Cited by 299Anxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesMental Health Treatment and AccessPsychological Testing and Assessment

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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

Haringsma, R., Engels, G. I., Beekman, A. T. F., Spinhoven, Ph.·2004·International Journal of Geriatric Psychiatry

DOI 10.1002/gps.1130

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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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“Volunteers who reported a diagnosis of depression were included if they had been receiving treatment for at least 3 months and were currently nonsymptomatic when assessed using the Center for Epidemiological Studies Depression Scale (CES-D) (Haringsma et al. 2004).”
Method
Barriers to depression care among middle-aged and older adults in Taiwan's universal healthcare system
Chang, T.-Y., Liao, S., Chang, C., Wu, C., Huang, W., Hwang, J., & Hsu, C. (2022) · The Lancet Regional Health - Western Pacific · doi:10.1016/j.lanwpc.2022.100501 · Cited by 26
Involvement as a Working Mechanism for Persuasive Technology
Kelders, S. M. (2015) · Lecture notes in computer science · doi:10.1007/978-3-319-20306-5_1 · Cited by 25
“Depressive symptoms were measured at baseline, post intervention and follow-up with the CES-D (a self-report questionnaire with 20 items, score 0-60; higher scores mean more depressive symptoms) [19, 21].”
Method
The Role of 5-HTT LPR and GNβ3 825C>T Polymorphisms and Gene–Environment Interactions in Irritable Bowel Syndrome (IBS)
Saito, Y. A., Larson, J. J., Atkinson, E. J., Ryu, E., Almazar, A. E., Petersen, G. M., & Talley, N. J. (2012) · Digestive Diseases and Sciences · doi:10.1007/s10620-012-2319-9 · Cited by 25
“The proband (case and control) study questionnaire contained items regarding demographics, gastrointestinal symptoms, social history, medical history, dietary history, somatization, anxiety and depression, and family history, and contained the following previously developed and validated survey instruments: Talley Bow…”
Effects of Intimate Partner Violence, Mental Health, and Relational Resilience on Perinatal Health
Scrafford, K. E., Grein, K., & Miller‐Graff, L. E. (2019) · Journal of Traumatic Stress · doi:10.1002/jts.22414 · Cited by 25
Assistive Walking Device Use and Knee Osteoarthritis: Results From the Health, Aging and Body Composition Study (Health ABC Study)
Carbone, L. D., Satterfield, S., Liu, C., Kwoh, K. C., Neogi, T., Tolley, E. A., & Nevitt, M. C. (2012) · Archives of Physical Medicine and Rehabilitation · doi:10.1016/j.apmr.2012.09.021 · Cited by 24
“Depression was recorded by the Center for Epidemiological Studies Depression scale and stratified into levels of 22 (major depressive disorder or clinically relevant depression) and <22, as described in the literature.(9) The level of physical activity was assessed by a questionnaire modeled from commonly used assessm…”
Cancer fear and the interpretation of ambiguous information related to cancer
Miles, A., Voorwinden, S., Mathews, A., Hoppitt, L. C., & Wardle, J. (2009) · Cognition & Emotion · doi:10.1080/02699930802091116 · Cited by 23
“A cut-off of more than 25 on the full 20-item scale has been cited as potentially indicating the presence of major depressive disorder (Haringsma, Engels, Beekman, & Spinhoven, 2004 ), suggesting a pro-rata cut-off of 12–13 for the shortened scale.”
Background
Prediction of HIV Sexual Risk Behaviors Among Disadvantaged African American Adults Using a Syndemic Conceptual Framework
Nehl, E. J., Klein, H., Sterk, C. E., & Elifson, K. W. (2015) · AIDS and Behavior · doi:10.1007/s10461-015-1134-7 · Cited by 28
“validity of the CES-D using different cut-points, those with scores higher than 22 were considered to indicate depressive symptoms [56, 73, 74].”
Generalized motor inhibitory deficit in Parkinson’s disease patients who freeze
Bissett, P. G., Logan, G. D., van Wouwe, N. C., Tolleson, C., Phibbs, F. T., Claassen, D. O., & Wylie, S. A. (2015) · Journal of Neural Transmission · doi:10.1007/s00702-015-1454-9 · Cited by 25
“The CES-D rating cutoff for clinical depression has been argued to be between [=20 and [=25 (Haringsma et al. 2004; Himmelfarb and Murrell 1983).”
