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The criterion validity of the Center for Epidemiological Studies Depression Scale (CES‐D) in a sample of self‐referred elders with depressive symptomatology
Abstract
Background: The criterion validity of the Center for Epidemiological Studies Depression scale (CES‐D) was assessed in a group of elderly Dutch community‐residents who were self‐referred to a prevention program for depression. Methods: Paper‐and‐pencil administration of the CES‐D to 318 elders (55–85 years). Criterion validity was evaluated with the Mini International Neuropsychiatric Interview (MINI), a clinical diagnostic interview based on DSM‐IV. Sensitivity and specificity for various cut‐off scores of CES‐D were compared with the DSM‐IV major depressive disorder (MDD) and with clinically relevant depression (CRD), a composite diagnosis of MDD, subthreshold depression or dysthymia. Furthermore the characteristics of true versus false positives were analyzed. Results: For MDD, the optimal cut‐off score was 25, (sensitivity 85%, specificity 64%, and positive predicted value of 63%). For CRD, the optimal cut‐off was 22 (sensitivity 84%, specificity 60%, and positive predicted value 77%). True positives, MDD and CRD, reported significantly more anxiety symptomatology and more co‐morbid anxiety disorders, false positives reported more previous depressive episodes. Conclusions: The criterion validity of the CES‐D for MDD and CRD was satisfactory in this semi‐clinical sample of elders. Subjects scoring ≥25 constitute a target group for further diagnostic assessment in order to determine appropriate treatment. Copyright © 2004 John Wiley & Sons, Ltd.
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“Its validity has been tested in different populations [48-50].”
From Long-Term Results of a Web-Based Guided Self-Help Intervention for Employees With Depressive Symptoms: Randomized Controlled Trial (2014) · cites this paper as [49]
In the citing paper
“This questionnaire is widely used for identifying people with depressive symptoms. Its validity has been tested in different populations [44-46].”
From Short-Term Effects of a Web-Based Guided Self-Help Intervention for Employees With Depressive Symptoms: Randomized Controlled Trial (2014) · cites this paper as [45]
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“Adequate validity of the CES-D in older community-dwelling adults has been demonstrated.(33,34) For each participant, we averaged all CES-D scores during the study interval as a measure of chronic or persistent symptoms (average number of CES-D measurements = 6.”
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“We chose a cutoff score of 25 because it can represent definite depression or major depressive disorder [31,32].”
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“1,84 Indeed, as seen in cutoff scores for all the measures, investigators suggested that this may be too low for some older adult populations, producing too many false-positives, 22,215 and too high for detecting depression in healthy populations.”
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“The total score range of the CES-D is between 0 and 60 and cutoffs of 16 and 25 have been suggested in various literature to detect depression [22]: a score up to 15 indicates low probability of depression, a score between 16 and 24 indicates mild depression, and a score of 25 or above indicates a major depressive dis…”
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Korte, J., Bohlmeijer, E. T., Westerhof, G. J., & Pot, A. M. (2011) · Aging & Mental Health · doi:10.1080/13607863.2010.551338 · Cited by 80
“However, the psychometric properties of the scale were found to be good in older populations (Radloff & Teri, 1986 ), and more particularly in a similar sample of older Dutch people with depressive symptoms (Haringsma, Engels, Beekman, & Spinhoven, 2004 ).”
