- 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
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.
ICF Domain
Body Function ▶ Mental Functions
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
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.
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)
Languages
Translations are available.
Training Required
Does not require advanced training but knowledge about depression and mental health is helpful.
Availability
The Center for Epidemiological Studies Depression Scale (CES-D) can be found here.
# of studies reporting psychometric properties: 4
Interpretability
- 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
- Typical values: Mean (Range) CES-D score:
- 15.2 (0-42)
- 39% of sample scored over 15
- 30% of sample scored over 19
(Miller et al. 2008; n=47, 37 males, 17 females; mean age = 40.6 years; 20 ASIA A, 18 ASIA B; > 1 year post-SCI)
MCID: not established in SCI
SEM: not established in SCI
MDC: not established in SCI
Reliability
- Low to High Test-retest Reliability:
CES-D ICC = 0.87
CES-D-10 ICC = 0.85
Items ICC = 0.11-0.73
(Miller et al. 2008: n=47, 30 males, 17 females; ASIA A-B; > 1 year post-SCI)
- High Internal Consistency: CES-D-20 α = 0.89-0.91
(Miller et al. 2008: n=47, 30 males, 17 females; ASIA A-B; > 1 year post-SCI)
(Rintala 2013: n=69, all male; paraplegia and tetraplegia; mean (SD) time since injury = 12.8 (7.2) years)
Validity
- Low to High correlation with SF-36 subscales:
CES-D: r = 0.27-0.75
CES-D-10: r = 0.37-0.71 - Moderate correlation with Visual Analogue Scale – Fatigue:
CES-D: r = 0.52
CES-D-10: r = 0.57
(Miller et al. 2008: n=47, 30 males, 17 females; ASIA A-B; > 1 year post-SCI)
- Moderate correlation between CES-D and Fatigue Severity Scale:
r = 0.58
(Anton et al. 2008: n=48, 31 males, 17 females; 48 motor complete SCI, 26 tetraplegia, 30 ASIA A; mean 14.9 years post-SCI)
- Moderate to High area under the curve (ROC) analysis:
AUC (SD) = 0.897 (0.017)
95% CI = 0.864-0.931
(Kennedy et al. 2019: Depressive Disorder Diagnosis: n=187 (87.2% male), mean age (SD): 38.48 (7.53); No Depressive Disorder Diagnosis: n=149 (86.6% male), mean age (SD): 36.72 (7.80))
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.
Reviewers
Dr. Carlos L. Cano-Herrera, Tyra Chu
Date Last Updated
31 December 2024
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
Kennedy JE, Reid MW, Lu LH, Cooper DB. Validity of the CES-D for depression screening in military service members with a history of mild traumatic brain injury. Brain Injury 2019;33:932-940.
https://www.ncbi.nlm.nih.gov/pubmed/31017474
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
