- 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
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.
- 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).
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
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; mixed injury types; > 1 year post-SCI)
- High Internal Consistency: CES-D-20 α = 0.89-0.91
(Miller et al. 2008: N=47, 30 males; mixed injury types; > 1 year post-SCI)
(Rintala 2013: N=69, all male; mixed injury types; 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; mixed injury types; > 1 year post-SCI)
- Moderate correlation between CES-D and Fatigue Severity Scale:
r = 0.58
(Anton et al. 2008: n=48, 31 males; mixed injury types; 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. Janice Eng, Christie Chan, Gita Manhas
Date Last Updated
20 July 2020
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