BackgroundJacobs, H. I. L., Visser, P. J., van Boxtel, M. P. J., Frisoni, G. B., Tsolaki, M., Papapostolou, P., Nobili, F. M., Wahlund, L., Minthon, L., Frölich, L., et al. (2010) · Neurobiology of Aging · doi:10.1016/j.neurobiolaging.2010.07.015 · Cited by 77
Haringsma, R., Engels, G. I., Cuijpers, P. J., & Spinhoven, P. (2005) · International Psychogeriatrics · doi:10.1017/s104161020500253x · Cited by 74
“In their study on the validity of the criteria of the Center for Epidemiologic Studies Depression Scale (CES-D), Haringsma et al. (2004) found that participants of the course varied widely in their level of Effectiveness of the CWD course for older adults 309 depression, from exhibiting only slight…”
BackgroundInfluentialSelf-citationDisease stage and psychosocial outcomes in colorectal cancer
Simon, A. E., Thompson, M. R., Flashman, K. G., & Wardle, J. (2008) · Colorectal Disease · doi:10.1111/j.1463-1318.2008.01501.x · Cited by 73
The Relation of Ego Integrity and Despair to Personality Traits and Mental Health
Westerhof, G. J., Bohlmeijer, E. T., & McAdams, D. P. (2015) · The Journals of Gerontology Series B · doi:10.1093/geronb/gbv062 · Cited by 76
Wuthrich, V. M., & Rapee, R. M. (2013) · Behaviour Research and Therapy · doi:10.1016/j.brat.2013.09.002 · Cited by 71
Depressive symptoms and risk of stroke: the Rotterdam Study
Bos, M. J., Linden, T. K. A., Koudstaal, P. J., Albert Hofman, D., Skoog, I. G., Breteler, M. M. B., & Tiemeier, H. W. (2008) · Journal of Neurology Neurosurgery & Psychiatry · doi:10.1136/jnnp.2007.134965 · Cited by 71
“whereas the positive predictive value (the proportion of persons with depressive disorder among all those who score positive) has been reported to be low in selected populations”
BackgroundSubthreshold depression: Characteristics and risk factors among vulnerable elders
Adams, K. B., & Moon, H. E. (2009) · Aging & Mental Health · doi:10.1080/13607860902774501 · Cited by 67
“The MINI has been used in a number of studies with primary care patients and older adults, with validity and reliability comparing favorably with longer diagnostic interviews such as the Composite International Diagnostic Interview (CIDI) or the Structured Clinical Interview for DSM Disorders (SCID) (Haringsma, Engels…”
BackgroundMethodCourse of mental fatigue and motivation in breast cancer patients receiving adjuvant chemotherapy
de Jong, N., Candel, M. J. J. M., Schouten, H. C., Abu‐Saad, H. H., & Courtens, A. M. (2005) · Annals of Oncology · doi:10.1093/annonc/mdi095 · Cited by 68
“Best cut-off scores above 20 were found in studies with different populations [34, 35].”
BackgroundJulian, L. J., Gregorich, S. E., Tonner, C., Yazdany, J., Trupin, L. S., Criswell, L. A., Yelin, E., & Katz, P. (2011) · Arthritis Care & Research · doi:10.1002/acr.20447 · Cited by 66
“This cut score of 24 is also similar to a recently suggested cut score of 25 for older adults (20).”
Delaney, J. A., Oddson, B. E., Kramer, H., Shea, S., Psaty, B. M., & McClelland, R. L. (2010) · Hypertension · doi:10.1161/hypertensionaha.109.139824 · Cited by 66
“The baseline MESA data included scores from the CES-D instrument [7,13] which can be used as marker of depressive symptoms.”
Dotson, V. M. (2014) · Journal of Depression & Anxiety · doi:10.4172/2167-1044.s1-003 · Cited by 69
“This widely-used measure has been validated in both young and older community-dwelling adults [61,62] and has a well-replicated factor structure that includes subscales for depressed mood, somatic symptoms, lack of well-being, and interpersonal symptoms [63].”
MethodMeasures of Depression and Depressive Symptoms
Smarr, K. L., & Keefer, A. L. (2020) · Arthritis Care & Research · doi:10.1002/acr.24191 · Cited by 66
“Although many studies continue to use the traditional cutoff score of greater than or equal to 16, alternative cutoffs have thus been proposed and used, ranging from 18 to 24 (26–33); the specific study cutoffs are as follows: 18 in veterans with mild traumatic brain injury (26), 19 in some rheumatology populations (2…”
BackgroundModerate–Severe Vasomotor Symptoms Are Associated with Moderate–Severe Depressive Symptoms
Worsley, R., Bell, R. J., Gartoulla, P., Robinson, P. J., & Davis, S. R. (2017) · Journal of Women s Health · doi:10.1089/jwh.2016.6142 · Cited by 65
“13 Thus, this study by using a higher threshold for depressive symptoms provides insights into women with clinically relevant symptomatology.”
Major Depression and Subthreshold Depression among Older Adults Receiving Home Care
Xiang, X., Leggett, A. N., Himle, J. A., & Kales, H. C. (2018) · American Journal of Geriatric Psychiatry · doi:10.1016/j.jagp.2018.05.001 · Cited by 66
Huang, J. X., Sherraden, M. W., & Purnell, J. Q. (2014) · Social Science & Medicine · doi:10.1016/j.socscimed.2014.04.023 · Cited by 72
Depression and Erectile Dysfunction
Makhlouf, A. A., Kparker, A., & NIEDERBERGER, C. S. (2007) · Urologic Clinics of North America · doi:10.1016/j.ucl.2007.08.009 · Cited by 65
Ros, L., Latorre, J. M., Aguilar, M. J., Serrano, J. P., Bravo, B. N., & Ricarte, J. J. (2011) · The International Journal of Aging and Human Development · doi:10.2190/ag.72.2.a · Cited by 62
Depressive symptoms in mid‐pregnancy, lifetime stressors and the 5‐HTTLPR genotype
Scheid, J. M., Holzman, C., Jones, N., Friderici, K. H., Nummy, K. A., Symonds, L. L., Sikorskii, A. E., Regier, M. K., & Fisher, R. A. (2006) · Genes Brain & Behavior · doi:10.1111/j.1601-183x.2006.00272.x · Cited by 61
“Some studies have used symptom checklists with a cutoff as a proxy for the presence of clinically significant depression (Eley et al. 2004; Haringsma et al. 2004), others have analyzed symptoms as a continuous measure (Grabe et al.”