Long-term moderate alcohol consumption does not exacerbate age-related cognitive decline in healthy, community-dwelling older adults
Moussa, M. N., Simpson, S. L., Mayhugh, R. E., Grata, M. E., Burdette, J. H., Porrino, L. J., & Laurienti, P. J. (2015) · Frontiers in Aging Neuroscience · doi:10.3389/fnagi.2014.00341 · Cited by 24
“Older drinkers scored similarly on depression [CES-D, light: 4.5 ± 3.6, moderate: 4.3 ± 4.9; t(39) = 0.12, p = 0.90] and mood screens [POMS, light: −3.4 ± 11.0, moderate: −1.6 ± 13.8; t(39) = −0.46, p = 0.65].”
MethodInfluential
A Taxometric Study of the Center for Epidemiological Studies Depression Scale
Baldwin, G., & Shean, G. D. (2006) · Genetic Social and General Psychology Monographs · doi:10.3200/mono.132.2.101-128 · Cited by 23
Exploring a Model for Integrating Child Development Accounts with Social Services for Vulnerable Families
Huang, J. X., Beverly, S. G., Kim, Y., Clancy, M. M., & Sherraden, M. W. (2019) · Journal of Consumer Affairs · doi:10.1111/joca.12239 · Cited by 21
Use of Brief Tools to Measure Depressive Symptoms in Women With a History of Intimate Partner Violence
Bonomi, A. E., Kernic, M. A., Anderson, M. L., Cannon, E. A., & Slesnick, N. (2008) · Nursing Research · doi:10.1097/01.nnr.0000319497.44499.b7 · Cited by 21
Relationship between obesity and depression in Korean adults
Hong, S. M., & Hur, Y. (2017) · Medicine · doi:10.1097/md.0000000000009478 · Cited by 20
“However, the optimal cut-off score is still under debate.([52,53]) Most studies described previously used a cut-off score of 10 on the CES-D to diagnose depression.”
Method
Health professionals’ detection of depression and anxiety in their patients with diabetes: The influence of patient, illness and psychological factors
Poulsen, K., Pachana, N. A., & McDERMOTT, B. M. (2014) · Journal of Health Psychology · doi:10.1177/1359105314559618 · Cited by 21
“The CES-D has also been validated in older populations (Haringsma et al., 2004).”
Method
Clusters of Behaviors and Beliefs Predicting Adolescent Depression: Implications for Prevention.
Paunesku, D., Ellis, J., Fogel, J., Kuwabara, S. A., Gollan, J. K., Gladstone, T. R. G., Reinecke, M. A., & Voorhees, B. W. V. (2008) · PubMed · Cited by 20
A reanalysis of the center for epidemiological studies depression scale (CES-D) using non-parametric item response theory
Kliem, S., Beller, J., Tibubos, A. N., Zenger, M., Schmalbach, B., & Brähler, E. (2020) · Psychiatry Research · doi:10.1016/j.psychres.2020.113132 · Cited by 21
Difference by sex but not by race/ethnicity in the visceral adipose tissue-depressive symptoms association: The Multi-Ethnic Study of Atherosclerosis
Remigio‐Baker, R. A., Allison, M., Schreiner, P. J., Szklo, M., Crum, R. M., Leoutsakos, J., Franco, M., Carnethon, M. R., Nettleton, J. A., Mujahid, M. S., et al. (2014) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2014.05.004 · Cited by 19
“The CES-D, however, has been validated in the literature as having good reliability and validity (Radloff, 1977; Haringsma et al., 2004); its reliability is comparable in European American, African American, MexicanAmerican and Chinese American groups (Roberts, 1980; Golding and Burnam, 1990; Li…”
The association of perceived stress with depressive symptoms in older Taiwanese—Result of a longitudinal national cohort study
Tsai, A. C.-H., Chi, S., & Wang, J. (2013) · Preventive Medicine · doi:10.1016/j.ypmed.2013.08.019 · Cited by 20
Positive emotion following spousal bereavement: Desirable or pathological?
Tweed, R. G., & Tweed, C. J. (2011) · The Journal of Positive Psychology · doi:10.1080/17439760.2011.558846 · Cited by 19
“For example, the 20-item CES-D Scale (CES-D; Radloff, 1977 ) has been shown to differentiate depressed participants from controls (Haringsma, Engels, Beekman, & Spinhoven, 2004 ).”
