Application of the Center for Epidemiologic Studies Depression Scale among first-visit psychiatric patients: a new approach to improve its performance
Abstract
Background Although the Center for Epidemiologic Studies Depression Scale (CES-D) is an internationally popular self-rating scale for depression both in community and clinical settings, extant literature concerning its validity has several shortcomings. The present paper aimed to overcome these problems.Methods We applied newer assessment technology of receiver operating characteristics (ROC) analyses and stratum-specific likelihood ratios (SSLRs) and cross-validated the results in the 'training' and 'testing' data sets of 591 patients representing various clinical settings all over Japan.Results The ROC analyses demonstrated that the CES-D had moderate convergent and discriminant validity to detect major depressive episodes among first-visit psychiatric patients. Selecting single optimal cutoffs, however, failed to arrive at consistent results across various settings. The efficacy of the instrument was most conveniently transportable into clinical practices when converted into SSLRs, which were 0.35 (95% CI: 0.25-0.49) for the score range 0-29, 2.3 (1.8-3.1) for the score range 30-49, and 11.7 (3.1-44.0) for the scores above 50. In addition, the SSLRs proved to be generalizable not only across various clinical settings in our sample but also across psychiatric, primary care and community samples in the published reports.Conclusion Clinicians and clinical epidemiologists can apply the SSLRs of the CES-D to various settings to estimate the probability of suffering from a major depressive episode in a convenient and intuitive manner.
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The CES-D has been tested for validity in different populations.
“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 [48]
The CES-D is widely used for identifying people with depressive symptoms and its validity has been tested in different populations.
“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 [44]
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“Its validity has been tested in different populations [44-46].”
BackgroundPascal de Raykeer, R., Hoertel, N., Blanco, C., Lavaud, P., Kaladjian, A., Blumenstock, Y., Cuervo-Lombard, C.-V., Peyre, H., Lemogne, C., Limosin, F., et al. (2019) · Journal of Affective Disorders · doi:10.1016/j.jad.2019.05.063 · Cited by 35 · see citing works
- Authors
- Furukawa, T., Hirai, T., Kitamura, T., & Takahashi, K.
- Affiliations
- Nagoya City University (JP)
- National Center of Neurology and Psychiatry (JP)
- Corresponding author
- Furukawa, T
- Venue
- Journal of Affective Disorders
- Publisher
- Elsevier BV
- Published
- 1997-10
- Volume
- 46
- Issue
- 1
- Pages
- 1-13
- ISSN
- 0165-0327 (ISSN-L)
- OpenAlex
- W2049183731
- Cited by
- 66
- References
- 61
- Citations by year
- 2025: 2 · 2023: 1 · 2022: 1 · 2021: 1 · 2020: 3 · 2019: 3 · 2017: 2 · 2016: 1 · 2015: 2 · 2014: 3 · 2013: 1 · 2012: 2
- FWCI
- 1.27
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Affective Disorders (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Decision Sciences › Management Science and Operations Research › Psychometric Methodologies and Testing
- Social Sciences › Psychology › Applied Psychology › Psychological Testing and Assessment
- Keywords
- Center for Epidemiologic Studies Depression Scale, CES-D, major depressive episode, depression screening, cut-off values, receiver operating characteristic, convergent and discriminant validity
- MeSH terms
- Mental Disorders, Depressive Disorder, Humans, Japan, Outpatient Clinics, Hospital, Personality Inventory, Psychiatric Department, Hospital, Psychometrics, ROC Curve, Reproducibility of Results, Comorbidity, Likelihood Functions
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