nih.gov/pubmed/17096372