Method
Effects of body mass index and education on verbal and nonverbal memory
Wit, L. D., Kirton, J. W., O’Shea, D. M., Szymkowicz, S. M., McLaren, M. E., & Dotson, V. M. (2016) · Aging Neuropsychology and Cognition · doi:10.1080/13825585.2016.1194366 · Cited by 19
Metabolic dysregulation in older adults with depression and loneliness: The ATHLOS study
de la Torre‐Luque, A., Lara, E., de la Fuente, J., Rico‐Uribe, L. A., Caballero, F. F., López-García, P., Niubo, A. S., Bobák, M., Koskinen, S. V. P., Haro, J. M., et al. (2020) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2020.104918 · Cited by 24
The onset of falls and its effects on perceived social exclusion and loneliness. Evidence from a nationally representative longitudinal study
Petersen, N., König, H., & Hajek, A. (2022) · Archives of Gerontology and Geriatrics · doi:10.1016/j.archger.2022.104622 · Cited by 18
Perceived Environmental Attributes: Their Impact on Older Adults’ Mental Health in Malaysia
Tan, T. H. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph19063595 · Cited by 20
“The CES-D is thought to be a reliable predictor of depressive symptoms in the elderly [59].”
Background
Relationship between maternal depression symptoms and child weight outcomes in Latino farmworker families
Marshall, S. A., Ip, E. H., Suerken, C. K., Arcury, T. A., Saldana, S. J., Daniel, S. S., & Quandt, S. A. (2018) · Maternal and Child Nutrition · doi:10.1111/mcn.12614 · Cited by 18
Differentiation, marital satisfaction, and depressive symptoms: an application of Bowen Theory
Glade, A. C. (2005) · OhioLink ETD Center (Ohio Library and Information Network) · Cited by 18
The effects of an Internet based self-help course for reducing panic symptoms - Don't Panic Online: study protocol for a randomised controlled trial
van Ballegooijen, W., Riper, H. M., van Straten, A., Kramer, J., Conijn, B., & Cuijpers, P. J. (2011) · Trials · doi:10.1186/1745-6215-12-75 · Cited by 18
“Participants with moderate to high suicidal risk will be excluded from this study.”
Background
Depression and lower urinary tract symptoms: Two important correlates of erectile dysfunction in middle‐aged men in Hong Kong, China
Wong, S. Y. S., Chan, D. C.-C., Hong, A. W. L., Leung, P., & Woo, J. (2006) · International Journal of Urology · doi:10.1111/j.1442-2042.2006.01560.x · Cited by 17
Moderating effect of emotional awareness on the association between maltreatment experiences and resilience
Lee, S. W., Won, S., & Jeong, B. (2019) · Personality and Individual Differences · doi:10.1016/j.paid.2019.05.037 · Cited by 17
Self-rated health and depressive symptoms in older adults: A growth mixture modeling approach
Jones, J. W., Ledermann, T., & Fauth, E. B. (2018) · Archives of Gerontology and Geriatrics · doi:10.1016/j.archger.2018.08.012 · Cited by 17
Central Sensitization: The Missing Link Between Psychological Distress and Poor Outcome Following Primary Total Knee Arthroplasty
Martin, J. R., Coronado, R. A., Wilson, J. M., Polkowski, G. G., Shinar, A. A., & Bruehl, S. P. (2023) · The Journal of Arthroplasty · doi:10.1016/j.arth.2023.12.026 · Cited by 16
Internet-Based Intervention to Promote Mental Fitness in Mildly Depressed Adults: Design of a Randomized Controlled Trial
Bolier, L., Haverman, M., Kramer, J., Boon, B. J. F., Smit, F., Riper, H. M., & Bohlmeijer, E. T. (2012) · JMIR Research Protocols · doi:10.2196/resprot.1791 · Cited by 18
Effects of emotional maltreatment on semantic network activity during cognitive reappraisal
Lee, S. W., Kim, S., Lee, S. J., Cha, H., Song, H., Won, S., Chang, Y., & Jeong, B. (2020) · Brain Imaging and Behavior · doi:10.1007/s11682-020-00318-2 · Cited by 17
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Cuijpers, P. J., Steunenberg, B., & van Straten, A. (2006) · Addictive Behaviors · doi:10.1016/j.addbeh.2006.03.003 · Cited by 16
Web-based guided self-help for employees with depressive symptoms (Happy@Work): design of a randomized controlled trial
Geraedts, A. S., Kleiboer, A. M., Wiezer, N. M., van Mechelen, W., & Cuijpers, P. J. (2013) · BMC Psychiatry · doi:10.1186/1471-244x-13-61 · Cited by 16
“Its validity has been tested in different populations [44-47].”