BackgroundMethodPatanwala, M., Tieu, L., Ponath, C., Guzman, D., Ritchie, C. S., & Kushel, M. (2017) · Journal of General Internal Medicine · doi:10.1007/s11606-017-4229-1 · Cited by 66
“For depressive symptoms, we considered someone to have symptomatology if they scored ≥16 on the Center for Epidemiologic Studies Depression Scale (CES-D).(24,25) For post-traumatic stress disorder (PTSD), we considered a score of ≥3 on the Primary Care PTSD (PC-PTSD) four-item screen(26,27) as indicative of PTSD sympt…”
MethodTwin Study of Depressive Symptoms Among Older African-American Women
Furner, S. E., Wallace, K., Arguelles, L., Miles, T. P., & Goldberg, J. H. (2006) · The Journals of Gerontology Series B · doi:10.1093/geronb/61.6.p355 · Cited by 58
Moradi, F., Lotfi, K., Armin, M., Clark, C. C. T., Askari, G., & Rouhani, M. H. (2021) · European Journal of Clinical Investigation · doi:10.1111/eci.13486 · Cited by 57
Kozik, P., Hoppmann, C. A., & Gerstorf, D. (2014) · Gerontology · doi:10.1159/000368716 · Cited by 55
Gaugler, J. E., Linder, J., Given, C. W., Kataria, R. S., Tucker, G., & Regine, W. F. (2009) · Journal of Family Nursing · doi:10.1177/1074840709347111 · Cited by 54
“…CES-D score for cancer caregivers in the present study (M = 13.28) was considerably higher than population norm results (M = 8.64) for U.S. adults aged 55 to 74 years (which roughly matches the average age of the current caregiving sample; see Haringsma et al., 2004; Himmelfarb & Murrell, 1983).”
ResultInfluentialWhite Matter Integrity and Depressive Symptoms in Cerebral Small Vessel Disease: The RUN DMC Study
van Uden, I. W. M., Tuladhar, A. M., de Laat, K. F., van Norden, A. G. W., Norris, D. G., van Dijk, E. J., Tendolkar, I., & de Leeuw, F. (2014) · American Journal of Geriatric Psychiatry · doi:10.1016/j.jagp.2014.07.002 · Cited by 53
Child Sexual Abuse and Depression in Late Life for Men: A Population-Based, Longitudinal Analysis
Easton, S. D., Kong, J., Gregas, M., Shen, C., & Shafer, K. M. (2017) · The Journals of Gerontology Series B · doi:10.1093/geronb/gbx114 · Cited by 54
“This scale has been widely used to assess later-life depression (Haringsma, Engels, Beekman, & Spinhoven, 2004).”
Kwan, A., Marzouk, S., Ghanean, H., Kishwar, A., Anderson, N. D., Bonilla, D., Vitti, M., Su, J., & Touma, Z. (2019) · Seminars in Arthritis and Rheumatism · doi:10.1016/j.semarthrit.2019.03.004 · Cited by 54
Assessment of Depression and Bereavement in Older Adults
Edelstein, B. A., Drozdick, L. W., & Ciliberti, C. M. (2010) · Elsevier eBooks · doi:10.1016/b978-0-12-374961-1.10001-6 · Cited by 56
Psychological strains and depression in Chinese rural populations
Zhang, J., & Lv, J.-C. (2013) · Psychology Health & Medicine · doi:10.1080/13548506.2013.808752 · Cited by 53
Leung, J., GARTNER, C. E., Hall, W., Lucke, J. C., & Dobson, A. J. (2011) · Psychological Medicine · doi:10.1017/s0033291711002261 · Cited by 58
“The CESD has good validity, with higher scores associated with clinical diagnosis of depressive disorders in a range of populations (Breslau, 1985; Caracciolo & Giaquinto, 2002; Haringsma et al. 2004; Stahl et al. 2008).”
