- 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.
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
- 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.
- a summary score is calculated.
- range of scores on the CES-D-20 is 0-60 (0-30 for the CES-D-10)
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).
Translations are available.
None but knowledge about depression and mental health is helpful.
See the 'How to use' page.
- 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
- 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]
- 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]
No values were reported for the responsiveness of the CES-D for the SCI population.
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
- 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]
- 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]
No values were reported for the responsiveness of the CES-D-10 for the SCI population.
No values were reported for the presence of floor/ceiling effects in the CES-D-10 for the SCI population.
Dr. Janice Eng, Christie Chan
Date Last Updated:
Feb 1, 2013
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.
Anton HA, Miller WC, Townson AF. Measuring fatigue in persons with spinal cord injury. Arch Phys Med Rehabil 2008; 89: 538-542.
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
Lachapelle DL, Alfano DP. Revised neurobehavioral scales of the MMPI: sensitivity and specificity in traumatic brain injury. Appl Neuropsychol. 2005;12(3):143-50.
Miller WC, Anton HA, Townson AF. Measurement properties of the CESD scale among individuals with spinal cord injury. Spinal Cord 2008; 46: 287-292.
Radloff LS. CES-D scale: A self report depression scale for research in the general populations. Applied Psychological Measurement 1977;1:385-401.
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.
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.
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.