Background
Anxiety and Depression in Parent Caregivers of Children with Cystic Fibrosis
Cronly, J., Horgan, A. M., Lehane, E. A., Howe, B., Duff, A. J. A., Riekert, K. A., Perry, I. J., Fitzgerald, T., Chróinín, M. N., & Savage, E. (2019) · Journal of Child and Family Studies · doi:10.1007/s10826-019-01349-0 · Cited by 15
Protective factors against suicidal ideation among community-dwelling older adults with experience of spousal physical abuse: focusing on direct and indirect protections
Yoon, S., Cummings, S. M., Nugent, W. R., & Forrest-Bank, S. S. (2019) · Aging & Mental Health · doi:10.1080/13607863.2019.1636208 · Cited by 15
Family Dysfunction and Suicide Risk in a Community Corrections Sample
Clark, C. B., Li, Y., & Cropsey, K. L. (2016) · Crisis · doi:10.1027/0227-5910/a000406 · Cited by 19
Depression and social context: primary supporter relationship factors associated with depressive symptoms among a disadvantaged population with HIV/AIDS
Knowlton, A. R., Curry, A. D., Hua, W., & Wissow, L. S. (2009) · Journal of Community Psychology · doi:10.1002/jcop.20311 · Cited by 15
How spousal physical abuse impacts suicidal ideation among community-dwelling older adults: the effects of protective factors
Yoon, S., Cummings, S. M., Nugent, W. R., & Forrest-Bank, S. S. (2020) · Aging & Mental Health · doi:10.1080/13607863.2020.1844144 · Cited by 14
The development and initial validation of the narrative foreclosure scale
Bohlmeijer, E. T., Westerhof, G. J., & Lamers, S. M. A. (2014) · Aging & Mental Health · doi:10.1080/13607863.2014.896865 · Cited by 14
Life review therapy for older adults with depressive symptoms in general practice: results of a pilot evaluation
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“The major risk factor for developingMDD is the presence of CRDS (Cuijpers et al., 2005), which is defined by a level of depressive symptoms that indicates a higher risk for developing MDD, yet not meeting the criteria for MDD (Beekman et al., 2002).”
BackgroundInfluential
Guided self-help on the internet for turkish migrants with depression: the design of a randomized controlled trial
Ünlü, B., Riper, H. M., van Straten, A., & Cuijpers, P. J. (2010) · Trials · doi:10.1186/1745-6215-11-101 · Cited by 14
“The optimal cut-off score varies in literature, but a score of 16 is usually regarded as indicating clinically relevant depressive symptoms [37].”
Background
Understanding the context of romantic partner relational victimization: Links between relationship satisfaction, depressive symptoms, and alcohol-related problems.
DiBello, A. M., Preddy, T. M., Øverup, C. S., & Neighbors, C. (2016) · Psychology of Violence · doi:10.1037/vio0000064 · Cited by 14
Vertex-wise examination of depressive symptom dimensions and brain volumes in older adults
McLaren, M. E., Szymkowicz, S. M., O’Shea, A. M., Woods, A. J., Anton, S. D., & Dotson, V. M. (2016) · Psychiatry Research Neuroimaging · doi:10.1016/j.pscychresns.2016.12.008 · Cited by 14
“…20-item self-report measure of depressive symptoms with a well validated four-factor structure consisting of negative affect, lack of positive affect, somatic symptoms, and interpersonal difficulties subscales (Carleton et al., 2013; Haringsma et al., 2004; Helmes and Nielson, 1998; Radloff, 1977).”

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
DOI: 10.1002/gps.1130
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
Licence: onlinelibrary.wiley.com/termsAndConditions#vor (vor)
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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The criterion validity of the Center for Epidemiological Studies Depression Scale (CES‐D) in a sample of self‐referred elders with depressive symptomatology

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