Factors Associated with Substance Use in Older Homeless Adults: Results from the Hope Home Study
Spinelli, M. A., Ponath, C., Tieu, L., Hurstak, E., Guzman, D., & Kushel, M. (2016) · Substance Abuse · doi:10.1080/08897077.2016.1264534 · Cited by 54
“We evaluated for posttraumatic stress disorder (PTSD) symptoms using the Primary Care PTSD Screen (PC-PTSD; score 3) and depressive symptoms using the Center for Epidemiologic Studies Depression Scale (CES-D; score 22) for major depressive symptoms as suggested in past studies with older adults.(34,35) We asked partic…”
MethodGeraedts, A. S., Kleiboer, A. M., Wiezer, N. M., van Mechelen, W., & Cuijpers, P. (2014) · Journal of Medical Internet Research · doi:10.2196/jmir.3185 · Cited by 48
“Its validity has been tested in different populations [44-46].”
BackgroundPots, W. T. M., Meulenbeek, P. A. M., Veehof, M. M., Klungers, J., & Bohlmeijer, E. T. (2014) · PLoS ONE · doi:10.1371/journal.pone.0109789 · Cited by 52
“Higher scores mean more depressive symptoms [24,25].”
Saito, Y. A., Rey, E., Almazar, A. E., Harmsen, S. W., Zinsmeister, A. R., Locke, R. G., & Talley, N. J. (2009) · The American Journal of Gastroenterology · doi:10.1038/ajg.2009.577 · Cited by 52
“The CES-D is a well-validated, self-administered 20-item instrument that measures depression symptoms (”
Dimensions of depressive symptoms and cingulate volumes in older adults
McLaren, M. E., Szymkowicz, S. M., O’Shea, A. M., Woods, A. J., Anton, S. D., & Dotson, V. M. (2016) · Translational Psychiatry · doi:10.1038/tp.2016.49 · Cited by 52
Chang, K.-F., & Weng, L. (2013) · Health · doi:10.4236/health.2013.53a078 · Cited by 51
“A number of studies have supported the use of the CES-D as a screening device for probable depression [10, 11].”
ResultLeggett, A. N., Zarit, S. H., Nguyen, N. H., Hoang, C. N., & Nguyen, H. (2012) · Aging & Mental Health · doi:10.1080/13607863.2012.667780 · Cited by 51
“The established cut-off score of 16 in Western countries on the CES-D is used in determining prevalence of clinically-significant depression in the sample (Beekman et al, 1997 ), however as some prefer a higher cut-off of 22 this prevalence is also reported (Haringsma, Engels, Beekman, & Spinhoven, 2004 ).”
MethodPark, S., & Lee, H. S. (2021) · Journal of Affective Disorders · doi:10.1016/j.jad.2021.05.120 · Cited by 54
van der Aa, H. P. A., Hoeben, M., Rainey, L., van Rens, G. H. M. B., Vreeken, H. L., & van Nispen, R. M. A. (2014) · Quality of Life Research · doi:10.1007/s11136-014-0835-0 · Cited by 55
Metadata
- Authors
- Haringsma, R., Engels, G. I., Beekman, A. T. F., & Spinhoven, P.
- Affiliations
- Leiden University (NL)
- Amsterdam UMC Location Vrije Universiteit Amsterdam (NL)
- Corresponding author
- Haringsma, R.
- ORCID
- Beekman, A. T. F.
- Venue
- International Journal of Geriatric Psychiatry
- Publisher
- Wiley
- Published
- 2004-05-17
- Volume
- 19
- Issue
- 6
- Pages
- 558-563
- ISSN
- 0885-6230 (ISSN-L)
- 1099-1166
- OpenAlex
- W2031940914
- Cited by
- 299
- References
- 24
- Citations by year
- 2026: 5 · 2025: 4 · 2024: 7 · 2023: 7 · 2022: 11 · 2021: 12 · 2020: 7 · 2019: 17 · 2018: 14 · 2017: 15 · 2016: 14 · 2015: 20 · 2014: 22 · 2013: 18 · 2012: 20
- FWCI
- 17.56
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- International Journal of Geriatric Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Amsterdam UMC (VU Amsterdam) - Institutional Repository (publishedVersion)
- Pure Amsterdam UMC (submittedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Health Sciences › Medicine › Psychiatry and Mental health › Mental Health Treatment and Access
- Social Sciences › Psychology › Applied Psychology › Psychological Testing and Assessment
- Keywords
- Center for Epidemiologic Studies Depression Scale, criterion validity, depression screening, older adults, major depressive disorder, subthreshold depression, dysthymia, cut-off values, sensitivity and specificity, anxiety comorbidity, MINI interview
- MeSH terms
- Aged, Aged, 80 and over, Anxiety Disorders, Depression, Depressive Disorder, Diagnostic Errors, Female, Humans, Male, Mass Screening, Middle Aged, Psychiatric Status Rating Scales, Referral and Consultation, Sensitivity and Specificity, Geriatric Assessment
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